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Effects of neuromuscular electrical muscle stimulation on the deltoid for shoulder function restoration after reverse total shoulder arthroplasty in the early recovery period: a prospective randomized study

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Neuromuscular electrical stimulation (NMES) is a treatment modality that has been used to accelerate the rehabilitation of patients with neurological damage. However, it is unclear whether NMES of the deltoid can lead to the early restoration of shoulder function after reverse total shoulder arthroplasty (RSA).

Materials and methods

In this prospective and randomized study, 88 patients who underwent RSA with the same prosthesis design for cuff tear arthropathy or irreparable rotator cuff tear were assessed. The patients were divided into two groups (NMES group and non-NMES group, 44 patients each). For the NMES group, two pads of the NMES device were placed over the middle and posterior deltoid area, and NMES was maintained for 1 month after surgery. Shoulder functional outcomes and deltoid thickness were compared at 3, 6, and 12 months postoperatively. Shoulder functional outcomes were assessed based on the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES), and Constant scores and the range of motion (ROM) and power of the affected shoulder. The thickness of the anterior, middle, and posterior deltoid was measured by ultrasonography.

Results

A total of 76 patients (NMES group, 33 patients; non-NMES group, 43 patients) were enrolled in the final analysis. The preoperative demographics and status of the remaining rotator cuff of both groups were not significantly different. At postoperative 3 months, the ROM and power of external rotation of the NMES group were significantly greater than those of the non-NMES group (ROM, 36° ± 14° vs. 29° ± 12°; P = .003; power, 4.8 kg ± 1.8 kg vs. 3.8 kg ± 1.0 kg; P < .002). The ROM of external rotation of the NMES group at postoperative 6 months was also greater than that of the non-NMES group (41° ± 12° vs. 34° ± 11°; P = .013). However, there was no significant difference in the VAS, ASES, and Constant scores at all follow-up points despite gradual improvements until 1 year postoperatively. Serial measurements of the thickness of the anterior, middle, and posterior deltoid of both groups did not show significant differences.

Conclusions

Postoperative NMES of the deltoid after RSA contributed to significantly faster ROM restoration and considerable improvement in the power of external rotation. Therefore, NMES following RSA could lead to the early restoration of external rotation and recovery of deltoid function.

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Acknowledgments

The authors thank Sang-Hyun Lee MD (Department of Orthopaedic Surgery, Ewha Shoulder Disease Center, Seoul Hospital, Ewha Womans University School of Medicine) and Hyung-Min Lee MD (Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University, College of Medicine) for data collection and analysis.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Republic of Korea

    Jae-Hoo Lee

  2. Department of Orthopaedic Surgery, College of Medicine, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University, Seoul, Republic of Korea

    Yong-Min Chun

  3. Department of Orthopaedic Surgery, Wonju College of Medicine, Wonju Severance Christian Hospital, Yonsei University, Wonju, Republic of Korea

    Doo-Sup Kim

  4. Department of Orthopaedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea

    Doo-Hyung Lee

  5. Department of Orthopaedic Surgery, Ewha Shoulder Disease Center, Seoul Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea

    Sang-Jin Shin

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Correspondence to Sang-Jin Shin.

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The authors declare that they have no conflict of interest.

Ethical approval

This study has been conducted with the approval of Institutional Review Board from Ewha Womans University Seoul Hospital (SEUMC 2019-10-029), Severance Hospital (1-2018-0067), Wonju Severance Christian Hospital (CR218005) and Ajou University Hospital (AJIRB-MED-THE-18-414).

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Informed consent was obtained from all individual participants included in the study.

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Lee, JH., Chun, YM., Kim, DS. et al. Effects of neuromuscular electrical muscle stimulation on the deltoid for shoulder function restoration after reverse total shoulder arthroplasty in the early recovery period: a prospective randomized study. Arch Orthop Trauma Surg 143, 3037–3046 (2023). https://doi.org/10.1007/s00402-022-04515-0

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