Limitation of motion and shoulder disabilities in patients with cardiac implantable electronic devices

Abstract

The aim of this study is to investigate the presence of limitations in the shoulder range of motion (ROM) or the loss of upper extremity function on the affected side in patients with cardiac implantable electronic devices (CIEDs) with respect to the implantation time. Forty-nine patients (30 men and 19 women), mean age 64.84±11.18 years, who had been living with a CIED for less than 3 months were included in the short-term recipient (STR) group and 127 patients (85 men and 42 women), mean age 64.91±14.70 years, and with the device for longer than 3 months were included in the long-term recipients group. Shoulder ROMs were measured using a digital goniometer. The other arm was used as the control. The Constant-Murler Score, Shoulder Pain Disability Index, and Shoulder Disability Questionnaire were used to assess the functional status. Limitations of ROM for flexion, abduction, and internal rotation were found to be significantly lower in the arm on the side of CIED compared with the control arm. Significant differences in shoulder flexion, abduction, and external rotation in STRs were found compared with long-term recipient (P<0.05). However, the functional comparison of groups by the Constant-Murler Score was not significant. A low to moderate amount of shoulder disability measured by Shoulder Pain Disability Index and Shoulder Disability Questionnaire was found in patients with CIEDs, which was more prominent in STRs (P<0.05). Pain, association of CIED with pectoral muscles, a possible subtle ongoing capsular pathology, and avoidance behaviors of patients to minimize the risk of lead dislodgement might be related to restriction of motion and function in the shoulder joint in patients with CIEDs.

Fragility fracture of the fourth rib in a patient with a cardiac pacemaker: an uncommon case

“…Shoulder dysfunction due to pain or fear of dislocation is reported following CP implantation [7]. In our patient, CP implantation might have caused disuse of the left upper extremity, resulting in weakness of rotator cuff and shoulder girdle muscles including serratus anterior.…”

Predictors of shoulder limitations and disability in patients with cardiac implantable electronic devices: Importance of device size

“…18,19 Also, patients may extend this period of their own accord to avoid the risk of device malfunction. 20 The proximity of the CIED to the pectoral muscles and the restriction of arm movements due to anxiety about electrode movement limit the shoulder joint's range of motion (ROM). 12,20 Moreover, frozen shoulder syndrome and adhesive capsulitis may develop after the previous surgery, such as CIED implantation.…”

The effect on upper extremity functions of cardiac electronic device placement on the dominant hand side

“…7,8 Moreover, patients could self-restrict the arm movements and arm-related daily activities to a further degree or for a longer duration to avoid the risk of device malfunction or to decrease pain. 9 However, prolonged immobilization or restriction of the arm movements have been associated with the development of shoulder problems such as adhesive capsulitis. 10 The implantation of ICD to the left pectoral is the conventional normal practice owing to lower defibrillation thresholds, but the right pectoral may be required for pathological reasons such as thrombosis and infection on the left side.…”

“…Although there are studies that have assessed upper extremity dysfunctions of patients with CIED, shoulder-related problems and the relationship to the side of the device has not been studied in literature to date. 3,9 The aim of this study was to determine the possible effects of the preference of the dominant side for CIED implantation on the ipsilateral superior extremity functions.…”