Effects of neuromuscular electrical muscle stimulation on the deltoid for shoulder function restoration after reverse total shoulder arthroplasty in the early recovery period: a prospective randomized study

Abstract

Introduction: Neuromuscular electrical stimulation (NMES) is a treatment modality that has been used to accelerate the rehabilitation of patients with neurological damage. However, it is unclear whether NMES of the deltoid can lead to the early restoration of shoulder function after reverse total shoulder arthroplasty (RSA). Materials and methods: In this prospective and randomized study, 88 patients who underwent RSA with the same prosthesis design for cuff tear arthropathy or irreparable rotator cuff tear were assessed. The patients were divided into two groups (NMES group and non-NMES group, 44 patients each). For the NMES group, two pads of the NMES device were placed over the middle and posterior deltoid area, and NMES was maintained for 1 month after surgery. Shoulder functional outcomes and deltoid thickness were compared at 3, 6, and 12 months postoperatively. Shoulder functional outcomes were assessed based on the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES), and Constant scores and the range of motion (ROM) and power of the affected shoulder. The thickness of the anterior, middle, and posterior deltoid was measured by ultrasonography. Results: A total of 76 patients (NMES group, 33 patients; non-NMES group, 43 patients) were enrolled in the final analysis. The preoperative demographics and status of the remaining rotator cuff of both groups were not significantly different. At postoperative 3 months, the ROM and power of external rotation of the NMES group were significantly greater than those of the non-NMES group (ROM, 36° ± 14° vs. 29° ± 12°; P =.003; power, 4.8 kg ± 1.8 kg vs. 3.8 kg ± 1.0 kg; P <.002). The ROM of external rotation of the NMES group at postoperative 6 months was also greater than that of the non-NMES group (41° ± 12° vs. 34° ± 11°; P =.013). However, there was no significant difference in the VAS, ASES, and Constant scores at all follow-up points despite gradual improvements until 1 year postoperatively. Serial measurements of the thickness of the anterior, middle, and posterior deltoid of both groups did not show significant differences. Conclusions: Postoperative NMES of the deltoid after RSA contributed to significantly faster ROM restoration and considerable improvement in the power of external rotation. Therefore, NMES following RSA could lead to the early restoration of external rotation and recovery of deltoid function.