Purpose: This project presents the case of a patient who was treated with ASTYM after she responded poorly to treatment of rotator cuff tendinopathy post cancer treatments and answers the PICO question: Is ASTYM more effective than traditional eccentric loading programs in the treatment of rotator cuff tendinopathies in patients who have undergone radiation therapy? Background: As the detection and treatment for cancer advances it is becoming more and more apparent that the sequelae from such treatments can have very real and detrimental effects on the quality of life that such patients experience after treatment. To survive cancer treatment only to live the rest of your life with pain and skeletal muscular deficits that keep you from living the life you want is tragic. ASTYM is an advanced form of soft tissue mobilization, which through the use of tooled massage, claims to initiate the remodeling, and regeneration phases of the healing process, eliminating scar tissue and allowing it to form in a healthier more functional alignment of tissues. As the use of ASTYM grows and becomes more popular among clinicians it is important to establish research examining the efficacy of this technique and to identify appropriate and safe populations for the application of this therapy. Case Description: Mrs. Q is a 56-year-old woman who presented to outpatient orthopedics 6 months post-double mastectomy. Mrs. Q's primary complaint was limited range of motion of the right shoulder with pain and weakness in all of the motions of the shoulder. She received 6 weeks of physical therapy but was not progressing as expected so ASTYM was added to her plan of care. Outcomes: A review of available literature revealed that there is little evidence for the use of ASTYM as a treatment in patients with tendinopathies who are otherwise healthy. There is no evidence to support or deny the efficacy of this treatment in patients who have received cancer treatment or have otherwise compromised health. There is also no evidence to prove that it is not effective and no patient has ever been injured in an ASTYM study therefore this treatment appears to be safe. DISCUSSION: This project examines the case of a woman who reported to outpatient physical therapy for treatment of a tendinopathy which she developed post breast cancer treatment. This patient had difficulty with treatment and was not healing in a time frame believed to be typical of this type of patient for this reason ASTYM was added to her plan of care. A review of literature examined the efficacy and appropriateness of this treatment technique on a patient who had received rotator cuff tendinopathy post radiation therapy verses the use of traditional eccentric loading protocols. No articles were found to include rotator cuff tendinopathies treated by ASTYM or ASTYM treatments used post-radiation therapy. Some poor quality evidence was found to support the use of ASTYM therapy to treat patients with tendinopathies in other areas of their bodies. Further research is needed before anyone can adequately estimate the effect that this treatment will have on more complex patient populations.
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Vendrely, Robbie. "ASTYM verses Resisted Eccentric Exercise in Post Radiation Rotator Cuff Tendinopathies: An Evidence Based Analysis." (2016). http://digitalrepository.unm.edu/dpt/26
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