Functional outcome of arthroscopic repair with concomitant manipulation in rotator cuff tears with stiff shoulder

Nam Su Cho, Yong Girl Rhee
American Journal of Sports Medicine 2008, 36 (7): 1323-9

BACKGROUND: Little has been reported on treatment of rotator cuff tears with shoulder stiffness.

HYPOTHESIS: Rotator cuff tears with shoulder stiffness will show worse clinical results than will tears without stiffness. Those with stiffness are expected to take longer time in pain reduction and recovery of range of motion.

STUDY DESIGN: Case control study; Level of evidence, 3.

METHODS: Among patients who underwent arthroscopic rotator cuff repairs, 15 cases with preoperative shoulder stiffness (group A) and 30 without shoulder stiffness (group B) were enrolled in this study. Preoperative mean forward flexion was 118.3 degrees in group A and 163.4 degrees in group B, whereas external rotation at the side was 34.6 degrees and 55.0 degrees , respectively. The mean follow-up period of group A was 29.8 months (range, 19.5-73.9 months) and 32.4 months (range, 16-70.6 months) in group B.

RESULTS: The mean visual analog scale during motion at the last follow-up was 0.75 in group A and 0.76 in group B (P = .942). The mean University of California at Los Angeles score was, respectively, 33.1 and 33.2 points (P = .561). Forward flexion was 166.7 degrees in group A and 170.2 degrees in group B, whereas external rotation at the side was 48.8 degrees and 53.4 degrees , respectively (P = .157 and .384, respectively). However, the 2 groups showed a significant difference in forward flexion until 1 year postoperatively as group A recovered more slowly (P = .021). Both groups showed significant differences in external rotation at the side, internal rotation to the back, and cross-body adduction until 6 weeks postoperatively (P = .009, P < .001, and P = .026, respectively).

CONCLUSION: Pain, range of motion, muscle strength, and function all significantly improved after arthroscopic rotator cuff repair, regardless of the presence of shoulder stiffness. Patients with full-thickness rotator cuff tears and stiffness of the shoulder can be treated with a single surgery and concomitant manipulation with overall good results. Although final outcomes were as good as those in patients without stiffness, the return of range of motion took longer in those patients undergoing manipulation for stiffness of the shoulder.

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