Management of the stiff shoulder

Abstract: Shoulder stiffness occurs as a result of (1) contractures of the intraarticular capsule or muscle–tendon units or (2) adhesions within the extraarticular humeroscapular or scapulothoracic motion interface. These contractures or adhesions may occur independently or in combination. A thorough history and physical examination usually reveal the diagnosis (idiopathic frozen shoulder or posttraumatic stiff shoulder) and the anatomical locations of fibrosis that is causing stiffness, and identifies other treatable conditions associated with shoulder stiffness (such as diabetes). A gentle home program of passive stretching is effective in most patients. When the home program is not effective, a manipulation or surgical release may be indicated. If manipulation is not effective, capsular contractures are best released arthroscopically as this allows circumferential release without damaging the rotator cuff and thus allows rehabilitation without the need to protect the rotator cuff. The humeroscapular motion interface adhesions can be released either open or arthroscopically, but we believe that an open release combined with an arthroscopic capsular release is quicker and does not interfere with rehabilitation. When necessary, operative management coupled with an aggressive rehabilitation program can provide significant relief of pain and restoration of shoulder motion. Approximately 90% of patients can expect a good result with this treatment algorithm.

[1]  H. Cotta,et al.  [The post-traumatic frozen shoulder]. , 1982, Unfallchirurgie.

[2]  P. Anthony,et al.  The pathology of frozen shoulder. A Dupuytren-like disease. , 1995, The Journal of bone and joint surgery. British volume.

[3]  B. Leduc,et al.  [Adhesive capsulitis of the shoulder: a comparative study of arthrography with intra-articular corticotherapy and with or without capsular distension]. , 1992, Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes.

[4]  J A Sidles,et al.  Translation of the humeral head on the glenoid with passive glenohumeral motion. , 1990, The Journal of bone and joint surgery. American volume.

[5]  R. Warren,et al.  Static capsuloligamentous restraints to superior-inferior translation of the glenohumeral joint , 1992, The American journal of sports medicine.

[6]  Coventry Mb.  Problem of painful shoulder. , 1953 .

[7]  G. Nicholson.  The effects of passive joint mobilization on pain and hypomobility associated with adhesive capsulitis of the shoulder. , 1985, The Journal of orthopaedic and sports physical therapy.

[8]  V. Wright,et al.  Periarthritis of the shoulder. I. Aetiological considerations with particular reference to personality factors. , 1976, Annals of the rheumatic diseases.

[9]  D. T. Harryman.  The Stiff Shoulder , 1998 .

[10]  E. Flatow,et al.  The anatomy and potential effects of contracture of the coracohumeral ligament. , 1992, Clinical orthopaedics and related research.

[11]  Leffert Rd.  Frozen shoulder. , 1985, Lancet.

[12]  J A Sidles,et al.  The role of the rotator interval capsule in passive motion and stability of the shoulder. , 1992, The Journal of bone and joint surgery. American volume.

[13]  J A Sidles,et al.  Arthroscopic labral repair to the glenoid rim. , 1994, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[14]  R. Sweetnam.  Corticosteroid arthropathy and tendon rupture. , 1969, The Journal of bone and joint surgery. British volume.

[15]  T. Lyons,et al.  Accumulation of Maillard reaction products in skin collagen in diabetes and aging. , 1993, The Journal of clinical investigation.

[16]  B. Reeves.  Arthrography of the shoulder. , 1966, The Journal of bone and joint surgery. British volume.

[17]  J. Lundberg,et al.  The frozen shoulder. Clinical and radiographical observations. The effect of manipulation under general anesthesia. Structure and glycosaminoglycan content of the joint capsule. Local bone metabolism. , 1969, Acta orthopaedica Scandinavica.

[18]  B. Hazleman.  The painful stiff shoulder. , 1972, Rheumatology and physical medicine.

[19]  R. Bucala,et al.  Lipid advanced glycosylation: pathway for lipid oxidation in vivo. , 1993, Proceedings of the National Academy of Sciences of the United States of America.

[20]  H Ikeda,et al.  Rotator interval lesion. , 1986, Clinical orthopaedics and related research.

[21]  J. Charnley.  Periarthritis of the Shoulder , 1959, Postgraduate medical journal.

[22]  Manuel Martínez-Lavín,et al.  Frozen shoulder triggered by cardiac catheterization via the brachial artery. , 1994, The American journal of medicine.

[23]  K. Nobuhara,et al.  Contracture of the shoulder. , 1990, Clinical orthopaedics and related research.

[24]  L. Bigliani,et al.  The use of arthroscopy in the treatment of resistant frozen shoulder. , 1994, Clinical orthopaedics and related research.

[25]  J. Warner,et al.  Arthroscopic release of chronic, refractory capsular contracture of the shoulder , 1996 .

[26]  F A Matsen,et al.  Arthroscopic management of refractory shoulder stiffness. , 1996, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[27]  Harryman Dt nd.  Shoulders: frozen and stiff. , 1993 .

[28]  R. Williams,et al.  The frozen shoulder: a review of manipulative treatment. , 1980, Rheumatology and rehabilitation.

[29]  R. Hawkins,et al.  Shoulder manipulation in patients with adhesive capsulitis and diabetes mellitus: A clinical note. , 1993, Journal of shoulder and elbow surgery.

[30]  Julius S. Neviaser,et al.  ADHESIVE CAPSULITIS OF THE SHOULDER: A Study of the Pathological Findings in Periarthritis of the Shoulder , 1945 .

[31]  T. Wickiewicz,et al.  The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder , 1990, The American journal of sports medicine.