Thursday, March 27, 2014

Longer immobilization after rotator cuff repair may increase risk of stiffness

Effect of Immobilization without Passive Exercise After Rotator Cuff Repair: Randomized Clinical Trial Comparing Four and Eight Weeks of Immobilization

Surgeons continue to search for an optimal rehabilitation program after a rotator cuff repair.

These authors assessed the effect of immobilization following rotator cuff repair in 100 patients who underwent arthroscopic single-row repair of a posterosuperior rotator cuff tear (mean, 2.3 cm in the coronal-oblique plane and 2.0 cm in the sagittal-oblique plane) who were prospectively randomized to be treated with immobilization for four or eight weeks using an abduction pillow.During the immobilization period, no passive or active range-of-motion exercise was allowed. 

On MRI at 6 months after surgery, there were five full-thickness retears in the four-week group and four in the eight-week group. At the time of final follow-up, the two groups showed no differences in range of motion or clinical scores. However, the proportion showing stiffness was higher in the eight-week group (38% compared with 18%).

Patients with preoperative stiffness had approximately a 50% rate of postoperative stiffness regardless of the duration of immobilization.

Comment: Surgeons may use abduction pillows to take tension off the cuff repair or to protect it from loading from loading during activities. However, use of an abduction pillow

may not really be 'immobilization" in that the patient must take the device off for bathing and changing clothes. It would be of interest to study the motion of shoulders that are thus 'immobilized'
Use of such a device represents an inconvenience for the patient in terms of their ability to get around and may actually result in increased movement of the arm as the patient moves from the standing to the lying position. It would seem that the maximal challenge to repair integrity would come during the position changes when the pillow is temporarily moved or when the pillow shifts on the body.

In any event, it is nice to see a randomized trial and to have attention called to the issue of stiffness after cuff repair.


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