Eccentric Versus Concentric Exercises for Rotator Cuff Tendinopathy in Patients With Rheumatoid Arthritis

Study Overview
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Brief Summary
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Study aiming at determining the efficacy of eccentric versus concentric exercises for improving tendon biological characteristics, pain, and shoulder overall function for rotator cuff tendinopathy in patients with Rheumatoid arthritis (RA). Moreover, investigation the relationship between RA activity and the severity of rotator cuff tendinopathy. Patients will be randomly assigned into either concentric or eccentric exercise group. Randomizations will be done using computer random generated numbers.

Detailed Description
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Study aiming at determining the efficacy of eccentric versus concentric exercises for improving tendon biological characteristics, pain, and shoulder overall function for rotator cuff tendinopathy in patients with RA. Moreover, investigation the relationship between RA activity and the severity of rotator cuff tendinopathy. Patients will be randomizations using computer random generated numbers. patients will receive either eccentric or concentric exercises for internal, external rotators and abductors muscles All patient will do stretching for posterior capsule and pectoralis minor Tendon biological changes and subacromial space will be assessed using musculoskeletal ultrasonography Shoulder function will be assessed using SPADI (shoulder pain and disability index Pain will be assessed using Visual Analogue Scale (VAS) Rheumatoid arthritis disease activity will be assessed using Disease Activity Score-28 for Rheumatoid Arthritis with erythrocyte sedimentation rate (DAS 28 ESR) patient will be assessed at base-line and after finishing of the study

Official Title
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Eccentric Versus Concentric Exercises for Rotator Cuff Tendinopathy in Patients With Rheumatoid Arthritis

Conditions
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Rheumatoid Arthritis, Rotator Cuff Tendinosis, Tendinopathy

Intervention / Treatment
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* Other: concentric exercises
* Other: eccentric exercises
* Other: Stretching


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients diagnosed with RA according to 2010 (American College of Rheumatology)(ACR)/European League Against Rheumatism (EULAR) Classification Criteria for RA Patients diagnosed with rotator cuff tendinopathy based on clinical and musculoskeletal Ultrasonography (MSUS) finding. Patient complaining of shoulder pain for at least 3 months Positive jobs test or hornblower sign or left off test Age ranged from 18 to 50 years. Exclusion Criteria: Patient indicated for surgical repair of rotator cuff Patient with previous shoulder surgery. Patient with history of intra-articular shoulder fracture. Patient with history of shoulder dislocation Diabetes mellitus

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Concentric exercises group<br>patient will do Concentric exercises. Patients will receive 3 sessions per week for 4 weeks. Exercise will be done under the supervision of the same physical therapist. During each session. Exercise will be in the form of glenohumeral scaption, internal and external rotation exercises. patient will also do stretching for posterior capsule and pectoralis minor | Other: concentric exercises<br>* concentric exercises for rotator cuff. internal rotators, external rotators and abductors Patient will do 3 sets of 10 repetitions resistance will be personalized to each patients<br>Other: Stretching<br>* stretching exercise for posterior capsule and pectoralis minor each stretch will be done for 30 seconds and repeated 3 times<br>|
| Experimental: Eccentric exercises group<br>patient will do eccentric exercises. Patients will receive 3 sessions per week for 4 weeks. Exercise will be done under the supervision of the same physical therapist during each session. Exercise will be in the form of glenohumeral scaption, internal and external rotation exercises. patient will also do stretching for posterior capsule and pectoralis minor | Other: eccentric exercises<br>* Eccentric exercises exercises for rotator cuff internal rotators, external rotators and abductors Patient will do 3 sets of 10 repetitions resistance will be personalized to each patients<br>Other: Stretching<br>* stretching exercise for posterior capsule and pectoralis minor each stretch will be done for 30 seconds and repeated 3 times<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Shoulder function | shoulder Pain and Disability Index (SPADI): It is a self-reported questionnaire evaluating the function of the shoulder. | one month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| tendon thickness, fibrillar pattern and echogenicity | tendon thickness, fibrillar pattern and echogenicity as measured Ultrasonography | one month | 
| subacromial space | shoulder subacromial space as measured by Ultrasonography | one month | 
| Pain measured by Visual analogue scale (VAS) | pain as measured by Visual analogue scale which a 10 cm scale marked at the beginning zero indicating no pain and 10 at the end indicating worst pain | one month | 
| ESR | Erythrocyte sedimentation rate | one month | 
| disease activity score 28 Erythrocyte sedimentation rate (DAS 28- ESR) | disease activity score 28 Erythrocyte sedimentation rate High disease activity is defined as a DAS 28 ESR>5.1, moderate activity as a DAS 28 ESR between 3.2 and ≤5.1, low activity as a DAS 28 ESR between 3.2 and >2.6, and remission as a DAS 28 ESR less than 2.6 | one month |