Abduction Pillow Research Articles

Is it necessary to use a sling or abduction pillow sling after superior rotator cuff repair? A preliminary report

Objectives: The study aimed to evaluate the effects of the use of a shoulder sling, shoulder sling with a pillow, or not using a sling on the shoulder functional score and pain levels following arthroscopic rotator cuff tear repair. Patients and methods: This randomized prospective study was performed with 90 patients (49 males, 41 females; mean age: 56.2±12.2 year; range, 33 to 77 years) with a small-to-mid, full-thickness rotator cuff tear between July 2020 and October 2022. All patients underwent arthroscopic double-row repair. The nonsling group wore no sling, the sling group wore a sling, and the abduction pillow sling group wore a sling with an abduction pillow. The same rehabilitation program was performed. The Visual Analog Scale (VAS) score, Constant-Murley scores, and degrees of flexion and abduction were recorded preoperatively, on the 15th and 45th days, and at three months, six months, and one year. Results: On the 15th postoperative day, the VAS score was found to be significantly lower in the nonsling group. On the 45th day, the Constant-Murley score was found to be significantly higher in the abduction pillow sling group. There was no significant difference between the groups regarding the Constant-Murley scores at three weeks, six months, and one year. The shoulder forward flexion angle was significantly lower in the nonsling group on the 45th day. There was no significant difference between the three groups in respect of the shoulder forward flexion at three months, six months, and one year. Conclusion: No difference was determined between the groups at the six-month and one-year functional results. Not using a sling bandage can be recommended by reducing pain in the early postoperative period.

Revision Anterior Glenoid Reconstruction With Distal Tibia Allograft Combined With Open Capsular Shift

Background: Managing patients with recurrent anterior shoulder instability and glenoid bony deficiency remains a challenge. Multiple graft options, including iliac crest, distal clavicle, coracoid, and distal tibia allograft have been used. There is a growing body of evidence that supports distal tibia allograft for glenoid restoration in patients with shoulder instability due to its ability to restore the articular surface as well as the glenoid depth and curvature. Indications: Surgical indications for anterior glenoid reconstruction with distal tibia allograft combined with open capsular shift include patients with recurrent shoulder instability and glenoid bone loss. Technique Description: A deltopectoral interval is utilized and the subscapularis is split in lines with its fibers. The subscapularis and capsule are split together in a horizontal fashion and tagged together. Any prior hardware is then removed utilizing appropriate removal sets, a burr, and a broken screw set if necessary. The anterior glenoid is then prepared and the defect is measured. Bone marrow aspirate is then harvested from the proximal humerus using a vortex needle. The distal tibia allograft is then cut to size and prepared utilizing pulsed lavage, pressurized sterile carbon dioxide, and the bone marrow aspirate. The allograft is then fixed with solid stainless steel 3.5-mm cortical screws with washers. The medial, glenoid based capsular repair it completed by placing 1.8-mm knotless FiberTak anchor at the bottom of the distal tibia allograft. A free needle is utilized to place a horizontal mattress stitch from the anchor to the inferior capsule, which is then loaded onto a shuttling suture, to repair it to the anterior inferior glenoid. A knotless anchor is then placed right off the chondral margin of the humeral head, and this is used to repair both the capsule and subscapularis in the correct position by passing through both inferior and superior leaflets. This is then loaded onto the knotless anchor and reduced, which shifts the subscapularis and capsule laterally. The remainder of the subscapularis split is then closed. Patients are then placed in a sling with an abduction pillow with no shoulder range of motion for 6 weeks. They can then progress their therapy with a goal of returning to sport at 6 months. Results: Several large systemic reviews have shown that return to sport rates after anterior glenoid reconstruction range between 80% and 90%, with returning to the same level of play in the 70% range. Discussion: Anterior glenoid reconstruction utilizing distal tibia allograft combined with an open capsular shift is a durable surgical option for patients presenting with shoulder instability and glenoid bone loss. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Range of motion at 6 weeks is an independent risk factor for non-healing at 6 months after arthroscopic supraspinatus repair.

PURPOSE: This study aimed to analyze the effect of the range of motion (ROM) progression pattern on healing after supraspinatus (SSN) repair. HYPOTHESIS: We hypothesized that a faster ROM recovery in the immediate postoperative period would be detrimental for tendon healing. Methods: This was a retrospective study of prospective collected data. All primary arthroscopic SSN repairs for full-thickness tears, with retraction Patte grade < 2, fatty infiltration Goutallier grade < 3 and no glenohumeral osteoarthritis were eligible. Patients who did not attend all follow-ups were excluded. One surgeon performed all arthroscopic repairs using a double-row technique. All patients followed the same rehabilitation protocol with an abduction pillow and passive ROM for 6 weeks. One observer assessed all patients preoperatively and at 1.5, 3 and 6 months postoperatively. Collected outcome measures included: ROM, Visual Analogue Scale (VAS) for pain and Constant Score (CS). Repair integrity was evaluated at 6 months by ultrasound. 2 groups were established based on repair integrity (healed/non-healed). A multivariable analysis was performed to assess potential confounding factors and ROC curve analysis was used to identify predictive thresholds for non-healing. Results: Of 1397 consecutive SSN repairs, 169 were excluded and 1207 were finally included. The overall healing rate was 87.3%. All preoperative outcome measures were similar between groups. Non-healed repairs at 6 months were slightly younger (57.8±7.9 vs 61.6±8.8, p < 0.001) and had a faster postoperative ROM recovery pattern. This difference was most distinct at 6 weeks in passive anterior elevation (AE) (143±22 vs 128±26, p < 0.001) and external rotation (ER) (32±17 vs 23±17,p < 0.001) but was fully compensated by 6 months. VAS pain and CS at each follow-up were similar between groups. Multivariable analysis confirmed 6-weeks passive EA (OR:1.36) and ER (OR:1.16) as independent risk factors for non-healing. The non-healing rate increased when 6-weeks passive EA >140° (20.4 vs 7.9%) and ER > 30° (18.4 vs 8.8%). Conclusions: In a large cohort of isolated arthroscopic SSN repairs treated with the same surgical technique and rehabilitation protocol, a faster postoperative ROM progression pattern, reflected by higher 6-weeks AE and ER, was associated with an increased rate of non-healing. This study illustrates the benefit of a conservative rehabilitation protocol on tendon healing without affecting ROM at 6 months.

Reliability of a Novel Preoperative Protocol for Determining Graft Sizes for Superior Capsular Reconstruction Using Plain Film Radiography.

Superior capsular reconstruction (SCR) for massive, irreparable rotator cuff tears involves anchoring a graft between the superior glenoid and the greater tuberosity of the humerus. Optimizing the graft size is important. We aimed (1) to evaluate the reliability of plain film radiography in determining graft size for SCR and (2) to create a database to help predict future graft sizes. An inter- and intra-rater reliability trial was conducted on 10 and 6 subjects with healthy shoulders, respectively, using plain film radiography to measure the distance between the superior glenoid and the supraspinatus footprint. The subjects were positioned upright with an abduction pillow modified to hold the shoulder at 30° abduction and 45° external rotation, afterwhich a true antero-posterior shoulder radiograph was captured. Thirty subjects were recruited for the database and grouped using the aforementioned protocol. The inter-rater and intra-rater trial agreement was excellent, with intraclass correlation coefficients of 0.94 (95% CI) and 0.76 (95% CI), respectively. Three medio-lateral patch sizes, of 33 mm, 38 mm, and 47 mm, were proposed based on the protocol in 30 subjects. Plain film radiography demonstrated excellent reliability in measuring the distance between the superior glenoid and the supraspinatus footprint. Three ordinal patch sizes are proposed.

Effects of Different Orthoses on Neuromuscular Activity of Superficial and Deep Shoulder Muscles during Activities of Daily Living and Physiotherapeutic Exercises in Healthy Participants.

This study aimed to investigate the effects of different shoulder orthoses on the neuromuscular activity of superficial and deep shoulder muscles during activities of daily living (ADL) and physiotherapeutic exercises. Ten participants with healthy shoulders (31 ± 3 years, 23.1 ± 3.8 kg/m2) were randomized to receive a "shoulder sling", an "abduction pillow" and a "variably adjustable orthosis" on the dominant side. With each orthosis, they completed seven ADL with and four physiotherapeutic exercises without wearing the orthoses. An electromyographic system was used to record the neuromuscular activity of three superficial (trapezius, deltoid, pectoralis major) and two deep shoulder muscles (infraspinatus, supraspinatus) using surface and intramuscular fine-wire electrodes. The neuromuscular activity differs between the orthoses during ADL (p ≤ 0.045), whereby the "variably adjustable orthosis" mostly showed the highest activation levels associated with the worst subjective wearing comfort rated on a visual analog scale. In addition, differences exist between the physiotherapeutic exercises (p ≤ 0.006) demonstrating the highest activations of the infra- and supraspinatus muscles for assistive elevation and wipe across a table, middle for pendulum and lowest for continuous passive motion exercises. The neuromuscular activity of superficial and deep shoulder muscles differs between the orthoses during ADL and also between the physiotherapeutic exercises.

Evaluating Postoperative Immobilization Following Hip Reconstruction in Children With Cerebral Palsy.

ObjectivesCurrently, there is no standardized protocol for postoperative immobilization techniques in patients with cerebral palsy undergoing hip reconstructive procedures. The purpose of this study was to evaluate the effects of several methods of postoperative immobilization and to determine which postoperative immobilization technique has the fewest complications.Materials and methodsA retrospective cohort study of pediatric patients with cerebral palsy who underwent hip reconstructive procedures, in which a hip spica cast, Petrie cast, or abduction pillow was placed for postoperative hip immobilization, was conducted. Patients who underwent revision surgery and those without cerebral palsy were excluded from the analysis. The final cohort consisted of 70 cases. Demographics, laterality of surgery, procedure type, hip immobilization technique, and 30-day postoperative complications were recorded. Complications were defined as those related to casting immobilization, such as re-dislocation or loss of surgical fixation, and soft tissue complications, such as pressure ulcers or any superficial or deep wound infection.ResultsOf the 70 patients, 27 received spica casting, 28 received Petrie casting, and 15 received an abduction pillow. The complication rates, as defined in the methods section, were 14.8% for the spica cast group, 17.9% for Petrie cast, and 26.7% for abduction pillow. There was no significant difference in complication rates among spica cast, Petrie cast, or abduction pillow groups (P=0.76).ConclusionsThere was no significant difference in length of stay, pain control duration, or complication rates among the three methods of immobilization. Clinicians should be advised of the comparable outcomes among the postoperative immobilization techniques.

Postoperative Immobilization After Hip Reconstruction in Cerebral Palsy: No Difference Between Hip Spica and Abduction Pillow

PurposeThis study aims to compare radiographic outcomes and complication rates of immobilization with an abduction pillow to spica casting for postoperative care after a hip reconstruction with varus derotational proximal femur osteotomy (VDRO) with or without pelvic osteotomy for children with cerebral palsy (CP).Methods233 children (1–18 years old) diagnosed with CP that underwent VDRO with or without pelvic osteotomy were identified, of which 188 patients were immobilized with a spica cast and 45 were immobilized with an abduction pillow, based on surgeon preference. 123 (65%) in the Spica group and 21 (47%) in the pillow group had pelvic osteotomies. Demographic data and complication rates were collected. Radiographic parameters, including anatomic medial proximal femoral angle (aMPFA), acetabular index (AI) and migration percentage (MP), were measured for each patient at the completion of surgery, six weeks post-operatively, and one year post-operatively.ResultsThere was not a statistically significant difference in BMI (p = 0.285), gender distribution (p = 0.984), or median follow-up time (p = 0.314) between groups. Rates of complications were consistent among groups with no differences in instances of delayed unions (p = 0.10), subluxations (p = 0.55), infection (p = 0.71), or non-unions (p = 0.10). There was no statistically significant difference in number of patients with an ideal aMPFA, AI, or MP (p = 0.44, p = 0.19, p = 1.00) at one year post-operatively.ConclusionsImmobilization with an abduction pillow is a safe and effective alternative to hip spica casting following hip reconstruction.

Latissimus dorsi tendon transposition combined with shoulder joint proximal capsule plasty with peroneal longus tendon autograft in the treatment of patients with massive rotator cuff ruptures and proximal dislocation of the humerus head (clinical case)

The frequency of rotator cuff injuries in people over 45 years of age is 25.6–50 %, and 40 % of these injuries are massive. Shoulder rotator cuff injury causes disorders in biomechanics of the shoulder joint such as anterior-superior dislocation of the humeral head. Injury of the deltoid muscle combined with a massive rupture of the rotator cuff causes proximal dislocation of the humeral head during any active movement. In the treatment of these cases, surgical methods of treatment are used, such as transposition of the latissimus dorsi muscle, proximal capsule plasty, and reverse shoulder arthroplasty. We present a successful clinical case of treatment of a patient with chronic massive injury of the right shoulder joint rotator cuff tendons in combination with the injury of shoulder joint proximal capsule, dislocation of the right humerus head, and hypotrophy of the anterior portion of the deltoid muscle. We performed transposition of the latissimus dorsi tendon in combination with shoulder joint proximal capsule plasty with an autograft of the peroneal longus tendon. The check-up X-rays show that the dislocation of the right shoulder joint was eliminated. In the early postoperative period, the patient started physiotherapy exercises of the operated limb using abduction pillow. By the 7th day after surgery, the abduction of the operated limb reached 70°. The described surgical technique allows to restore congruence in the shoulder joint and the function of the injured limb in severe multiple injuries of the shoulder joint structures.

A Protocol of Pose Avoidance in Place of Hip Precautions After Posterior-Approach Total Hip Arthroplasty May Not Increase Risk of Post-operative Dislocation.

Post-operative rehabilitation after posterior-approach total hip arthroplasty (P-THA) includes the use of standard hip precautions, defined as no hip flexion beyond 90°, hip adduction, or hip internal rotation for 6 to 12weeks after surgery (sometimes for life). Since they were first implemented in the 1970s, subsequent advances may have made standard hipprecautions no longer necessary, although little evidence supports that hypothesis. A modified set of precautions, a "pose avoidance protocol," could be effective in enhancing recovery, but its effectiveness on early dislocation and post-surgical outcomes is not known. We sought to determine the functional recovery of patients on a pose avoidance protocol after P-THA according to levels of pain and patient satisfaction, rates of dislocation, the use of assistive devices, and a return to driving. We conducted a retrospective, descriptive study of data from a consecutive case series of 164 patients treated by a single surgeon between January 2014 and December 2015. Patients whohad undergone a primary uncemented P-THA were prescribed a pose avoidance protocol and followed for a minimum of 6weeks. Exclusion criteria were patients with congenital hip dysplasia, revision THA, femoral neck fracture, rheumatoid arthritis, or neuromuscular disease. Changes to the rehabilitation protocol included elimination of the requirements to use elevated chairs, raised toilet seats, and abduction pillows for sleeping. Patients couldresume driving at 2 and 3weeks for left and right P-THA, respectively. The only motion restriction was avoiding the combination of hip flexion past 90°, hip adduction, and hip internal rotation. Patients could perform all other movements and to bear weight and stop using walking aids as tolerated. Patients completed a biweekly questionnaire to assess their functional recovery, opioid use, and pain levels. At 2weeks after surgery, 80% of patients reported no pain, 86% did not require walking aids, and 92% were satisfied with their recovery. At 6weeks after surgery, 89% of patients reported no pain. Patients returned to driving at a mean of 2.7weeks after surgery. No patients had experienced a dislocation at 6weeks of follow-up. A pose avoidance rehabilitation protocol in this P-THA population was found to be safe and was associated with accelerated functional recovery and high patient satisfaction without increased risk of early post-operative dislocation.

Rotator Cuff Tear and its Challenges

Over a century after Codman’s description of Open rotator cuff repair and close to almost half a century after Neer enhanced the repair with a acromioplasty, we remain at crossroads on several aspects about rotator cuff repair. We still lack consensus and uniformity on issues ranging from acromioplasty, Single VS double row repairs, early or late rehab, Steroid injections utility before or after surgery, surgery for asymptomatic cuff tears, Surgery above 70 years age, Arthroscopy for partial cuff tears, grafts (either Xeno, allo or auto grafts) for irreparable cuff tears, Co-morbid factors such as smoking, obesity, Diabetes nor the use of sling, abduction pillow or brace or infusion catheters. Arthroscopic cuff repair is arguably the gold standard across the globe, with improved suture anchors, simplified instruments, better anesthesia, precision pumps and RF devices has led to a consistent, improved and lasting result.

Rotator Cuff Tear and its Challenges

Over a century after Codman’s description of Open rotator cuff repair and close to almost half a century after Neer enhanced the repair with a acromioplasty, we remain at crossroads on several aspects about rotator cuff repair. We still lack consensus and uniformity on issues ranging from acromioplasty, Single VS double row repairs, early or late rehab, Steroid injections utility before or after surgery, surgery for asymptomatic cuff tears, Surgery above 70 years age, Arthroscopy for partial cuff tears, grafts (either Xeno, allo or auto grafts) for irreparable cuff tears, Co-morbid factors such as smoking, obesity, Diabetes nor the use of sling, abduction pillow or brace or infusion catheters. Arthroscopic cuff repair is arguably the gold standard across the globe, with improved suture anchors, simplified instruments, better anesthesia, precision pumps and RF devices has led to a consistent, improved and lasting result.

No Functional Difference Between Three and Six Weeks of Immobilization After Arthroscopic Rotator Cuff Repair: A Prospective Randomized Controlled Non-Inferiority Trial

The aim of this study was to compare clinical and radiologic results among patients with 3 versus 6weeks of immobilization after arthroscopic rotator cuff (RC) repair in a prospective randomized controlled non-inferiority trial. One hundred twenty patients were included after RC surgery for a small- to medium-sized tear of supraspinatus and upper infraspinatus tendons. Group A was immobilized in a simple sling for 3weeks, and group B had a brace with a small abduction pillow with the arm in neutral position for 6weeks. All patients started active range of motion when they removed the sling/brace. One hundred eighteen (98%) patients were assessed at 1-year follow-up. They underwent magnetic resonance imaging (MRI) of the shoulder, filled out the Western Ontario Rotator Cuff (WORC) index, and were evaluated with a Constant Murley (CM) score. Statistical non-inferiority was demonstrated for the 2 groups on the basis of the WORC index, the primary endpoint at 1year. The objective for the non-inferiority test was to determine whether the expected mean WORC index for group A was at most 13% worse than standard treatment (Group B). The WORC index at 1year was similar in both groups, with mean percent scores of 83% in group A and 87% in group B (mean difference=-4; 95% one-sided CI-9,-4). Age-adjusted CM scores were also similar, with means of 86 in group A and 90 in group B (mean difference=-4; 95% CI-13, 5; P= .37). MRI after 1year showed 50 (89%) patients in each group with healed RC repair. Four patients in group A had complications: 1 acute postoperative infection, 2 cases of postoperative capsulitis treated with corticosteroid injections, and 1 repeat operation because of a loose anchor and subacromial pain. No patients in group B had complications. RC repair resulted in improved postoperative shoulder function, regardless of whether the shoulder was immobilized for 3 or 6weeks. Three weeks of postoperative immobilization with sling use was non-inferior to the commonly used regimen involving 6weeks of immobilization in a brace with regard to the WORC index at 12months' follow-up. MRI indicated similar degrees of healing between the groups. Based on these findings, it is safe to immobilize patients in a simple sling for 3 to 6weeks after repair of small to medium RC tears. Level I, high-quality randomized controlled trial with statistically significant differences.

Shoulder abduction diminishes self-reinforcement in transosseous-equivalent rotator cuff repair in both knotted and knotless techniques.

The self-reinforcement mechanism after double row suturebridge rotator cuff repair generates increasing compressive forces at the tendon footprint with increasing tendon load. Passive range of motion is usually allowed after rotator cuff repair. The mechanism of self-reinforcement could be adversely affected by shoulder abduction. Rotator cuff tears were created ex vivo in nine pairs of ovine shoulders. Two different repair techniques were used. One group was repaired using a double row 'suturebridge' construct with tied horizontal medial row mattress sutures (Knotted repair group). The other group was repaired identically except that medial row knots were not tied (Knotless repair group). Footprint compression was measured at varying amounts of abduction and under tendon loads of 0, 10, 20, 30, 40, 50 and 60N. The rate of increase of contact pressure (degree of self-reinforcement) was calculated for each abduction angle. Abduction diminishes footprint contact pressure in both knotted and knotless double row suturebridge constructs. Progressive abduction from 0 to 40 abduction in the knotless group and 0-30 in the knotted group results in a decrease in self-reinforcement. Abduction beyond this does not cause a further decrease in self-reinforcement. There was no difference in the rate of increase of footprint contact pressure at each angle of abduction when comparing the knotted and knotless groups. In the post-operative period, high tendon load combined with minimal abduction would be expected to generate the greatest amount of footprint compression which may improve tendon healing. Therefore, to maximize footprint compression the use of abduction pillows should be avoided while early isometric strengthening should be used.

Effects of Abduction Pillows on Rotator Cuff Repair: A Biomechanical Analysis.

After rotator cuff repair, some surgeons use abduction pillows to unload or protect the repair construct, while others do not. The aim of this study was to determine which type of sling-one with a small or large abduction pillow or one without a pillow-places the repaired rotator cuff in the best position to reduce tension on the supraspinatus. An X-ray study was performed on asymptomatic subjects to determine what position the shoulder is placed in when wearing a sling with or without an abduction pillow. Positions were then reproduced in human cadaveric shoulders using a custom-made testing jig, and tension on the repaired supraspinatus was measured. X-rays showed that abduction of the glenohumeral joint with a sling was only 4°, with a sling with a small pillow was 13°, and with a sling with a large abduction pillow was 25°. Placing the cadaveric shoulders in the position of a sling with a small abduction pillow caused a reduction in tension on the supraspinatus of 27% anteriorly and 55% posteriorly compared to placing the shoulder in the position of a sling without an abduction pillow; a large abduction pillow caused a further reduction in tension, of 42% anteriorly and 56% posteriorly. These findings show that abduction pillows reduce tension on the repaired supraspinatus tendon.

Arthroscopic Repair of Subscapularis Tendon Tears.

The subscapularis is the largest and strongest muscle of the rotator cuff, and it plays an essential role in global shoulder function. Beyond its primary function as an internal rotator, the subscapularis also acts to pull the humeral head posteriorly on the glenoid and is an important dynamic and static anterior stabilizer of the glenohumeral joint. In comparison with tears of the tendons of the rest of the rotator cuff, isolated tears of the subscapularis have a tendency for both early retraction and fatty infiltration. Consequently, full-thickness tears of the subscapularis tendon generally require surgical management. Arthroscopic suture-anchor repair allows anatomic reconstruction of the anterior aspect of the rotator cuff, with all of the benefits of arthroscopic surgery. The principal steps of this procedure include (1) verifying the subscapularis tear and identifying any concomitant lesions during diagnostic arthroscopy, (2) exposing the subscapularis tendon, (3) releasing tendon adhesions and so enabling anatomic reduction, (4) placing suture anchors at the anatomic subscapularis footprint on the lesser tuberosity and anatomically repairing the subscapularis tendon to its anatomic insertion, and (5) performing biceps tenodesis or tenotomy, if indicated. Postoperatively, patients with an isolated subscapularis tear are managed with immobilization in a sling for 6 weeks, while those with combined anterosuperior rotator cuff tears are managed with an abduction pillow. Arthroscopic subscapularis reconstruction provides a good structural repair, substantially restores shoulder mobility and strength, reduces pain, and results in high levels of patient satisfaction and return of shoulder function as measured by functional outcome scores.

Postoperative Rehabilitation After Rotator Cuff Repair: A Web-Based Survey of AANA and AOSSM Members.

Background:Postoperative rehabilitation after arthroscopic rotator cuff repair (ARCR) remains controversial and suffers from limited high-quality evidence. Therefore, appropriate use criteria must partially depend on expert opinion.Hypothesis/Purpose:The purpose of the study was to determine and report on the standard and modified rehabilitation protocols after ARCR used by member orthopaedic surgeons of the American Orthopaedic Society for Sports Medicine (AOSSM) and the Arthroscopy Association of North America (AANA). We hypothesized that there will exist a high degree of variability among rehabilitation protocols. We also predict that surgeons will be prescribing accelerated rehabilitation.Study Design:Cross-sectional study; Level of evidence, 4.Methods:A 29-question survey in English language was sent to all 3106 associate and active members of the AOSSM and the AANA. The questionnaire consisted of 4 categories: standard postoperative protocol, modification to postoperative rehabilitation, operative technique, and surgeon demographic data. Via email, the survey was sent on September 4, 2013.Results:The average response rate per question was 22.7%, representing an average of 704 total responses per question. The most common immobilization device was an abduction pillow sling with the arm in neutral or slight internal rotation (70%). Surgeons tended toward later unrestricted passive shoulder range of motion at 6 to 7 weeks (35%). Strengthening exercises were most commonly prescribed between 6 weeks and 3 months (56%). Unrestricted return to activities was most commonly allowed at 5 to 6 months. The majority of the respondents agreed that they would change their protocol based on differences expressed in this survey.Conclusion:There is tremendous variability in postoperative rehabilitation protocols after ARCR. Five of 10 questions regarding standard rehabilitation reached a consensus statement. Contrary to our hypothesis, there was a trend toward later mobilization.

Paper #11 - The effect of postoperative immobilization on clinical outcome and cuff integrity following arthroscopic rotator cuff repair: a prospective, randomized study of ultrasling vs. abduction pillow

Paper #11 - The effect of postoperative immobilization on clinical outcome and cuff integrity following arthroscopic rotator cuff repair: a prospective, randomized study of ultrasling vs. abduction pillow

Effect of glenohumeral abduction on supraspinatus repair tension

A pilot x-ray study was performed on three healthy subjects using a x-ray fluoroscopy InSight (Hologic, Inc. Bedford, MA, USA) in true anterior-posterior (AP) view, to determine what position the shoulder is placed in when wearing a sling only (Donjoy Ultrasling II (DJO, Normanhurst, NSW, Australia)), sling with small abduction pillow (Donjoy Ultrasling II (DJO)) and sling with large abduction pillow (ProCare Shoulder Abduction Kit (DJO)). Figure 1: AP view of a shoulder X-Ray

Use of an abduction pillow and re-tear rate at six months following arthroscopic rotator cuff repair

Introduction: The re-tear rate following rotator cuff repair is reported to be 11–94%. Slings are typically used to immobilize the shoulder following surgery however the benefits of using of an abduction pillow are unclear, with evidence for and against the use of the abduction pillow. The aim of this study was to determine if the use of an abduction pillow for six weeks following rotator cuff repair affected re-tear rate of rotator cuff repair at six months.

Traumatic bilateral posterior dislocation of the shoulder: a case report

Abstract Introduction. Bilateral posterior dislocation of the shoulder is a rare injury, accounted for about 2–5% of all shoulder dislocations. Main courses are electrical shock, epilepsy or extreme trauma with uncontrolled muscle forces. We report about a case of bilateral posterior shoulder dislocation without additional fractures but with a concomitant acromioclavicular joint dislocation. Case presentation. A 46-year-old Caucasian motorcyclist presented to our facility after a fall on slippery ground. He claimed pain in both shoulders with limited range of motion. The initial X-rays were inconclusive, clinical examination showed typical findings of a Rockwood injury with an additional limited external rotation so that a posterior shoulder dislocation was suspected. The CT scan confirmed the clinical suspicion. A closed reduction was performed followed by immobilization in a shoulder abduction pillow for 4 weeks and continuous physiotherapy. Upon follow up normal function with full range of motion was observed. Conclusion. A bilateral posterior shoulder dislocation can be caused by trauma and results in a limited range of motion with often additional injuries. Due to the unusually presentation the risk of missing the injury is increased. Therefore it is most important to consider this rare diagnosis and in case of clinical suspicion perform a careful algorithm of diagnostic.