A recent study in the Journal of Shoulder and Elbow Surgery compared outcomes of patients who had rotator cuff surgery based on how faithful they were with wearing their sling.
They asked 50 patients undergoing rotator cuff repair to wear an abduction sling for the first six weeks after surgery and report their level of compliance with these orders. Eighty-eight percent of the patients reported wearing the sling full time as instructed.
They were not able to discern any major differences in clinical outcome based on patients who wore the sling as instructed versus those that did not. There are a few issues with this study that may limit how far you can practically use these findings.
- The study likely did not have enough patients to draw a meaningful conclusion. If only 12% of patients did NOT wear their sling then you have a very small number (6) to compare to the group that DID wear the sling (44).
- Compliance was gauged by questioning the patients. Other studies have shown that patients often overestimate their own compliance with treatments. In the future perhaps sensor technology could aid in determining whether a sling is being worn full time or not. For instance a temperature sensor on the sling may sense when the sling is close to the body and give a more accurate measure of time in the sling.
Take-home points for surgeons: it’s probably not ethical to do a study in which we repair rotator cuffs and then give half of patients a sling and half no sling as we do not have clinical equipoise. A different way of designing this study is necessary and sensor technology may be one way of doing it. Also larger numbers are probably needed to draw better conclusions.
Take-home point for patients: sorry, you still need to wear a sling after rotator cuff repair surgery.
Remember though, that there is a difference between rotator cuff repair and debridement. Repair is a more involved procedure that necessitates some immobilization of the shoulder after the surgery. Debridement is a “clean-out” in which rough edges of tissue are smoothed. You typically do NOT have to wear a sling for as long a period of time as for rotator cuff repair if you just have a debridement, acromioplasty, distal clavicle excision or bicep tenotomy procedure.