External rotation shoulder braces vary in ability to achieve, maintain joint position

Investigators saw significant differences in external rotation between braces tested after initial fitting, simulated daily activities and after reapplication.

Commercially available shoulder braces vary significantly in their abilities to achieve and maintain desired external rotation, according to a study by University of Michigan researchers.

Of four braces studied, none actually achieved the anticipated extent of external rotation and all lost the amount of rotation achieved after participants performed simulated activities of daily living, the authors reported.

Lawrence G. Sullivan, MD, and colleagues at the university evaluated the ability of four shoulder braces to achieve and maintain external rotation, including the dj Ultrasling ER [dj Orthopaedics] with a 15° wedge, the EBI Sports Medicine Shoulder System Brace [EBI], the dj Gunslinger Brace [dj Orthopaedics] and the USMC Gunslinger II Brace [USMC].

The study included 12 healthy subjects with no previous shoulder injuries or surgery. A physician applied each brace to the dominant arm of each participant. Investigators then measured the degree of external rotation achieved after being fitted, after each participant performed simulated activities of daily living and after each participant removed and reapplied each brace on their own without the aid of a physician.

The researchers found that the dj Gunslinger brace achieved the greatest amount of initial external rotation, which averaged 21.5°. However, mean external rotation decreased to 14° after performing simulated daily living activities and to 11.5° after brace reapplication, according to the study, published in Arthroscopy.

Initial external rotation averaged 20.25° for the USMC Gunslinger brace, which decreased to 16.5° after simulated daily living activities and to 19.92° after brace reapplication.

For the dj Ultrasling ER, external rotation initially averaged 9° and decreased to 7° after simulated daily living activities and to 6.7° after reapplication.

The EBI brace had the least consistent performance, the researchers noted. The EBI brace initially achieved 4.92° of external rotation, which decreased to 1.75° after simulated daily living activities and to 5.5° after reapplication, according to the study.

The differences in external rotation between braces after initial fitting, simulated daily living activities and after reapplication were statistically significant, they noted.

The researchers also evaluated how comfortable each participant rated each brace using a 5-point scale. They found significant differences in comfort between braces, with the dj Ultrasling ER considered most comfortable, followed by the USMC Gunslinger II, the dj Gunslinger and the EBI brace, according to the study.

"As expected, the rigid braces were most successful in achieving and maintaining the desired position of external rotation. Similarly, as expected, one of the soft cushion braces was rated as the most comfortable," the authors wrote.

"Because it is reasonable to assume that comfort would be an important factor in patient compliance, the surgeon must select a device based on each individual clinical scenario. This decision should acknowledge the trade-off between brace performance and brace comfort," they said.

For more information:
Sullivan LG, Bailie R, Weiss N, Miller BS. An evaluation of shoulder external rotation braces. Arthroscopy. 2007;23:129-134.