The rotator cuff tendinopathy is very common and associated with degenerative or traumatic
changes of the rotator cuff and/or the sub-acromial bursa or the long head of the biceps.
Lesions go of the simple tendinopathy without tear to the full-thickness tear of the cuff
which means a loss of mobility or strength. The origin of this pathology remains
controversial and many causes have been evoked (subacromial mechanical impingement,
degenerative changes, muscle imbalance…). The clinical impairment is not always the same and
varies from a painful shoulder with correct range of motion to a pseudoparalysis shoulder.
The first treatment of the rotator cuff pathology is always non surgical and consists in
relative resting, painkillers and/or non-steroidal anti-inflammatory drugs (NSAD) and
physiotherapy. The aim of this management is to relieve pain and to restore the mobility and
a good function of the shoulder.
There is no consensus about the physiotherapy protocol for the treatment of the rotator cuff
tendinopathy. In France, the most used physiotherapy protocol uses the strengthening of the
muscles which stabilize the scapula (rhomboide muscles, trapezius and serratus anterior) and
which lower the humerus (pectoralis major, latissimus dorsi and teres major). The aim of this
approach is to augment the subacromial space in order to decrease the inflammation of the
rotator cuff tendons and the associated pain. A technique of Dynamic Humeral Centering (DHC)
uses a new method of glenohumeral centering in closed kinetic chain has been described ("3C
Concept" for Centering in a Closed Chain). Dynamic humeral centring (DHC) is a modality of
physiotherapy that aims to prevent subacromial impingement of rotator cuff tendons. In order
to simplify and to improve its reliability, a special device called Scapuleo® has been
developed. The aim of this device is to help the physiotherapist to realize simultaneously a
subacromial decompression, a specific strengthening of the rotator cuff muscles and an
optimal activation of the lower trapezius and the anterior serratus.
Our hypothesis was that the DHC was not inferior to the conventional physiotherapy protocol
for the medical treatment of the rotator cuff tendinopathy without full-thickness tear.
We proposed a prospective and randomized study. All the patients treated in our department
for simple tendinopathy of the rotator cuff or partial thickness tear were included in this
study after signed consent. The physiotherapy protocol consists in 20 sessions of either
"Conventional program" (Control group) or "Dynamic Humeral Centering" (Study group). The
clinical evaluation included the range of motion measurement, Constant Score, Quick-DASH and
Oxford Shoulder Score at 3 months and 6 months. Patients were blinded to the study
hypothesis. The assessor of all outcomes was blinded to the interventions.