Is a sling necessary for immobilization after rotator cuff repair?
Probably not, according to a new study from Switzerland: Researchers found that for patients with small- to medium-sized rotator cuff tears repaired arthroscopically, not wearing a sling – and engaging in early motion of the shoulder after surgery – leads to less pain and better shoulder function at 6 months after surgery.
The findings of the study by Tirefort et al, published in The Journal of Bone & Joint Surgery, are consistent with the recent trend toward early-motion rehabilitation programs after rotator cuff surgery, rather than 4 to 6 weeks of immobilization.
The study included 80 patients undergoing arthroscopic surgery to repair a rotator cuff tear of 3 cm or less at a single hospital in Switzerland. Patients were divided into 2 groups:
- Sling for the first 4 weeks after surgery, with no active shoulder motion permitted (n=40)
- No sling after rotator cuff repair (n=40)
Both groups performed passive mobilization for 4 weeks after surgery, followed by progressive active mobilization and exercises.
Ten days after surgery, pain scores were similar between groups (5.2 for both groups). One-and-a-half months after surgery, patients who did not wear a sling had increased shoulder motion, including external rotation and active elevation. Both groups showed continued improvement at 3 months, but shoulder elevation remained greater in the no-sling group. By 6 months, measures of shoulder movement were similar between groups.
Ultrasound examinations performed at 6 months showed no significant differences between the sling and no-sling groups, including the integrity of the rotator cuff repair. 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% of normal on the Single Assessment Numeric Evaluation (SANE) scale, compared with 79% in the sling group. Six-month pain scores were also lower for patients who didn’t wear a sling: 0.8 versus 1.5. Wearing a sling was significantly associated with higher pain scores, even after adjustment for other factors.
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 randomized study by Tirefort et al 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 in the first 6 months after surgery. “Postoperative mobilization with a sling may therefore not be required for patients treated for a small or medium tear,” the authors conclude. They note that their findings corroborate the results of other recent studies reporting the benefits of early-motion rehabilitation protocols.
Tirefort J, Schwitzguebel Aj, Collin P, Nowak A, Plomb-Holmes C, Lädermann A. Postoperative mobilization after superior rotator cuff repair: sling versus no sling: a randomized prospective study. J Bone Joint Surg Am. 2019 Mar 20;101(6):494-503. doi: 10.2106/JBJS.18.00773.