How Does External Rotation Bracing Influence Motion and Functional Scores After Arthroscopic Shoulder Stabilization?

Abstract

Background After arthroscopic shoulder stabilization, the loss of motion or delayed recovery of motion remains a clinical problem and may lead to poor patient satisfaction. There remains no consensus regarding the optimal position for postoperative immobilization and it is not known whether the position for shoulder immobilization has an effect on motion and functional recovery. Questions/purposes We asked: (1) Do patients treated with external rotation (ER) bracing after arthroscopic anterior shoulder stabilization reliably regain ROM and shoulder function? And (2) what is the frequency of recurrent instability and brace-related complications associated with the use of ER bracing? Methods Forty consecutive patients with a primary diagnosis of anterior shoulder instability underwent arthroscopic stabilization and received postoperative ER bracing; 33 patients (83%; mean age, 23 years; range, 13-44 years) were followed for at least 1 year postoperatively and seven patients were lost to followup. Shoulder ROM and functional scores were recorded preoperatively and at 2 weeks, 12 weeks, 6 months, and greater than 1 year (mean, 16 months) after surgery. Results All patients recovered their preoperative ROM and most patients achieved normal ROM by 3 months after surgery. Significant improvements in American Shoulder and Elbow Surgeons (ASES) and Western Ontario Shoulder Instability (WOSI) scores were observed at each postoperative time point. The mean (± SD) final scores were 95 ± 9 for the ASES and 87%

Rehabilitation after arthroscopic Bankart repair: a systematic scoping review identifying important evidence gaps

“…Study Characteristics: Of nine studies [14][15][16][17][18][19][20][21][22], two were randomized controlled trials (RCT) comparing rehabilitation approaches [16,17] while the remaining studies were either cohort [20], or case series [14,15,18,19,21,22]. Data from a surgical RCT that compared arthroscopic and open surgical approaches, but detailed postoperative rehabilitation [18] was included as a case series using only the ABR group.…”

Mid- to long-term results of postoperative immobilization in internal vs. external rotation after arthroscopic anterior shoulder stabilization

“…A suspected advantage of better ER due to postoperative immobilization in ER, while reported restriction with immobilization in IR, could not be detected. 24 , 34 Although a significantly better ER in the group of immobilization in ER appeared in the early postoperative period (up to the sixth postoperative week), the results nullified over time, so that there was no significant difference in terms of ER at the time of long-term follow-up.…”

“…Yin et al first evaluated the influence of external immobilization on the postoperative range of motion and shoulder-specific function scores after arthroscopic stabilization surgery. 34 They studied 33 patients with a mean follow-up duration of 16 months and could show that the preoperative level of ER was achieved at 3 months postoperatively and showed an increase in the mean ER from 62° preoperatively to 72° postoperatively at the mean follow-up. The authors reported a recurrence rate of 3%.…”

Atraumatic shoulder instability: pathophysiology clinical assessment and practical management

“…Immobilization in a shoulder orthosis is advised for 3-6 weeks with strict instructions to avoid active ER for 4-6 weeks in those patients with an additional labral repair [62] . An immobilization position of 10-20 degrees of ER and 30 degrees of abduction has been associated with a better functional improvement [63] . The therapist may allow gentle passive and active ROM in 90 -100 degree of elevation in the first4-6 weeks.…”