Comparison of Two Treatments for Acute Rotator Cuff Tendinopathy
Condition: Acute Rotator Cuff Tendinopathy
MeSH terms: Tendinopathy
Study type: Interventional

Summary: 
      The primary objective of this study is to compare the short-term effectiveness (2 and 6 weeks
      following the start of the rehabilitation program), in terms of symptoms and functional
      limitations, of a rehabilitation program centered on gradual reloading to a rehabilitation
      program centered on rest and cryotherapy in individuals with acute rotator cuff tendinopathy.
      The secondary objective is to explore the effects of these programs on shoulder control
      (acromiohumeral distance), subacromial structures (supraspinatus tendon thickness) and
      central pain modulation. The hypothesis is that the rehabilitation program centered on
      gradual reloading will lead to a faster improvement at week 2 and 6 when compared to the
      program centered on rest and cryotherapy.
    

Detailed description: 
      44 adults (aged between 18 and 65) with acute (< 6 weeks) unilateral symptomatic RC
      tendinopathy will be recruited.This single-blind (assessor), parallel-group RCT will include
      three evaluation sessions over 6 weeks (baseline, week 2, week 6) and one meeting with the
      treating physiotherapist (right after the baseline evaluation). All participants will take
      part in the baseline evaluation. They will first complete a questionnaire on
      sociodemographic, symptomatology and comorbidity, as well as self-administered questionnaires
      that evaluate symptoms and functional limitations (DASH, WORC and BPI). Then,
      ultrasonographic (US) measurements of AHD and of the supraspinatus tendon and subacromial
      bursal thickness will be conducted. Thereafter, pain inhibitory control will be assessed
      using conditioned pain modulation. Finally, the corticospinal excitability of the
      infraspinatus muscle will be evaluated. Thereafter, participants will be randomly assigned to
      one of two intervention groups, and then take part in their assigned home program. At week 2
      and 6, the self-administered questionnaires will be re-administered (by phone for the week 6
      evaluation). A global rating of change question (with % of change since baseline) will also
      be completed at week 2 and 6. US measurements, conditioned pain modulation and corticospinal
      excitability will only be revaluated at week 2. To evaluate the effectiveness of blinding,
      the assessor will complete a question related to his/her opinion of the allocation at week 2.
      The study will be carried out at the Centre interdisciplinaire de recherche en réadaptation
      et en intégration sociale (CIRRIS) by two different physiotherapists and in two different
      laboratories. Ethics approval will be obtained from Institutional Review Board of IRDPQ.
    

Intervention name(s): Gradual reloading; Rest and cryotherapy
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Participants will be asked to perform isometric strengthening exercises in lateral rotation and abduction. Participants will place their affected arm by the side with the elbow gently tucked in close to the body, elbow flexed at 90°, and the thumb pointing upwards. The opposite hand will resist the lateral rotation and abduction. They will be asked to push against the uninvolved hand, building up to sub-maximal pressure (approximately 50% to 75% of the maximum possible force) over five seconds. Then the contraction will be slowly released. A maximum pain level of 5/10 will be accepted when performing the contraction. Elevation movements will also be performed 3 times a day in the frontal, sagittal and scapular plane.; Participants will be asked to apply ice wrap on their painful shoulder 3 times a day over the area of pain for 15 minutes. They will be asked to place the ice wrap inside a damp towel cloth (minimise the risk of an ice burn) and secure around the shoulder with a towel. After the 15 minutes, they will be asked to perform gentle, slow, pain free shoulder movements that do not provoke pain. All participants will be provided with a commercial ice wrap. They will also be asked to avoid painful movements, working above shoulder level, repeated or sustained elevation movements and lifting weights.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Acute; rotator cuff tendinopathy; exercise; loading; ice; cryotherapy; randomised control trial