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Boudreau N, Gaudreault N, Roy JS, et al. The Addition of Glenohumeral Adductor Coactivation to a Rotator Cuff Exercise Program for Rotator Cuff Tendinopathy: A Single-Blind Randomized Controlled Trial. J Orthop Sports Phys Ther. 2019 Mar;49(3):126-135. doi: 10.2519/jospt.2019.8240. Epub 2018 Nov 30. (Original study)
Abstract

BACKGROUND: Treatments for rotator cuff tendinopathy include rotator cuff muscle strengthening to promote better muscle recruitment in order to minimize subacromial narrowing during active movement. Glenohumeral adductor recruitment has also been shown to prevent such narrowing in asymptomatic individuals; therefore, adding glenohumeral adductor coactivation during rotator cuff strengthening could enhance the efficacy of rotator cuff strengthening. However, no study has explored its benefits.

OBJECTIVES: To compare the short-term efficacy of adding glenohumeral adductor coactivation to a rotator cuff-strengthening program to improve function, reduce symptoms, and increase acromiohumeral distance in adults with rotator cuff tendinopathy.

METHODS: In this single-blind randomized controlled trial, 42 participants with rotator cuff tendinopathy were randomly assigned to 2 groups, one that received strengthening of the scapular and rotator cuff muscles or one that received rotator cuff strengthening plus coactivation with pectoralis major and latissimus dorsi recruitment. The daily programs were performed at home for 6 weeks, with supervised training and follow-up sessions. Functional limitations/symptoms (Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire as the primary outcome, and the Western Ontario Rotator Cuff index), pain (visual analog scale), and acromiohumeral distance were measured at baseline, 3 weeks, and 6 weeks. Data were analyzed using a mixed-model analysis of variance.

RESULTS: No significant group-by-time interaction was observed for the Disabilities of the Arm, Shoulder and Hand questionnaire, Western Ontario Rotator Cuff index, visual analog scale, and acromiohumeral distance (P=.055). Significant time effects were obtained for the Western Ontario Rotator Cuff index and visual analog scale for pain with movement (P<.001).

CONCLUSION: The present findings show that adding glenohumeral adductor coactivation to a rotator cuff-strengthening program does not result in improved short-term efficacy in any of the measured outcomes. This study was registered with ClinicalTrials.gov (NCT02837848).

LEVEL OF EVIDENCE: Therapy, level 1b. J Orthop Sports Phys Ther 2019;49(3):126-135. Epub 30 Nov 2018. doi:10.2519/jospt.2019.8240.

Ratings
Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Comments from MORE raters

Rehab Clinician (OT/PT) rater

The research in this article did not support the author's hypothesis but it was still an excellent article. The exercise program they used is well laid out and would be easy to implement in our clinics. The intro and discussion sections had a wealth of information on the rotator cuff. The list of references is impressive giving us an opportunity to look up some of the articles to better our knowledge about the rotator cuff. The author's offered thoughtful insight as to the limitations of the study and why it may not have supported their hypothesis.

Rehab Clinician (OT/PT) rater

Due to the null hypothesis being proved, 'the present findings show that adding glenohumeral adductor coactivation to a rotator cuff–strengthening program does not result in improved short-term efficacy in any of the measured outcomes'. This means that this research has little clinical relevance though has a level of newsworthiness.

Rehab Clinician (OT/PT) rater

Managing the shoulder and especially RCT related issues remains challenging. This article has made a great attempt to see what effect additional muscle co-contraction has on shoulder function and disability. It appears based on this article that there is no additional benefits. Therefore, the clinical challenge that remains to identify if patents perform exercises appropriately, which impacts clinical and functional outcomes.
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