Preventing shoulder pain after cardiac rhythm management device implantation: a randomized, controlled study.
BACKGROUND
Shoulder pain and disability ipsilateral to the implant site is a common complication of cardiac rhythm device implantation, yet very little has been published about this morbidity. We designed a study to assess the potential benefit of a simple exercise protocol in preventing shoulder pain postoperatively.


RESULTS
Patients undergoing subcutaneous device implantation were randomized to one of two groups. The control group received standard instructions, whereas the exercise group was instructed on specific exercises aimed at strengthening or stretching the shoulder girdle, to be completed 3 days per week. Groups were postoperatively monitored for the development of shoulder discomfort and shoulder impingement by using physical examination and disability questionnaires. At 1 month, seven of 21 control patients reported developing shoulder pain or discomfort compared to one of 23 in the exercise group (P = 0.02). At 6 months, four of 23 control patients still reported worsening shoulder symptoms, compared to none in the exercise group (P = 0.11). In the control group, five of 19 patients developed a positive impingement test at 1 month, versus none in the exercise group (P = 0.01). Scores for the questionnaires designed to assess shoulder pain and dysfunction were worse in the control group. There were no activity-related complications in either group.


CONCLUSIONS
Shoulder pain and disability occurs often following cardiac rhythm management device implantation. A simple exercise program aimed at strengthening the shoulder girdle is effective at preventing this complication.
Department of Internal Medicine (Cardiology, Clinical Cardiac Electrophysiology), University of Texas Southwestern Medical Center, Dallas, Texas 75390-8837, USA.
James D
JD
Daniels
Shining
S
Sun
Jason
J
Zafereo
Abu
A
Minhajuddin
Carol
C
Nguyen
Owen
O
Obel
Richard
R
Wu
Jose A
JA
Joglar
D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000009:adverse effects*; D020069:Shoulder Pain / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control* / Q000534:rehabilitation; D016896:Treatment Outcome