Emerg Med J 28:634-635 doi:10.1136/emermed-2011-200306
  • Best Evidence Topic reports

BET 4: Hydrotherapy following rotator cuff repair


A short cut review was carried out to establish whether hydrotherapy is beneficial in rehabilitation after rotator cuff repair. 27 papers were found using the reported searches, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of that best paper are tabulated. It is concluded that while there may be some short term benefit to passive range of movement, further research is needed.

Report by: Laura Hay, Naheed Ahmed, Physiotherapists

Search checked by: Katherine Wylie, Senior Information Officer

Institution: Manchester Royal Infirmary

Clinical scenario

A 24-year-old man attends the emergency department having suffered an injury to his right shoulder while playing rugby. He has severely restricted movement. Plain x-ray shows no fracture. MR scan shows rotator cuff disruption. He is referred and subsequently undergoes operative repair. He is sent for rehabilitation postoperatively. You wonder whether hydrotherapy will benefit him.

Three-part question

In (adult patients with rotator cuff repairs) does (the addition of hydrotherapy to standard physical treatment) improve (functional recovery)?

Search strategy

Medline, Embase, Cinahl, AMED using the NHS Evidence with multifile searching 13 May 2011 (exp Hydrotherapy/ OR hydrotherapy.ti,ab OR (aquatic AND therapy).ti,ab OR balneotherapy.ti,ab OR (water AND exercise).ti,ab OR (water AND rehabilitation).ti,ab) AND (exp Rotator cuff/ OR exp Rotator cuff injuries/).

Pedro database May update 2011 (Therapy: Hydrotherapy, balneotherapy) AND (Body part: upper arm, shoulder, shoulder girdle).

The Cochrane Library May 2011: MeSH descriptor hydrotherapy explode all trees AND MeSH descriptor rotator cuff explode all trees one record not relevant.

Search outcome

Twenty-seven papers were retrieved of which one directly addressed the three-part question.


One feasibility study looking into the use of hydrotherapy following rotator cuff repair was found. While the subjects were well matched and a good description of the intervention was documented, treatments were allocated by the clinicians rather than randomly and numbers were very small. The study suggests that hydrotherapy intervention may lead to significant changes in passive flexion at 3 and 6 weeks but showed no differences in any measured outcomes at 12 weeks. More studies with larger numbers are required to make definite recommendations.

Clinical bottom line

The addition of hydrotherapy to standard therapy for rotator cuff repairs may improve passive movement in the short term. Further research is needed.

▶ Brady B, Redfern J, MacDougal G, et al. The addition of aquatic therapy to rehabilitation following surgical rotator cuff repair: a feasibility study. Physiother Res Int 2008;13:153–61.

Table 4

Hydrotherapy following rotator cuff repair


  • Provenance and peer review Not commissioned; internally peer reviewed.