The Role of the Peripheral and Central Nervous Systems in Rotator Cuff Disease

J Shoulder Elbow Surg, 2015 · DOI: 10.1016/j.jse.2015.04.004 · Published: August 1, 2015

Simple Explanation

Rotator cuff (RC) disease is a common source of shoulder pain, limiting function and quality of life. The disease involves changes in the tendons, and rotator cuff tears can cause further muscle changes that affect surgical outcomes. Clinical evidence suggests a weak link between the severity of RC tears and patient symptoms, highlighting that RC disease is influenced by multiple factors. This review looks at how the nervous system (peripheral, spinal cord, and brain) may worsen muscle problems from tendon tears, hinder recovery after surgery, contribute to pain, reduce shoulder function, and explain why people respond differently to treatments.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Narrative Review

Key Findings

1
RC disease is associated with structural and functional alterations of proprioceptors. Either reduced or inconsistent proprioceptive information from the injured muscle-tendon unit and altered muscle reflex activity may impair shoulder proprioception and contribute to impaired kinematics and muscle recruitment.
2
Patients with a RC tendon tear and signs of central sensitization have been shown to have worse clinical outcomes after surgery.
3
Motor nerve injury associated with RC tendon tear appears to be less frequent than first assumed, yet peripheral nerve dysfunction remains a non-negligible aggravating factor.

Research Summary

The review identifies a number of neural structures and mechanisms that may contribute to pain and shoulder dysfunction in patients with RC disease, including proprioceptive function disruption and altered muscle reflex activity. Motor control and proprioception impairments in patients with RC diseases have been insufficiently assessed and require further investigations, as do pain assessment and sensory abnormalities. Different profiles involving different degrees of biomechanical, motor control, proprioceptive, and nociceptive impairments may exist amongst patients with RC disease, necessitating the development of standardized clinical tests.

Practical Implications

Improved Diagnostics

Develop and implement improved diagnostic tools for identifying peripheral nerve dysfunction in patients with RC disease.

Personalized Treatment

Develop standardized clinical tests to assess biomechanical, motor control, proprioceptive, and nociceptive impairments for comprehensive patient assessment and management.

Neurorehabilitation Strategies

Explore neurorehabilitation approaches to address nervous system impairments, improving muscle force generation and shoulder function after RC reconstruction.

Study Limitations

1
Heterogeneous and incompletely documented EMG/NCS methods limit comparisons between studies.
2
Imaging techniques cannot discriminate muscle impairments related to tendon tear or denervation when they happen simultaneously.
3
Small animal models have a limited ability to replicate human RC disease.

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