title: A comparison of shoulder pressure among different patient stabilization techniques.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the pressure placed on the shoulders as a function of varying degrees of head-down tilt (the Trendelenburg position) and to compare these pressures among 3 different patient-positioning systems.
  
  
  METHODS
  Participants were placed in the dorsal-lithotomy position with arms tucked and tilted at 5, 10, 15, 20, 25, and 30 degrees of head-down tilt. Using a manometer, we measured the pressure (centimeters of water) on the shoulders at each angle for 3 support devices: the Skytron shoulder support (Skytron, Grand Rapids, MI), the Allen shoulder support (Allen Medical Systems, Acton, MA), and the Allen Hug-u-Vac.
  
  
  RESULTS
  Among 23 participants, body mass index (mean ± SD) was 24.5 ± 4.3 kg/m(2). As the tilt angle increased, so did the shoulder pressure for all support systems. At a 30-degree Trendelenburg position, the Allen Hug-u-Vac transmitted less pressure to the shoulders than the Skytron (right and left, P < .001) and the Allen shoulder supports system (right, P < .001; left, P = .434). Each participant was asked, "Which system was most comfortable?" Seventy-four percent of the participants reported that they preferred the Hug-u-Vac (P < .001).
  
  
  CONCLUSIONS
  Shoulder pressure increases as tilt angle increases. Of the 3 support systems that were tested, the Allen Hug-u-Vac transmitted less pressure to the shoulders at a 30-degree Trendelenburg position than the Skytron and the Allen shoulder support systems.
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT. Electronic address: bsuozzi@harthosp.org.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Suozzi
authors.forename: Hema D
authors.initials: HD
authors.lastname: Brazell
authors.forename: David M
authors.initials: DM
authors.lastname: O'Sullivan
authors.forename: Paul K
authors.initials: PK
authors.lastname: Tulikangas
mesh_terms: D001917:Brachial Plexus / Q000293:injuries; D020516:Brachial Plexus Neuropathies / Q000517:prevention & control; D005260:Female; D018475:Head-Down Tilt / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D056888:Patient Positioning / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D011312:Pressure / Q000009:adverse effects*; D011446:Prospective Studies; D012782:Shoulder; D016683:Supine Position
keywords: Trendelenburg position; brachial plexus injury; dorsal lithotomy; patient positioning device; shoulder pressure