Management Of Shoulder Stiffness Research Articles

Effect of Arthroscopic Capsular Release on Shoulder Stiffness Concomitant with a Rotator Cuff Tear -Diabetes as a Predisposing Factor Associated with Treatment Outcome

14 EFFECT OF ARTHROSCOPIC CAPSULAR RELEASE ON SHOULDER STIFFNESS CONCOMITANT WITH A ROTATOR CUFF TEAR -DIABETES AS A PREDISPOSING FACTOR ASSOCIATED WITH TREATMENT OUTCOME SeokWon Chung,MD, Kyung-Soo Oh, MD, Jong Pil Yoon, MD, Jin-Young Park, MD, Department of Orthopaedic Surgery, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, South Korea; Kyungpook University Hospital, Dae-gu, South Korea Introduction: In spite of the high prevalence,optimal management of shoulder stiffness during rotator cuff repair remains unclear. The purpose of this study was to identify the effect of capsular release during rotator cuff repair on the outcomes of patients with both shoulder stiffness and a rotator cuff tear using subgroup analyses. Methods: Forty-nine consecutive patients (mean age, 61.568.3 years) who underwent arthroscopic repair of a small-to-large sized full-thickness rotator cuff tear and manipulation for concomitant shoulder stiffness (FF#120 and ER at side#45 ) were enrolled. The first 21 consecutive patients underwent manipulation alone to treat stiffness, and the second 28 consecutive patients underwent capsular release with manipulation. Among the 49 patients, 25 showed severe stiffness (FF#100 and ER at side#30 : 11 in the first series and 14 in the second series) and 15 (30.6%: 6 in the first series and 9 in the second series) had diabetes mellitus (DM). The postoperative ROM was measured 6 weeks, 3 months, 6 months, and 1 year postoperatively and at final follow-up visit. Simultaneously, functional outcome was evaluated from pain VAS, ASES score, Constant score, and muscle strength ratio (involved/uninvolved), and cuff integrity was assessed ultrasonographically at least 1 year postoperatively. Results: All ROM, functional scores, and muscle strength ratios significantly improved postoperatively in all patients (all p<0.01). No outcome measure differed significantly between patients who did and did not undergo capsular release. However, among patients with severe stiffness, those who underwent capsular release showed greater improvement in ER at side 3 months postoperatively (p1⁄40.036) despite the lack of significant difference in the final outcome. Moreover, among patients with DM, those who underwent capsular release showed greater improvement in FF after 3 months and 1 year and in ER atside at all timepoints, except 6 weeks postoperatively (all p<0.05) and also a significantly higher final ASES score (p1⁄40.030). Two of 21 patients who underwent manipulation alone and 1 of 28 who underwent capsular release and manipulation developed retears. Conclusions: Both manipulation and capsular release with manipulation significantly improved ROM and produced satisfactory functional outcomes. However, in patients with severe stiffness, capsular release at the time of rotator cuff repair increased ER in early postoperative period. Capsular release was also beneficial in patients with diabetes, especially for ER and final postoperative function.

Shoulder stiffness and rotator cuff repair

Shoulder stiffness is a frequent complication of surgical repair of rotator cuff tears. Post-operative stiffness negatively affects surgical outcomes leading to a substantial comorbidity and to the failure of surgical treatment. Also, a stiff shoulder could commonly be concomitant with an rotator cuff tear (RCT). We performed a comprehensive search of CINAHL, Embase, Medline and the Cochrane Central Registry of Controlled Trials, from inception of the database to 31 July 2011. Sixteen articles published in peer-reviewed journals were included in this comprehensive review. The management of shoulder stiffness is still controversial. The role of rehabilitation programs (standard versus early passive mobilization) after RCT repair on the development of stiffness is not clear, while the role of arthroscopic capsular release for post-operative stiffness is better defined, although a threshold of decreased the range of movement for which capsular release is advised has not been identified. Several factors have been identified to predispose the development of shoulder stiffness. There is also evidence in favor of surgical management of RCTs even when accompanied by shoulder stiffness, and there are strong evidences that arthroscopic capsular release is reliable and effective in managing shoulder stiffness. The post-operative rehabilitation protocol remains controversial. We are still far from definitive guidelines for the management of pre- and post-operative stiffness, and prospective double-blinded randomized clinical trials are needed to obtain evidence allowing to establish a reliable and effective management plan for shoulder stiffness.

Assessment and Management of Shoulder Stiffness: A Biomechanical Approach

T he problem of motion, as described in Butterfield's The Origin of Modern Science, relates to the 17th-century dilemma of understanding motion or, more specifically, inertia from a mechanistic viewpoint. 1 As we near the 21st century, health care professionals continue to be confronted with the problem of motion or, more specifically, the lack of motion in our patients' joints. Unlike Calileo's contemporaries, today's clinicians are comfortable with biomechanical descriptions of the force, motion, and strength of biologic tissues. However, intellectual hurdles pertaining to motion continually need to be cleared. Despite the fact that restoring functional, painfree range of motion (ROM) to stiff joints is one of the most common clinical endeavors of therapists, there is a great discrepancy among treatment approaches. 2 This may be due in part to the lack of objective clinical comparisons of treatments for shoulder stiffness. It may also be due to the manual therapy approach for managing stiffness, which has evolved from an eclectic set of evaluation and treatment procedures. 3 Consequently, the treatment of patients who have stiff shoulders traditionally comprises a variety of treatments. These vary from ROM activities and soft-tissue/joint mobilization techniques5,6 to continuous passive motion (CPMf,8 and splinting of the shoulder. 9 Hand therapists deal with joint stiffness on a