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Cross-education effects on shoulder rotator muscle strength and function after shoulder stabilization surgery: a randomized controlled trial
Yildiz TI, Turhan E, Huri G, Ocguder DA, Duzgun I
Journal of Shoulder and Elbow Surgery 2024 Apr;33(4):804-814
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVES: To investigate the effects of cross-education on RC muscle strength recovery and shoulder function in patients with arthroscopic anterior shoulder stabilization surgery. METHODS: Twenty-eight patients with shoulder stabilization surgery were included in the study (age 25+/-6 years and body-mass index 24.8 +/- 3.6 kg/m2). The patients were randomly divided into either cross-education (n = 14) or control (n = 14) groups. All patients received a standardized rehabilitation program until the end of the postoperative 12th week. The cross-education group also received an isokinetic training with the non-operated shoulder focusing on the RC muscles (twice a week, 3 sets of 10 repetitions). RC muscle strength was measured preoperatively and three, and six months postoperatively using an isokinetic dynamometer at 60degree/sec and 180degree/sec angular velocities. Shoulder function was assessed with Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) and Y-balance Test for Upper Quarter (YBT-UQ). Analyses of covariance were used for the statistical analyses. RESULTS: At the postoperative six months and at 60degree/sec angular velocity, there was higher IR strength in the cross-education group (p = 0.02) and similar ER strength (p = 0.62) between the groups. At 180degree/sec angular velocity, both IR (p = 0.04) and ER (p = 0.02) strength were higher in the cross-education group. The CKCUEST (p = 0.47), YBT-UQ (p = 0.95) and WOSI (p = 0.12) scores were similar between the groups at six months after the surgery. CONCLUSIONS: Cross-education in the early periods of the postoperative rehabilitation following the stabilization surgery improves the RC strength recovery. However, it has no effects on the functional outcomes. Integrating the cross-education program to the postoperative rehabilitation may help to improve dynamic shoulder stability but not the functional capacity.

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