Sling or no sling after rotator cuff surgery? #rotatorcuff #aaos

Do you need a sling after rotator cuff surgery? Many shoulder surgeons, myself included, commonly have patients wear slings for a limited time after rotator cuff surgery. A recent study presented at the American Academy of Orthopedic Surgeons Annual Meeting titled Postoperative Mobilization after Rotator Cuff Repair: Sling versus Nothing: A Randomized Prospective Study by A Laedermann et al. looked into whether this practice improved outcomes in patients.

80 patients with a supraspinatus (top rotator cuff tendon) tear less than 3cm and scheduled for arthroscopic repair were placed in two groups:  4-week sling immobilization or no sling use after surgery. Below is the a summary of the findings:

Pros for no sling:

better shoulder motion at 6 weeks and 3 months.

Better pain at 6 months 

Cons for no sling:

None noted, specifically, no higher rate of re-tear at 6 months on ultrasound.

My take home points from the study are:

Based on this study, there does not seem to be a benefit in the use of a sling for small, isolated rotator cuff repairs.  What I have noticed in practice, however, is that slings do help discourage patients from using their arm too early.  No sling does not mean the patient can begin moving their arm immediately.  Patients still are restricted from any active shoulder range of motion after surgery for up to 12 weeks to allow for full tendon healing.  My full rotator cuff rehabilitation protocol is given here.  The bottom line is that I believe that no sling is acceptable in patients that feel comfortable with not using the arm, but may continue to be a benefit in some patients.