A shoulder to lean on

Cecilia Wu

A mugging robbed Cecilia Wu the use of her shoulder. A USC physical therapy research team gave it back to her using an innovative new rotator cuff treatment option funded by a private grant. 

BY JAMIE WETHERBE MA ’04

On a Sunday morning in 2006, Cecilia Wu was mugged after leaving church. 

“I was at a small shopping center, and a guy came up from behind and grabbed my purse,”says Wu, who recently turned 70. “I instinctively held on; he pulled again and sent me flying.”

When she hit the ground, she broke her right clavicle. Although she’s not sure when the tear took place — she felt pain while performing everyday tasks — the injury eventually caused damage to her rotator cuff.

“I was living with pain off and on for years, and I thought it was related to the clavicle,”she says. “A couple of years ago, the pain became unbearable.”

Discouraging treatment options

In 2016, Wu underwent a round of rehab at Casa Colina Hospital in Pomona, Calif, but the treatment only agitated her injury. A series of scans later revealed a full-thickness rotator cuff tear.

Wu contacted orthopedic surgeons to research options to fix the tear: One recommended surgery, which would entail a painful recovery, while another prescribed a topical anti-inflammatory to possibly ease her pain.

“That [medication] was almost $3,000; it was outrageous,” she says, adding there was no guarantee of long-term improvement.

Discouraged with her treatment options, Wu opted to participate in a pilot study at theClinical Biomechanics Orthopedics and Sports Outcome Research Lab.

“It was better than surgery or the ointment,” Wu says.

Funded by a $463,000 donation from Barbara Fried, who experienced a similar injury, the lab conducts revolutionary research for patients with full-thickness rotator cuff tears.

Related: From Pain to Gain: Gift to Let USC Explore How Physical Therapy Helps Torn Rotator Cuffs 

The “unheard-of” treatment

Rehab for this type of injury typically involves non-weight bearing, open-chain exercises —for instance, holding a band and rotating the arm, while the end of the limb is free.

The concept behind USC’s research protocol involves closed-chain exercises often using the patient’s body weight — including push-ups, pull-ups, dips and reverse rows —while the end of the limb is braced.

“It’s a not anew type of exercise, but it’s new as it applies to people with full-thickness rotator cuff tears,” says Lori Michener, lab director and professor of clinical physical therapy. “Our idea was that using this approach would facilitate less pain for the patient and better muscle activation.”

This treatment is “unheard of” for this type injury, says Jonathan Sum, assistant professor of clinical physical therapy. “To my knowledge, there have only been one or two studies looking at the efficacy of doing these traditionally more difficult exercises,” he adds.

Goal: sleeping without pain

In phase one patients go through the study’s exercise protocol as part of their comprehensive physical therapy treatment, which could entail other interventions based on the injury. In the second phase, patients progress to a gym program with intermittent supervision. 

In the summer of 2016, Wu started the study’s first phase, undergoing 30-minute therapy sessions twice a week for 12 weeks.

“When we started, she had difficulty raising her arm, lifting anything, and she wasn’t able to exercise,” says Sum, Wu’s primary physical therapist. “One of her big goals was to sleep through the night.”

Now in the second phase of rehab, Wu says her shoulder has completely recovered.

“Before therapy, I couldn’t even wash my back in the shower. Now, I forget I’ve ever had an injury,” she says. “I exercise; I do Zumba. The only reason I’m not playing tennis is because I can’t find a group to take me — I’m not that good.”    

A potential game changer

The study which started with 15 participants in 2015, has shown improvement in patients’ function and pain “dramatically,” Sum says. 

“I can’t think of a patient who didn’t show improvement,” he continues. “In my opinion, this is one of these game-changers that could alter the standard of care for people with full-thickness rotator cuff tears,” Sum adds.

Surgery is often the protocol for this injury, which becomes more common as people age.

“By the time you reach 70, there’s a 50 to 70 percent chance you have some degree of full-thickness rotator cuff tear,” Michener says.

Through the work at USC, Michener hopes more patients can recover non-operatively.

“Many people who have surgery end up tearing their cuff again for a whole host of reasons,”she explains. “Some statistics are as high as 50 percent; others are as low as15 percent, depending on the injury and the procedure.”

This new approach could provide clinicians, including physical therapists and surgeons with a non-surgical option.

Your own physical therapy team

“If we can prolong someone’s natural anatomy as long as possible, they’ll do better overall,” Sum says. “We want patients to have an alternative to surgery that returns them to better function and pain control.”

Michener and her team continue to examine the outcome of these exercises and are applying for a grant to investigate the short- and long-term impacts of the protocol.

Wu wants to spread the message to other patients. 

“This is a very good alternative to surgery and the painful recovery,” she says. “The coaching atmosphere made it feel like you had your own team. I saw that I was improving and that made me actually want to go to therapy.” 

Posted 04.13.2018