Original Research Article
Year: 2019 | Month: March | Volume: 9 | Issue: 3 | Pages: 99-104
Shoulder Joint Dysfunction in Patients with Cardiac Device Implantation
Garima Yadav1, Mariya Prakash Jiandani2, Amita Mehta3, Ashish Nabar4
1Post Graduate Student, Physiotherapy School & Centre, Seth GSMC & KEMH, Mumbai
2Associate Professor, Physiotherapy School & Centre, Seth GSMC & KEMH, Mumbai
3Professor & Head, Physiotherapy School & Centre, Seth GSMC & KEMH, Mumbai
4Associate Professor, Department of Cardiology, Seth GSMC & KEMH, Mumbai
Corresponding Author: Mariya Prakash Jiandani
Background: Fear associated with dislodgement or fracture of pacemaker lead is common following cardiac device implantation, hence immobilization of the upper extremity of the site of device implantation is advised. It has been an observation that these patients eventually have shoulder dysfunction. This study aimed to assess the dysfunction of shoulder joint in patients following cardiac device implantation with respect to range and scapular posture and measure the disability associated with it at two weeks and four weeks post implantation.
Method: It was a prospective observational study where 72 patients of either sex in the age group of 20-80 yrs who were admitted for cardiac device implantation for the first time, at a tertiary care hospital of Mumbai were enrolled. Patients with pre-existing shoulder complex dysfunction or not willing to participate in evaluation and refused to provide consent were excluded from the study. After recording of demographic details patients were asked to fill self-reported questionnaire to evaluate Shoulder Pain and Disability Index score (SPADI Score). Shoulder joint range of motion was measured using a universal goniometer. Scapular posture was measured at three levels in centimetres using a measuring tape. Measurements were recorded pre implantation, at 2 weeks and 4 weeks post implantation.
Statistical analysis was done using SPSS version 16.0. Friedman Anova test was applied for SPADI score, repeated measure Anova test was applied for the Shoulder range of motion and Scapula posture.
Results: A highly significant reduction in all the ranges of Shoulder joint (p<0.05) was observed at the end of 2 weeks. A trend towards significant gain in range of motion was seen at the end of 4 weeks however the ranges did not reach baseline levels. A greater reduction was observed in external rotation, abduction and extension range at the shoulder joint. Similarly scapula posture was altered at all 3 levels (p< 0.05) post 2 week of implantation of cardiac devices, it returned to baseline at end of 4 weeks. On evaluation of SPADI an increased disability was seen with score of pain and disability (p<0.05) post 2 week of implantation of cardiac devices with a reduction in SPADI score indicating improvement at the end of 4 weeks.
Conclusion: A significant dysfunction is observed in shoulder range of motion along with altered scapular posture at the end of two weeks post implantation. This resulted in increase in disability index as measured on SPADI. A trend was observed towards improvement in ranges and reduced disability at the end of 4 weeks however it did not return to baseline values.
Key words: Shoulder dysfunction, Pain, Range of motion, Implanted cardiac devices