The Study On Proprioception In Patients With Rotator Cuff Injury

Objective:To evaluate the reliability of patients with unilateral rotator cuff injury(RCI)using the Biodex System 4 Pro multi-joint isokinetic muscle strength test training system.To seek the best and the most sensitive measurement angle to evaluate the shoulder joint proprioception in patients with RCI,and to explore the differences of the shoulder joint proprioception between patients with RCI and healthy control group and its correlation with the grade and function of shoulder joint injury.To provide theoretical guidance for subsequent rehabilitation program selection and efficacy evaluation of patients with RCI.Methods:Thirty-six patients with unilateral RCI,ranging in age from 48 to 68 years old,were randomly selected from 36 healthy subjects in the hospital who met the nanexclusion criteria.Part 1:Twenty patients with unilateral RCI were selected using the random-number control principle as assessment subjects.Two evaluators(A and B)used the Biodex System 4 Pro Multi-joint isometric muscle strength test training system to evaluate the 50%ROM,80%ROM and 100%ROM active and passive joint position sense(JPS)at three different angles of and 0° kinesthetic sense(JKS)of shoulder joint abduction at bilateral scapular plane.On the third day,the 20 subjects were evaluated again by evaluator A for bilateral shoulder proprioception,intraclass correlation coefficient(ICC)and standard error of measurement(SEM)were calculated.Part 2:The test training system was used to assess shoulder abduction proprioception.Active joint position sense(AJPS)at the bilateral scapular plane of 72 subjects at 30%ROM,50%ROM and 80%ROM angles and 0° JKS were used as the shoulder joint proprioception,and the rotator cuff injury degrees of patients were graded according to MRI results.Constant-Murley score(CMS)was used to collect the shoulder function score data of patients.The differences of AJPS and JKS in bilateral shoulder joints were compared within the group.To compare whether there were differences in proprioception of shoulder joint between the two groups and whether there were differences in AJPS of RCI people under different abduction angles.The correlation between shoulder joint proprioception and rotator cuff injury grade and functional score of shoulder joint in patients with RCI was also discussed.Results:1.In patients with RCI,the intra-rater reliability of bilateral shoulder abduction proprioception evaluation using the Biodex System 4 Pro Multi-joint isokinetic muscle strength test training system was moderate to excellent(ICC0.536-0.894),the inter-rater reliability was moderate to excellent(ICC 0.518-0.855).2.In RCI patients,the AJPS of bilateral shoulder joint was different at the angle of 50%ROM and 80%ROM,the difference was statistically significant(P<0.01),and the 0° JKS was statistically significant(P<0.01).There was no difference in bilateral shoulder joint proprioception in healthy control group(P>0.05).Compared with healthy controls,patients with RCI had worse AJPS in the unaffected shoulder at 50%ROM and 80%ROM(P<0.05 and P<0.01).The AJPS of the affected shoulder joint in RCI patients was worse at 50%ROM and 80%ROM,and the difference was statistically significant(P<0.01).There was no significant difference in JKS between RCI patients and healthy control group(P>0.05).The AJPS between 80%ROM and 30%ROM and 50%ROM in RCI patients was statistically different(P<0.05).There was a low positive correlation between AJPS and CMS at the abduction angle of 50%ROM(p=0.353),and a significant positive correlation between AJPS at 50%ROM abducting angle and AJPS at 30%ROM and 80%ROM(p=0.569,p=0.675).There was no significant correlation between KS,JPS and CMS.The degree of rotator cuff injury was negatively correlated with CMS(p=-0.359).AJPS tended to deteriorate with the aggravation of rotator cuff injury.Conclusions:1.The intra-rater and inter-rater reliability of shoulder proprioception evaluation in patients with RCI using the Biodex System 4 Pro multi-joint isokinetic muscle strength test and training system are both good,In the future,this system can be used for periodic evaluation of proprioceptive rehabilitation of patients with RCI.2.AJPS is best measured when the scapular plane abduction angle is the largest in patients with RCI,which can be selected for AJPS evaluation.3.In patients with RCI,the shoulder joint proprioception on the affected side was worse than that on the healthy side.AJPS of the healthy side and the affected side in RCI patients were poorer in patients with RCI.And no significant difference was found in JKS.There was a low positive correlation between AJPS and CMS in RCI patients with shoulder scaption at 50%ROM angle,suggesting that we should pay attention to shoulder position sense training during functional rehabilitation training,and the correlation between JKS and CMS needs further study.4.With the aggravation of RCI injury,the higher the MRI imaging grades,AJPS showed a trend of deterioration.