MSc, Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand / Introduction Rotator cuff tears can cause great impairment of the shoulder joint with debilitating pain and dysfunction. The surgical repair of rotator cuff tears result in an extensive rehabilitation being required. This process can be affected by various demographic, surgical and rehabilitative factors. There appear to be no studies relating these factors to the rehabilitation process. The aim of this study was to determine the prevalence of partial and full thickness tears seen in one physiotherapy practice over the period of four and a half years. It also was to identify and analyse the factors affecting the amount of physiotherapy following a rotator cuff repair. Methods This was a retrospective record review. It was also a cross sectional correlational study. Results The prevalence of partial and full thickness rotator cuff tears seen over a period of four and a half years in one physiotherapy practice is very similar. Partial thickness tears constituted 46% of the entire sample and full thickness made up 54% of the sample. Four out of eleven factors were found to be associated with the amount of physiotherapy received after a rotator cuff repair. These factors included the age of the patient, whether the patient was injured on duty, iv preoperative physiotherapy and additional procedures after surgery such as a revision of the repair or a manipulation of the shoulder. Conclusion There are only a few factors shown to be associated with the rehabilitation process after a rotator cuff repair. These factors would need to be correlated against outcome in future studies.

Aim: This pilot study compared the efficacy of superficial dry needling (SDN), deep dry needling (DDN), placebo dry needling (PDN) and a common physiotherapy control group (CON) when used in the treatment of myofascial trigger points (MTrPs) in rotator cuff syndrome (RCS) patients. Methodology: A randomised, single-blind, placebo-controlled pilot study (n=20) was conducted comparing the three needling groups to each other and to a common physiotherapy protocol. Participants were selected patients presenting for treatment in a private practice. The objectives of the study were to compare the groups on three levels: Pre trial-Post trial, within individual treatment session (Intra-treatment), and between treatment sessions (Inter-treatment). All groups were treated with the same basic common protocol but three of them had the addition of one each of the needling interventions. A modified Constant-Murley scale, range of motion and power were used as outcomes measures. Ethical permission was obtained from the University of the Witwatersrand. Results: Results were analysed for the four groups using an ANCOVA. DDN had significant improvement over CON over the trial period (p≤0.05) and SDN (p≤0.02). This was particularly due to highly significant intra-treatment effect on internal range of motion at session 3 (p≤0.01) and the highly significant inter-treament effect between session 3 and 4 (p≤0.03). DDN was significantly less effective than the other groups at session 3 (p≤0.01) and session 4 (p≤0.03). External rotation power was also significantly greater for DDN between sessions 2 and 3 (inter-treatment) (p≤0.05). 49% of the MTrPs identified were found within the infraspinatus muscles. Discussion: Twitch-obtaining dry needling (DDN) appears to show greater clinical benefit on the effects of myofascial trigger points than SDN, CON or PDN. The effect appears to correlate with the greater incidence of MTrPs in the infrapinatus muscles whose functions directly relate to the improved parameters. The clinical effect may be related to the effects of the bleeding elicited by intramuscular needling (humoral effects). This is evidenced by the transiently poor effect of DDN immediate following treatment becoming significanly better by the following treatment. Conclusion: The pilot study showed that DDN may be an effective treatment for RCS when used in conjunction with a conventional physiotherapy programme. The elicitation of a local twitch response and associated bleeding may be significant. In future studies, particular attention should be paid to both the infraspinatus muscle and the timing of the intervention and observation intervals.