Sunday, November 15, 2015

Stiff shoulders with cuff tears - what does this teach us?

Rotator Cuff Lesions in Patients with Stiff Shoulders: A Prospective Analysis of 379 Shoulders.

These authors use MRI to investigate the prevalence of rotator cuff lesions in a a series of 379 patients with stiff shoulders (excluding those with traumatic etiology, diabetes, or radiographic abnormalities).
Group 1 included 89 shoulders with severe and global loss of passive motion (≤100° of forward flexion, ≤10° of external rotation with the arm at the side, and internal rotation not more cephalad than the L5 level).  91% of these patients had an intact rotator cuff and 9% had a partial-thickness rotator cuff tear
Group 2 included 290 shoulders with severe but not global loss. 44% of these patients had intact cuffs, 17% had partial thickness tears and 39% had full thickness tears.
Group 3 included 179 shoulders with mild to moderate limitation. 35% of these had intact cuffs, 16% ha partial thickness tears, and 50% had full thickness tears.

The results are easier to see in this chart we prepared from their data

The authors concluded that shoulder stiffness with severe and global loss of passive range of motion is not commonly associated with full-thickness rotator cuff tears, although some stiff shoulders may have a partial-thickness tear. 

Comment: To us the real take home message is that shoulders with full-thickness cuff tears can have mild, moderate or severe stiffness. This stiffness may be as much a contribution to the patient's loss of comport and function as the tear itself. If a cuff repair is attempted on a stiff shoulder, there is a real risk that the stiffness will be exacerbated as a result of the surgical tightening and the post operative protection of the repair. 
We often use the smooth and move procedure (see this link) in chronic degenerative tears and failed prior repair attempts. This is a procedure that does not attempt to repair the cuff, but instead includes a lysis of adhesions and a manipulation under anesthesia, followed by immediate post-operative full passive motion stretching exercises. Prior to the manipulation we are often impressed by the amount of stiffness in these shoulders. We are also impressed by the rapid recovery of function and comfort after this procedure that treats the stiffness but not the cuff defect.


Check out the new Shoulder Arthritis Book - click here.

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'