Triangular Forearm Support in Rotator Cuff Syndrome – A Randomized Controlled Crossover Trial with Kinesiological Analysis

Background: Surgery for rotator cuff syndrome (RCS) is painful and expensive with 3 months rehabilitation thereafter. Physical therapy has short-term success, but no longer-term studies confirm its permanence. We report the efficacy, safety and mechanism of triangular forearm support (TFS) at a wall, to reduce pain and improve active range of motion in MRI-confirmed RCS. Noteworthy is that several, or even a single repetition of the maneuver gives long term benefits in many cases. Methods: This single-visit randomized controlled crossover trial with intervention group (IG) doing TFS and placebo (CG) group patients had 3 self-rated visual analogue scale (VAS) ratings before performing intervention or sham maneuvers. IG: n = 80; mean age 65.3 and CG: n = 87; mean age 63.8. Difference in age: t = - 0.14854; p = 0.8821; df = 165. Groups held TFS or placebo for 45 seconds, then rated pain in maximal abduction and flexion immediately three times. CG patients then immediately crossed over and performed TFS and underwent three trials of abduction and flexion after doing TFS, as above. Results: averaged each set of 3 trials and summed each case’s change before comparing IC and CG. We took the mean of the differences, not the differences of the means. Abduction: mean immediate post-TFS and post-sham VAS dropped 1.98 and 1.08 points from 6.14 and 5.03 respectively or 32.3% vs. 21%, respectively (p = 0.004). Flexion: baseline IG and CG values: 5.13 and 4.57 immediately dropped 1.08 and .93, 32% and 20.4% lower, respectively (p =.002); (CI: - 0.0317 - 0.0317). Mean 52-month telephone, email or Internet follow-up: Abduction and flexion VAS improvement from initial VAS: 3.2 points (95% CI: 0.13 to 1.71), p = 0.001 and 3.04 points (95% CI 0.54 - 1.73), p <0.001) respectively. VAS values for abduction and flexion were 67.6% and 74.5% below VAS values at study onset. Full abduction/flexion ranges of motion were reported by 31/54 and 32/54 patients. Since follow-up was done remotely, goniometric measurement was impossible. Conclusion: Standing TFS may improve abduction and flexion ROM and reduce pain in RCS.