Cosgun, Muharrem Said; Cosgun, Cansu

Background: Device-related shoulder impairment is a common complication in cardiac implantable electronic device (CIED) recipients. This study examined the relationship between the extent of device displacement toward the shoulder while in the supine position and ipsilateral shoulder impairment. Methods: This cross-sectional study included 142 consecutive patients with CIEDs. The effects of the extent of device displacement on functional limitations, muscle strength, pain–disability, and quality of life were evaluated. Range of motion (ROM), grip strength (GS), the Shoulder Pain and Disability Index (SPADI), and the 36-item Short-Form (SF-36) Health Survey were used. Results: The mean device displacement was greater in patients with than without device-related shoulder impairment (51 ± 19 vs. 38 ± 15 mm; p <.001). Female gender (p =.046), high body mass index (p =.008), and defibrillator implantation (p =.004) were significantly more frequent in patients with than without impairment. Patients with excessive device displacement had significantly higher ROM limitation rates (p =.003) and SPADI scores (p =.02) and significantly lower GS (p =.04) and SF-36 scores (p =.032). Defibrillator implantation (OR: 2.569, 95% CI: 1.216–4.681; p =.03) and the extent of device displacement (OR: 1.502, 95% CI: 1.186–1.852; p =.01) were independent predictors of shoulder impairment. Conclusions: Excessive displacement of the device toward the shoulder while in the supine position causes shoulder impairment by contacting more muscle fibers. Obese female patients with defibrillators have the highest risk.

Cosgun, Muharrem Said; Cosgun, Cansu

Background: Shoulder impairment on the implant side is common after cardiac implantable electronic device (CIED) implantation. The aim of this study was to compare the efficacy and safety of the pendulum exercise (PE) and stretching and strengthening exercises (SSE) in preventing postimplantation shoulder impairment. Methods: This prospective, randomized study collected data from 89 patients, including 30 in a control group, 31 in a PE group, and 28 in an SSE group. Shoulder functions on the implant side were evaluated by grip strength (GS), range of motion (ROM), Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and 36-Item Short-Form Survey (SF-36). Results: Shoulder median flexion and abduction ROM were significantly improved 2-month postimplantation compared to two-week postimplantation in PE (156 ± 11 vs. 146 ± 10, p =.002; 147 ± 9 vs. 136 ± 9, p =.001, respectively) and SSE (158 ± 13 vs. 147 ± 11, p =.003; 149 ± 13 vs. 138 ± 9, p =.002, respectively) groups, but not in the control group. Two months after implantation, the two exercise groups showed no significant differences in any assessment. Compared with the PE and SSE groups, the control group had significantly lower GS (p =.012 and p =.002, respectively) and SF-36 physical component summary (p =.007 and p =.003, respectively) and significantly higher VAS (p =.003 and p =.001, respectively) and QuickDASH (p =.002 and p =.005, respectively) scores 2-month postimplantation. Conclusions: PE and SSE for the ipsilateral upper arm starting two-week after CIED implantation provided similar benefits in preserving shoulder girdle muscle strength, maintaining shoulder motion, relieving shoulder pain, preventing shoulder injury, and improving quality of life, without the risk of lead dislodgement.

Cosgun, Muharrem Said; Cosgun, Cansu

Background: Generator-induced shoulder impairment is a common complication of cardiac implantable electronic device (CIED) implantation. Although implantable cardioverter–defibrillators (ICDs) have become smaller in size, they are still bigger than pacemakers (PMs). This study aimed to investigate the effects of single-chamber PM and ICD sizes on shoulder function. Methods: This retrospective study included 200 consecutive patients, of whom 123 had PMs and 77 had ICDs. The CIED implantation effects on shoulder function, pain, disability, and quality of life (QoL) were evaluated. The range of motion (ROM), Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and Short Form-36 (SF-36) Health Survey (Physical and Mental Component Summary [PCS and MCS]) were used. Results: The flexion and abduction range limitation rates were significantly higher in the ICD group than in the PM group (16.9% vs. 7.3%, p =.035 and 19.5% vs. 8.9%, p =.031, respectively). The two groups had similar VAS scores. The median QuickDASH score was significantly higher in the ICD group than in the PM group (8.2 [3.6–19.6] vs. 4.6 [2.6–17.9], p =.034). There were no significant differences in SF-36 components between the two groups. ICD implantation (OR: 1.642, 95% CI: 1.293–2.776; p =.001) and incision length (OR: 1.343, 95% CI: 1.194–2.064; p =.01) were independent predictors of shoulder ROM limitations. Conclusions: Reduced device sizes with advancing technology can decrease shoulder functional limitations and disability after implantation. Healthcare professionals should not neglect shoulder evaluations during the pre- and postimplantation periods.