No benefit of compressive cryotherapy vs ice for managing pain after shoulder arthroscopy

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: 2
Dr. Matthew J. Kraeutler discusses the use of compressive cryotherapy versus ice following shoulder arthroscopy
57 patients were randomized to receive either compressive cryotherapy or cryotherapy alone in this randomized study. The purpose was to determine if compressive cryotherapy reduced pain and analgesic consumption compared to a standard ice wrap over the first week after shoulder arthroscopy for rotator cuff repair or subacromial decompression. Results indicated no Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Industry funded
Sponsor: CoolSystems, Inc
Conflicts: None disclosed
Why was this study needed now?
Postoperative analgesia remains crucial following rotator cuff repair and subacromial decompression. Both cryotherapy and compression have traditionally been used in soft tissue injury to reduce pain and swelling. The combination of the two, compressive cryotherapy (CC), has been shown to be effective compared to an absence of cryotherapy, though it is unknown whether compression presents significant advantages over cryotherapy alone in the management of these patients postoperatively.
What was the principal research question?
In the first postoperative week following arthroscopic rotator cuff repair or sumbacromial decompression, does compressive cryotherapy reduce pain and analgesic consumption as compared to cryotherapy (ice) alone?
Population: 57 patients (aged 18-75) undergoing unilateral rotator cuff repair or subacromial decompression. Patients were instructed to apply their cryotherapy treatment for 1 hour followed by 1 hour of no treatment for the first 2 days after treatment, during all waking hours of their day. From days 3-7 patients applied their cryotherapy 2-3 times a day for 1 hour, at any time of the day (46 completed follow-up).
Intervention: Compressive cryotherapy (CC) group: Participants received compressive cryotherapy using a commercial device (Game Ready; CoolSystems, Inc.) for the first postoperative week (25 completed follow-up, Mean age: 55.4).
Comparison: Cryotherapy (IW) group: Cryotherapy alone was used during the first postoperative week. The standard ice wrap (IW) was made of zip lock bags for ice and an ACE bandage (3M, MN, USA) that wrapped over the ice bag and around the shoulder/body (21 completed follow-up, Mean age: 55.8).
Outcomes: Patients completed a diary recording pain on a visual analog scale (VAS) twice a day, total daily narcotic usage (in morphine equivalent dosage), and number of times that cryotherapy was applied each day as well as the duration of application. At initial follow-up patients completed a modified version of the acute 12-Item Short Form Health Survey (SF-12, version 2).
Methods: Prospective, single-centered, RCT.
Time: The diary was completed each day and follow-up was carried out at day 7 postoperatively.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.
Dr. Frank Smith
January 27, 2016
Orthopaedic Surgeon - Canada
Useful to know as patients often are quite forceful in wanting compressive therapy, often on the advice of their therapist.