Early Arthroscopic Contracture Release for Postoperative Shoulder Stiffness (SS-05)

Abstract

Introduction Severe postoperative stiffness following shoulder surgery is a common problem that usually resolves. However, some cases are very resistant to normal measures, and controversy exists regarding management of these patients. The present study was carried out in an effort to determine the effectiveness of early arthroscopic intervention for severe postoperative shoulder stiffness occurring in patients with previously normal shoulder range of motion. Methods From January 2004 to January 2008, all patients who underwent arthroscopic contracture release secondary to postoperative shoulder stiffness with previously normal shoulder motion were identified. Inclusion criteria included all patients who developed postoperative forward flexion of less than 100° and passive external rotation of less than 20°, and were ultimately treated with arthroscopic contracture release. All patients undergoing this procedure had failed a minimum of 3 months of postoperative treatment measures prior to arthroscopic release. Medical records were reviewed, and all patients were evaluated preoperatively and postoperatively. Results A total of 30 consecutive patients were identified with the initial procedure being a rotator cuff repair in 23 patients, subacromial decompression in 5 patients and SLAP repair with decompression in 2 patients. Surgical intervention was carried out after an average of 4 months (3-6 months) of postoperative treatment. Closed manipulation and arthroscopic contracture release were performed in all patients. After an average follow-up of 43 months (16-79 months), range of motion in all planes was improved in all patients. Most notable were passive external rotation improvement from a mean of 5° (-10° to 20°) to 60° (45° to 80°) (p<.05) and passive forward flexion improvement from a mean of 50° (30° to 80°) to 160° (150° to 180°) (p<.05). Statistically significant improvements were also noted in both the Constant (p<.05) and UCLA shoulder scores (p<.05). No complications following contracture release were seen, and no patient underwent a subsequent shoulder surgery. Conclusion This study demonstrates that early arthroscopic contracture release is a safe and effective method for treating severe postoperative shoulder stiffness unresponsive to postoperative measures and is helpful in restoring shoulder motion and function. Severe postoperative stiffness following shoulder surgery is a common problem that usually resolves. However, some cases are very resistant to normal measures, and controversy exists regarding management of these patients. The present study was carried out in an effort to determine the effectiveness of early arthroscopic intervention for severe postoperative shoulder stiffness occurring in patients with previously normal shoulder range of motion. From January 2004 to January 2008, all patients who underwent arthroscopic contracture release secondary to postoperative shoulder stiffness with previously normal shoulder motion were identified. Inclusion criteria included all patients who developed postoperative forward flexion of less than 100° and passive external rotation of less than 20°, and were ultimately treated with arthroscopic contracture release. All patients undergoing this procedure had failed a minimum of 3 months of postoperative treatment measures prior to arthroscopic release. Medical records were reviewed, and all patients were evaluated preoperatively and postoperatively. A total of 30 consecutive patients were identified with the initial procedure being a rotator cuff repair in 23 patients, subacromial decompression in 5 patients and SLAP repair with decompression in 2 patients. Surgical intervention was carried out after an average of 4 months (3-6 months) of postoperative treatment. Closed manipulation and arthroscopic contracture release were performed in all patients. After an average follow-up of 43 months (16-79 months), range of motion in all planes was improved in all patients. Most notable were passive external rotation improvement from a mean of 5° (-10° to 20°) to 60° (45° to 80°) (p<.05) and passive forward flexion improvement from a mean of 50° (30° to 80°) to 160° (150° to 180°) (p<.05). Statistically significant improvements were also noted in both the Constant (p<.05) and UCLA shoulder scores (p<.05). No complications following contracture release were seen, and no patient underwent a subsequent shoulder surgery. This study demonstrates that early arthroscopic contracture release is a safe and effective method for treating severe postoperative shoulder stiffness unresponsive to postoperative measures and is helpful in restoring shoulder motion and function.