title: How does external rotation bracing influence motion and functional scores after arthroscopic shoulder stabilization?
abstract: BACKGROUND
  After arthroscopic shoulder stabilization, the loss of motion or delayed recovery of motion remains a clinical problem and may lead to poor patient satisfaction. There remains no consensus regarding the optimal position for postoperative immobilization and it is not known whether the position for shoulder immobilization has an effect on motion and functional recovery.
  
  
  OBJECTIVE
  We asked: (1) Do patients treated with external rotation (ER) bracing after arthroscopic anterior shoulder stabilization reliably regain ROM and shoulder function? And (2) what is the frequency of recurrent instability and brace-related complications associated with the use of ER bracing?
  
  
  METHODS
  Forty consecutive patients with a primary diagnosis of anterior shoulder instability underwent arthroscopic stabilization and received postoperative ER bracing; 33 patients (83%; mean age, 23 years; range, 13-44 years) were followed for at least 1 year postoperatively and seven patients were lost to followup. Shoulder ROM and functional scores were recorded preoperatively and at 2 weeks, 12 weeks, 6 months, and greater than 1 year (mean, 16 months) after surgery.
  
  
  RESULTS
  All patients recovered their preoperative ROM and most patients achieved normal ROM by 3 months after surgery. Significant improvements in American Shoulder and Elbow Surgeons (ASES) and Western Ontario Shoulder Instability (WOSI) scores were observed at each postoperative time point. The mean (± SD) final scores were 95 ± 9 for the ASES and 87% ± 17% for the WOSI (p < 0.001 compared to preoperative scores). One patient (3%) developed recurrent instability. No patients underwent reoperation for the injured shoulder for any reason during the followup period.
  
  
  CONCLUSIONS
  ER bracing after arthroscopic shoulder stabilization is associated with a predictable recovery of ROM and functional score improvement. Future studies comparing ER bracing to traditional sling use should be conducted to determine the optimal method of postoperative immobilization.
  
  
  METHODS
  Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedic Surgery, Columbia University Medical Center, 622 West 168 Street, PH11-Center, New York, NY, 10032, USA.
authors.forename: Bob
authors.initials: B
authors.lastname: Yin
authors.forename: David
authors.initials: D
authors.lastname: Levy
authors.forename: Molly
authors.initials: M
authors.lastname: Meadows
authors.forename: Todd
authors.initials: T
authors.lastname: Moen
authors.forename: Prakash
authors.initials: P
authors.lastname: Gorroochurn
authors.forename: Edwin R
authors.initials: ER
authors.lastname: Cadet
authors.forename: William N
authors.initials: WN
authors.lastname: Levine
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ahmad
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000009:adverse effects; D001696:Biomechanical Phenomena; D001915:Braces; D005260:Female; D006801:Humans; D007103:Immobilization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D007593:Joint Instability / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D017060:Patient Satisfaction; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012008:Recurrence; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult