Arm adductor with arm abduction in rotator cuff tear patients vs. healthy--design of a new measuring instrument

The incidence of (a)symptomatic rotator cuff tears is high, but etiologic mechanisms are unclear and treatment outcomes vary. A practical tool providing objective outcome measures and insight into etiology and potential patient subgroups is desirable. Symptomatic cuff tears coincide with humerus cranialization. Adductor co-activation during active arm abduction has been reported to reduce subacromial narrowing and pain in cuff patients. We present an easy-to-use method to evaluate adductor co-activation. Twenty healthy controls and twenty full-thickness cuff tear patients exerted EMG-recorded isometric arm abduction and adduction tasks. Ab- and adductor EMG's were expressed using the "Activation Ratio (AR)" (-1 ≤ AR ≤ 1), where lower values express more co-activation. Mean control AR's ranged from .7 to .9 with moderate to good test-retest reliability (ICC: .60-.74). Patients showed significantly more adductor co-activation during abduction, with adductor AR's ranging between .3 (teres major) and .5 (latissimus dorsi). In conclusion, the introduced method discriminates symptomatic cuff tear patients from healthy controls, quantifies adductor co-activation in an interpretable measure, and provides the opportunity to study correlations between muscle activation and humerus cranialization in a straightforward manner. It has potential as an objective outcome measure, for distinguishing symptomatic from asymptomatic cuff tears and as a tool for surgical or therapeutic decision-making.