HealthMarch 21, 2019

To sling or not to sling? Study finds better outcomes with early motion after rotator cuff surgery

Do you need to wear a sling after surgery to repair a torn rotator cuff? In a new study, not wearing a sling and engaging in early motion of the shoulder after surgery leads to faster recovery and better six-month outcomes, reports the March 20, 2019 issue of The Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio in partnership with Wolters Kluwer.

For patients who had small- to medium-sized tears repaired arthroscopically, not wearing a sling in the first few weeks after rotator cuff surgery led to less pain and better shoulder function at six months, concludes the randomized trial by Alexandre Ladermann, MD, of University Hospitals of Geneva, Switzerland, and colleagues. The findings are consistent with the recent trend toward early-motion rehabilitation programs after rotator cuff surgery, rather than several weeks of immobilization.

Randomized Trial Compares 'Sling Versus No Sling' after Rotator Cuff Repair

The study included 80 patients undergoing arthroscopic surgery to repair a small or medium tear (less than three centimeters) of the rotator cuff at one Swiss hospital. One group of 40 patients wore a sling for the first four weeks after surgery, with no active shoulder motion permitted. This period of postoperative immobilization is commonly recommended. The other group of 40 patients did not wear a sling after rotator cuff repair. Both groups performed passive mobilization for four weeks after surgery, followed by progressive active mobilization and exercises.

Ten days after surgery, pain scores were similar between groups: about 5 on a 0-to-10 visual scale. One-and-a-half months after surgery, patients who did not wear a sling had increased shoulder motion, including external (outward) rotation and active elevation. Both groups showed continued improvement at three months, but shoulder elevation remained greater in the no-sling group. By six months, measures of shoulder movement were similar between groups.

Ultrasound examinations performed at six months showed no significant differences between the sling and no-sling groups, including the integrity of the rotator cuff repair. Also at six months, the American Shoulder and Elbow Surgeons (ASES) score was unaffected by whether or not the patient wore a sling. However, patients in the no-sling group rated their shoulder at about 86 percent of normal on the Single Assessment Numeric Evaluation (SANE) scale, compared to 79 percent in the sling group. Six-month pain scores were also lower for patients who didn't wear a sling: 0.8 versus 1.5 out of 10. Wearing a sling was significantly associated with higher pain scores, even after adjustment for other factors.

Rotator cuff tears are a common cause of shoulder pain, especially in people older than 50. Rotator cuff repair can reduce pain and improve shoulder function, although there is a risk of repeat tears or incomplete healing. Patients are often advised to wear an immobilizing sling or brace for the first few weeks after rotator cuff surgery. However, early immobilization can have negative effects including muscle atrophy. Some studies have suggested that immobilizing the shoulder leads to increased pain and decreased function, even increasing the risk of falls.

Meanwhile, a growing body of research suggests that starting movement early after rotator cuff repair leads to greater range of motion, less pain and stiffness, and earlier return to activities. This new randomized study is one of the first to compare sling immobilization versus early motion after rotator cuff repair.

The results show that the no-sling approach with early movement leads to faster recovery of shoulder motion, less pain, and better overall patient ratings throughout the six months after surgery. "Postoperative mobilization with a sling may therefore not be required for patients treated for a small or medium tear," Dr. Ladermann and colleagues conclude. They note that their findings corroborate the results of other recent studies reporting the benefits of early-motion rehabilitation protocols.

Click to read "No Sling After Rotator Cuff Repair: Balancing Short-Term Benefit with Long-Term Health of Shoulder"

DOI: 10.2106/JBJS.18.01424

About The Journal of Bone & Joint Surgery

The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.

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