BACKROUND: Codman's pendulum exercises are commonly prescribed after shoulder surgery and injury to provide grade I and II distraction and oscillation resulting in decreased pain, increased flow of nutrients into the joint space, and early joint mobilization. Many shoulder protocols suggest that weight may be added to these pendulum exercises as rehabilitation progresses, however, very few guidelines exist to stipulate how much weight should be added.To determine if added weight affected the subject's ability to relax the shoulder musculature during pendulum exercises.Twenty-six participants, ages 20 to 56 years old (mean 32.26, ± 8.51 years) were divided into two groups, nine pathological and 17 non-pathological. The muscle activity (EMG) of four variations of Codman's pendulum exercises 1) wrist suspended 1.5 kg weighted-ball, 2) hand-held 1.5 kg dumbbell, 3) hand-held 1.5 kg weighted-ball, and 4) no weight were recorded in each muscle.When grouped across all patients and all other factors included in the ANOVA, the type of pendulum exercise did not have a significant effect on shoulder EMG activity regardless of patient population or muscle tested. Generally, the supraspinatus/upper trapezius muscle activity was significantly higher than the deltoid and infraspinatus activity - especially in the patients with pathological shouldersPerforming the exercises with added weight did not result in significant increased shoulder EMG activity for the deltoid and infraspinatus muscles in subjects with and without shoulder pathology. However, patients with shoulder pathology had greater difficulty relaxing their supaspinatus/upper trapezius muscle group during Codman's pendulum exercises than healthy subjects.

Subacromial corticosteroid injection is one of the most frequently used management tools in subacromial impingement syndrome (SIS) despite controversial reports on the efficacy. Our purpose, in this single blinded, randomised and controlled study was to clarify whether the corticosteroid injection provides additional benefit when used with other conservative treatment modalities in 48 patients with stage 2 SIS. The patients were randomly divided into three groups according to the two therapeutic injections applied with a 10-day interval: group 1: 10 cc of 1% lignocaine + 40 mg of methylprednisolone for the first and second injections, group 2: 10 cc of 1% lignocaine + 40 mg of methylprednisolone for the first injection and only 10 cc of 1% lignocaine for the second injection, group 3: only 10 cc of 1% lignocaine for the first and second injections. All the patients were prescribed 500 mg of naproxen sodium to use two times daily, instructed to rest and perform Codman's pendulum exercises during the first 15 days. Shoulder pain during rest, activity, and causing disturbance of sleep was evaluated using a visual analogue scale and shoulder function was investigated by total Constant score and its subsectional parameters which are pain, daily living activities, active range of motion and strength before the therapy and 1 and 3 months after the therapy onset. Significant improvements from the baseline values in all pain and function parameters were observed at the first and second evaluation in all groups. Group 1 patients had more favourably improved values in pain causing sleep disturbance and daily living activity parameters than group 2 and 3 patients only in the 1st month after therapy onset. We found that subacromial corticosteroid injections in the acute or subacute phase of SIS provided additional short-term benefit without any complication when used together with nonsteroidal anti-inflammatory drugs (NSAIDs) and exercise.

Passive shoulder motion is standard early rehabilitation in patients undergoing rotator cuff repair. A number of rehabilitation protocols exist to obtain this goal. This article evaluated different rehabilitation protocols using electromyographic analysis of the rotator cuff muscles to determine if the different protocols promote passive motion. Ten healthy volunteers underwent EMG to investigate the relative activity of the rotator cuff muscles during various exercises used postoperatively following shoulder surgery. The exercises tested were continuous passive motion machine (CPM), pulley, pendulum, self-assisted bar raise using the contralateral arm for power, self-assisted internal and external rotation, therapist-assisted elevation in plane of the scapula, and therapist-assisted internal and external rotation. The relative activity of the supraspinatus, infraspinatus, anterior deltoid, and trapezius muscles were measured and expressed as a percentage of maximal activity. For all muscle groups tested, the pulley exercise showed significantly more activity than the CPM machine. In the supraspinatus muscle, the pulley exercise averaged 17.6% of maximal activity and 8.7% for the self-assisted bar raise using contralateral arm power compared with 5.0% for the CPM machine. In general, therapist-assisted exercises and Codman's pendulum exercises showed activity that was not significantly different from the CPM machine. These results indicate that CPM and therapist-assisted passive range of motion, by being more passive, may increase the safety margin for obtaining early passive range of motion without disrupting the rotator cuff repair.