Summary

During the “balloon dip” phase, the perceived ability to lift 10-lbs above shoulder level, to reach a high shelf, and to do usual work activities were the most impaired tasks.

Abstract

Objective

Subacromial balloon spacer implantation (SBSI) attempts to decrease glenohumeral joint (GHJ) pain and improve function in patients with an irreparable rotator cuff tear (RCT) and minimal osteoarthritis. A previous study found that gradual implant resorption from 12-26 weeks post-SBSI may create a “balloon dip” that decreases GHJ function and increases pain. This retrospective cohort study attempted to delineate shoulder function, active mobility, strength, pain, and specific functional task impairment during this “balloon dip” period in relation to five key rehabilitation phases: Phase I (early pain control ≤ 3 weeks post-SBSI), Phase II (early rehabilitation > 3-11 weeks post-SBSI), Phase III (advanced rehabilitation-early balloon resorption > 11-16 weeks post-SBSI), Phase IV (early strength training > 16-24 weeks post-SBSI), and Phase V (advanced strength training >24 weeks post-SBSI).

Materials And Methods

Sixty-five consecutive patients (55.9 ± 7 years of age, 42 men) with an irreparable RCT underwent arthroscopic SBSI by a fellowship-trained shoulder surgeon. Outcome measurements collected pre-SBSI and during Phase I-V included the American Shoulder and Elbow Society (ASES) score for perceived bilateral shoulder function, visual analog scale (VAS) surgical shoulder pain score, active mobility and shoulder manual muscle strength testing (p ≤ 0.05).

Results

Mean final follow-up time was 40 weeks post-SBSI (range = 24.1 to 89.7 weeks). The surgical shoulder had higher ASES scores at Phase V than pre-SBSI. Surgical shoulder pain was less during Phase V than pre-SBSI. The surgical shoulder had greater flexion during Phase V than at Phase II or pre-SBSI, and greater external rotation (adducted) during Phases III-V than pre-SBSI. Peak shoulder internal rotation to level 12 (tip of extended thumb level with thoracic vertebra #10 spinous process) occurred during Phase V. Peak shoulder flexor, external rotator and internal rotator strength occurred during Phase V. During Phase I, most patients were unable to sleep on their surgical shoulder, wash their back/do up their bra, reach a high shelf, or lift 10-lbs overhead. Specific impaired functional tasks during the “balloon dip” period (between Phase III and V) were lifting 10-lbs overhead, reaching a high shelf, and doing normal work. By the end of Phase V, however, most patients could perform all tasks with minimal or no difficulty.

Conclusion

Over the entire study, surgical shoulder function improved and pain decreased, however, during the “balloon dip” period the perceived ability to lift 10-lbs above shoulder level, to reach a high shelf, and to do usual work activities were the most impaired tasks. This information defines the “balloon dip” period providing the surgical and rehabilitation teams with the information needed to target these impairments and better counsel patients.