***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: PURPOSE The purpose of this study was to compare the clinical outcomes of immediate rotator cuff repair with capsular release and those of rotator cuff repair after the stiffness was treated with rehabilitative therapy . METHODS Between June 2007 and December 2010 , we recruited 63 patients with rotator cuff tears and stiffness . In 33 patients arthroscopic rotator cuff repair was performed with capsular release simultaneously ( group I ) . In 30 patients arthroscopic rotator cuff repair was performed after 6 months of preoperative rehabilitation for stiffness ( group II ) . The American Shoulder and Elbow Surgeons score , Simple Shoulder Test score , Constant score , and visual analog scale score for pain and range of motion ( ROM ) were assessed at the start of the study ; at 3 , 6 , and 12 months ; and at the last visit . The postoperative cuff tendon integrity was assessed between 6 and 12 months using magnetic resonance or ultrasound images . RESULTS There were no significant differences in preoperative demographic data between the groups ( P > .05 ) . The mean follow-up period was 21.54 months . After treatment , there was significant improvement in ROM and functional scores in both groups , as measured at the last follow-up ( P < .05 ) . No statistical differences were found in clinical scores and ROM at the last follow-up ( P > .05 ) . On assessment of the magnetic resonance or ultrasound images taken 6 to 12 months postoperatively , the retear rate for the repaired cuff tendon in each group was 12.1 % in group I and 13.4 % in group II . CONCLUSIONS In the treatment of rotator cuff tears with stiffness , satisfactory results can be achieved either by repairing the tear with simultaneous capsular release or by waiting to perform the repair after preoperative rehabilitation for stiffness . Because a delayed rotator cuff repair after improving ROM offered no clear advantage over an immediate operation , we recommend surgically treating rotator cuff tears with concomitant stiffness early using a simultaneous capsular release method to save time and to avoid unnecessary rehabilitation . LEVEL OF EVIDENCE Level II , prospect i ve comparative study The purpose of this study was to document the intrarater reliability of manual muscle test ( MMT ) grade s in assessing muscle strength in patients with Duchenne 's muscular dystrophy ( DMD ) . Subjects were 102 boys , aged 5 to 15 years , who were participating in a double-blind , multicenter trial to document the effects of prednisone on muscle strength in patients with DMD . Four physical therapists participated in the study . Two identical ( duplicate ) evaluations were performed within 5 days of each other by the same examiner initially and after 6 and 12 months of treatment . A total of 18 muscle groups were tested on each patient , 16 of them bilaterally , using a modification of the Medical Research Council scale . Reliability of muscle strength grade s obtained for individual muscle groups and of individual muscle strength grade s was analyzed using Cohen 's weighted Kappa . The reliability of grade s for individual muscle groups ranged from .65 to .93 , with the proximal muscles having the higher reliability values . The reliability of individual muscle strength grade s ranged from .80 to .99 , with those in the gravity-eliminated range scoring the highest . We conclude the MMT grade s are reliable for assessing muscle strength in boys with DMD when consecutive evaluations are performed by the same physical therapist A self-administered question naire was design ed to assess the severity of symptoms related to and the functional status of the shoulder . It includes domains of global assessment , pain , daily activities , recreational and athletic activities , work , satisfaction , and areas for improvement . Each domain is grade d separately and is weighted to arrive at the total score . The over-all scale and each domain were prospect ively tested for validity , reliability , and responsiveness to clinical change . One hundred patients who were seen for evaluation of the shoulder were enrolled in the study . The validity of the scale was demonstrated by moderate-to-high correlation of the domains and individual questions of the Shoulder Rating Question naire with those of the Arthritis Impact Measurement Scales 2 . Validity was supported further by significant correlation of the scores in each domain with the level of satisfaction in that domain and by significantly lower scores in domains that patients selected as areas important for improvement . The over-all scale and each domain were internally consistent ( Cronbach alpha , 0.71 to 0.90 ) . Reproducibility was evaluated by repeated administration of the question naire after a mean of three days to forty patients whose condition was clinical ly stable . Reproducibility of the over-all question naire and individual domains was excellent ( Spearman-Brown index , 0.94 to 0.98 ) . Individual questions were reproducible , with a weighted kappa value of more than 0.7 for each . Responsiveness was evaluated by comparison of the preoperative and postoperative scores of thirty patients who had a satisfactory result one year after an operation on the shoulder . The over-all Shoulder Rating Question naire and each domain were responsive to clinical change as demonstrated by favorable st and ardized response means ( range , 1.1 to 1.9 ) and indices of responsiveness ( range , 1.1 to 2.0 ) . Similar analysis performed for individual diagnostic groups supported the validity , reliability , and responsiveness of the question naire in each group . The self-administered shoulder question naire was found to be valid , reliable , and responsive to clinical change . These qualities should make it a useful instrument for the prospect i ve assessment of the outcome of treatment of disorders related to the shoulder Background The role of degenerative changes in rotator cuff musculature with respect to the functional outcomes of rotator cuff repair have only recently been recognized and are still not well understood . In addition , the reversibility of these changes with repair of the tendons is question able . Hypothesis Poorer preoperative muscle quality negatively affects outcome , and a successful outcome ( in terms of a healed repair ) might demonstrate improvements in fatty infiltration and muscle atrophy . Study Design Cohort study ; Level of evidence , 2 . Methods Thirty-eight patients ( mean age , 62 years ) were prospect ively evaluated with preoperative and 1-year postoperative clinical examination and appropriate magnetic resonance image sequencing to determine grade s of muscle atrophy and fatty infiltration of the supraspinatus and infraspinatus muscles . American Shoulder and Elbow Society ( ASES ) , Constant , and pain scores were determined as well as strength measurements . The retear rate and progression of muscle degeneration were also evaluated . Independent predictors of outcome measurements and cuff integrity were determined . Results The overall clinical outcome , including ASES , Constant , and pain scores , improved significantly ( P < .0001 ) . Strength in forward elevation improved significantly ( P < .006 ) , while external rotation strength did not . There was a strongly negative correlation between muscle quality and outcome results in most cases . When the results were adjusted for multivariate effect , muscle atrophy and fatty infiltration of the infraspinatus muscle were the only independent predictors of ASES and Constant scores ( P < .03 ) . Tear size and rotator cuff healing did not play an independent role . Tear size , however , was the only independent predictor of ultimate cuff integrity ( P = .002 ) . Both atrophy and fatty infiltration progressed significantly over the course of the study . In cases in which the tendon had re-torn , the progression was found to be more significant than when the repair proved successful ( P < .003 ) . Conclusion Muscle atrophy and fatty infiltration of the rotator cuff muscles , particularly of the infraspinatus , play a significant role in determining functional outcome after cuff repair . Tear size appears to have the most influential effect on repair integrity . A successful repair did not lead to improvement or reversal of muscle degeneration and a failed repair result ed in significantly more progression . In general , healed repairs demonstrated minimal progression . These findings suggest that repairs should be performed , if possible , before more significant deterioration in the cuff musculature in order to optimize outcomes , and that underst and ing the degree of muscle atrophy and fatty infiltration before surgery can help guide patient expectations Background : Massive tears of the tendons of the rotator cuff cause atrophy and fatty degeneration of the rotator cuff muscles and painful loss of function of the shoulder . Repair of massive rotator cuff tears is often followed by retears of the tendons , additional muscular degeneration , and a poor clinical outcome . The purpose s of this study were to determine whether a new method of repair of rotator cuff tendons can yield a lower retear rate and a better clinical outcome than previously reported methods , to assess the muscular changes following repair of massive tears of the musculotendinous units , and to correlate findings on magnetic resonance imaging with the clinical results . Methods : Twenty-nine massive rotator cuff tears involving complete detachment of at least two tendons were repaired operatively with use of a new laboratory-tested technique in a prospect i ve study . At least two years ( average , thirty-seven months ; range , twenty-four to sixty-one months ) postoperatively , twenty-seven patients were evaluated clinical ly and with magnetic resonance imaging to determine the clinical outcome , the integrity of the repair , and the condition of the rotator cuff muscles . Results : The age and gender-adjusted Constant score improved from an average of 49 percent preoperatively to an average of 85 percent postoperatively , corresponding to a subjective shoulder value of 78 percent of that of a normal shoulder . Pain-free flexion improved from an average of 92 degrees to an average of 142 degrees , and abduction improved from an average of 82 degrees to an average of 137 degrees . Pain decreased and performance of activities of daily living improved significantly ( p < 0.05 ) . The seventeen patients who had a structurally successful repair all had an excellent clinical outcome . Muscle atrophy could not be reversed except in successfully repaired supraspinatus musculotendinous units . Fatty degeneration increased in all muscles . Conclusions : The method of repair of massive rotator cuff tears that was used in this study yielded a comparatively low retear rate and good-to-excellent clinical results ; however , the repair did not result in substantial reversal of muscular atrophy and fatty degeneration . Retears occurred more often in patients who had had a shorter interval between the onset of the symptoms and the operation ( p < 0.05 ) . Patients who had a retear had improvement of the shoulder compared with the preoperative state , but they had less improvement than did those who had a successful repair During a 15-month period , 24 patients with arthroscopically verified frozen shoulders were treated with manipulation while under general anesthesia and early passive motion . The minimum follow-up was 12 months , and the average duration from onset of the disease until treatment was 8 months . All patients had moderate to severe pain , and the average range of motion was less than 40 % of the opposite shoulder . During the follow-up period , 75 % of the patients obtained normal or almost full range of motion , and 79 % had slight pain or no pain at all . Eighteen ( 75 % ) patients returned to work 9 weeks ( mean ) after treatment . There was no relationship between the end result and the initial pathologic condition . We believe that manipulation combined with arthroscopy is an effective way of shortening the course of an apparently self-limiting disease and should be considered when conservative treatment has failed PURPOSE The purpose of this study was to determine whether moderate preoperative shoulder stiffness affects the clinical outcome of rotator cuff repair , and to evaluate the serial change in range of motion ( ROM ) , functional scores , pain , and satisfaction after rotator cuff repair . METHODS  Rotator cuff repair was performed in 125 consecutive patients ( 127 shoulders ) . Thirty patients had concomitant moderate shoulder stiffness at the time of the repair . There were no statistical differences in sex ratio , age , the size and retraction of the tear , or the associated pathologies and repair procedure between the stiffness and nonstiffness groups . Arthroscopic capsular release and manipulation were added to the stiffness group , and the same rehabilitation protocol was applied according to the size of the tear . Clinical outcomes were evaluated using ROM , American Shoulder and Elbow Surgeon ( ASES ) score , Constant score , Simple Shoulder Test ( SST ) , and short form 36 . Pain and postoperative patient satisfaction were measured by a visual analog scale . All clinical parameters were prospect ively recorded on the day before surgery , and at 3 , 6 , and 9 months postoperatively , and at their last follow-up visit . RESULTS Differences of ROM did not reach statistical significance after 6 months of operation . Other functional outcome instruments showed no statistical difference at any follow-up period . Postoperative cuff integrity after 1 year showed no statistical difference between 2 groups . CONCLUSIONS This study suggests that moderate preoperative shoulder stiffness does not affect clinical outcomes of rotator cuff repair if arthroscopic capsular release with manipulation is added to the index procedure . Arthroscopic capsular release with manipulation and a well programmed rehabilitation program can avoid any delay of surgery and limitation of motion after cuff repair in patients with concomitant moderate shoulder stiffness . LEVEL OF EVIDENCE Level III , retrospective comparative study 
    Output:
    
There was no significant difference in comparing preoperative and postoperative outcome scores including visual analog scale for pain , Constant , modified American Shoulder and Elbow Surgeons , and University of California-Los Angeles scores .
CONCLUSIONS Concomitant surgical treatment of nonmassive RCT and moderate shoulder stiffness in 1 stage may have comparable results to the surgical treatment of RCT in patients without preoperative stiffness .