Management of postoperative shoulder stiffness.
ABSTRACT Arthroscopic surgery has become the most popular treatment to repair rotator cuff tears. Although the exact prevalence of postoperative stiffness is unknown, many studies report an incidence rate of 4% to 15%. Management of postoperative shoulder stiffness depends on the cause of the stiffness. Nonoperative and operative management modalities are available, but postoperative shoulder stiffness is often resistant to nonsurgical management. When conservative treatment fails, surgical release of the scar tissue and adhesions can be performed both by arthroscopic or open surgery. Arthroscopic capsular release is the preferred technique for capsule contraction and adhesion formation, as it allows precise and selective debridement of the scar tissue and division of the shortened and thickened capsule by partial or extensive capsulectomy.
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ABSTRACT: Purpose In this prospective case control study, the effectiveness of surgical management of irreparable rotator cuff tears in terms of patient’s status and quality of life was evaluated in two groups of patients: one group receiving arthroscopic debridement associated with acromioplasty and bursectomy and the other receiving an arthroscopic partial repair of the rotator cuff tear. Methods Sixty-eight patients (47 males and 21 females) undergoing arthroscopic shoulder surgery for massive irreparable rotator cuff tear were enrolled in our study. Patients were divided into two groups: Group AP (debridement associated with acromioplasty and bursectomy) and Group PR (partial repair). Pre- and post-operative range of motion (ROM), modified-UCLA shoulder score and strength measurement were performed. The RC-QOL was used at the time of the last follow-up to assess patients’ perception of their quality of life. Results The final follow-up was 7.8 (±2.3, range 5-9) years. ROM measures were significantly increased from pre- to post-operative evaluations, with significant intergroup differences (P P P P Conclusion Both techniques are effective in reducing patients’ symptoms, with higher functional outcomes for partial repair. However, the choice of which technique to undertake should take into account the patients’ features concerning the acromio-humeral interval and levels of daily activities. Level of evidence Therapeutic case-control study, Level III.Knee Surgery Sports Traumatology Arthroscopy 12/2012; 23(2). DOI:10.1007/s00167-012-2317-7
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ABSTRACT: Stiffness after a rotator cuff tear is common. So is stiffness after an arthroscopic rotator cuff repair. In the literature, however, postoperative restriction of passive range of motion after open rotator cuff repair in shoulders with free passive range of motion at surgery has seldom been recognized. We hypothesize that this postoperative stiffness is more frequent than recognized and slows the primary postoperative healing after a rotator cuff reconstruction. We wondered how common is postoperative restriction of both active and passive range of motion after open rotator cuff repair in shoulders with free passive preoperative range of motion, how it recovers, and whether this condition influences short- and long-term results of surgery. We also explored factors predicting postoperative shoulder stiffness. We retrospectively identified 103 postoperative stiff shoulders among 416 consecutive open rotator cuff repairs, evaluating incidence and duration of stiffness, short-term clinical results and long-term range of motion, pain relief, shoulder strength, and functional results 3-20 (mean 8.7) years after surgery in 56 patients. The incidence of postoperative shoulder stiffness was 20%. It delayed primary postoperative healing by 3-6 months and resolved during a mean 6.3 months postoperatively. External rotation resolved first, corresponding to that of the controls at 3 months; flexion and abduction took less than 1 year after surgery. The mean summarized range of motion (flexion + abduction + external rotation) increased as high as 93% of the controls' range of motion by 6 months and 100% by 1 year. Flexion, abduction, and internal rotation improved to the level of the contralateral shoulders as did pain, strength, and function. Age at surgery and condition of the biceps tendon were related to postoperative stiffness. Postoperative stiff shoulder after open rotator cuff repair is a common complication resolving in 6-12 months with good long-term results.Scandinavian journal of surgery: SJS: official organ for the Finnish Surgical Society and the Scandinavian Surgical Society 04/2014; 103(4). DOI:10.1177/1457496913514383
- STRENGTH AND CONDITIONING JOURNAL 08/2014; 36(4):23-33. DOI:10.1519/SSC.0b013e318291cb98