A Systematic Review of EMG Studies in Normal Shoulders to Inform Postoperative Rehabilitation Following Rotator Cuff Repair

Background Electromyography (EMG) has previously been used to guide postoperative rehabilitation progression following rotator cuff repair, to prevent deleterious loading of early surgical repair. Objective To review the current literature investigating EMG during rehabilitation exercises in normal shoulders, to identify exercises that meet a cut point of ≤15% maximal voluntary isometric contraction (MVIC) and unlikely to result in excessive loading in the early postoperative stages. Methods An electronic search of MEDLINE via Ovid, EMBASE, CINAHL, SPORTDiscus, PubMed and Cochrane Library for all years up until June 2016 was performed. Studies were selected in relation to pre-defined selection criteria. Pooled mean MVICs were reported and classified as low (0%-15% MVIC); low-moderate (16-20% MVIC) moderate (21%-40% MVIC); high (41%-60% MVIC); and very high (>60% MVIC). Results 2159 studies in total were initially identified, and after applying the selection criteria, 22 studies were included for quality assessment, data extraction and data synthesis. In total, 43 exercises spanning passive ROM, active-assisted ROM and strengthening exercises were evaluated. Nine (out of 13) and 10 (out of 13) active-assisted exercises were identified to be suitable (≤15%MVIC) to load supraspinatus and infraspinatus respectively, early postoperatively. All exercises were placed in a theoretical continuum model whereby general recommendations can be made for prescription in patients post rotator cuff repair. Conclusion This review identifies passive and active-assisted exercises that are proposed to be appropriate in the early stages post rotator cuff repair.