Skip to main content
SpringerLink
Log in

Postoperative Shoulder Stiffness After Rotator Cuff Repair

  • Chapter
Shoulder Stiffness

Abstract

Postoperative shoulder stiffness (POSS) is an acquired loss of motion, occurring after a known surgical or traumatic event. Biomechanically, a stiff shoulder is one in which at least one of the shoulder’s motion interfaces has been compromised, thus, limiting maximal excursion. The definition of what POSS is remains controversial, with a wide variability in its definition. Incidence of POSS is variable and has been reported as high as 32.7 %. It accounts for one of the most common complications following surgical repair of the rotator cuff. Management of POSS is important as it can severely limit the activities of daily living. There remains a lack of consensus in regard to the etiology and prevention of POSS. This chapter discusses the various etiologies and risk factors for POSS after RCR, preoperative ROM and POSS, operative techniques and POSS, the postoperative surgical changes and their biomechanical impact on shoulder motion, and postoperative therapy protocols.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Abrams JS, Bell RH. Arthroscopic rotator cuff surgery: a practical approach to management. New York: Springer; 2008.

    Book  Google Scholar 

  2. Accousti KJ, Flatow EL. Technical pearls on how to maximize healing of the rotator cuff. Instr Course Lect. 2007;56:3–12.

    PubMed  Google Scholar 

  3. Beaufils P, Prévot N, Boyer T, Allard M, Dorfmann H, Frank A, Kelbérine F, Kempf J-F, Molé D, Walch G. Arthroscopic release of the glenohumeral joint in shoulder stiffness: a review of 26 cases. French society for arthroscopy. Arthroscopy. 1999;15(1):49–55.

    Article  CAS  PubMed  Google Scholar 

  4. Bey MJ, Ramsey ML, Soslowsky LJ. Intratendinous strain fields of the supraspinatus tendon: effect of a surgically created articular-surface rotator cuff tear. J Shoulder Elbow Surg. 2002;11(6):562–9.

    Article  PubMed  Google Scholar 

  5. Bey MJ, Song HK, Wehrli FW, Soslowsky LJ. Intratendinous strain fields of the intact supraspinatus tendon: the effect of glenohumeral joint position and tendon region. J Orthop Res. 2002;20(4):869–74.

    Article  PubMed  Google Scholar 

  6. Bigliani LU, Cordasco FA, McIveen SJ, Musso ES. Operative treatment of failed repairs of the rotator cuff. J Bone Joint Surg Am. 1992;74:1505–15.

    CAS  PubMed  Google Scholar 

  7. Brislin KJ, Field LD, Savoie 3rd FH. Complications after arthroscopic rotator cuff repair. Arthroscopy. 2007;23(2):124–8.

    Article  PubMed  Google Scholar 

  8. Burkhart SS, Lo IKY. Arthroscopic rotator cuff repair. J Am Acad Orthop Surg. 2006;14(6):333–46.

    PubMed  Google Scholar 

  9. Burkhart SS, Nottage WM, Ogilvie-Harris DJ, Kohn HS, Pachelli A. Partial repair of irreparable rotator cuff tears. Arthroscopy. 1994;10(4):363–70.

    Article  CAS  PubMed  Google Scholar 

  10. Burks RT, Crim J, Brown N, Fink B, Greis PE. A prospective randomized clinical trial comparing arthroscopic single- and double-row rotator cuff repair: magnetic resonance imaging and early clinical evaluation. Am J Sports Med. 2009;37(4):674–82.

    Article  PubMed  Google Scholar 

  11. Chen AL, Shapiro JA, Ahn AK, Zuckerman JD, Cuomo F. Rotator cuff repair in patients with type I diabetes mellitus. J Shoulder Elbow Surg. 2003;12(5):416–21.

    Article  PubMed  Google Scholar 

  12. Cho NS, Rhee YG. Functional outcome of arthroscopic repair with concomitant manipulation in rotator cuff tears with stiff shoulder. Am J Sports Med. 2008;36(7):1323–9.

    Article  PubMed  Google Scholar 

  13. Chuang T-Y, Ho W-P, Chen C-H, Lee C-H, Liau J-J, Huang C-H. Arthroscopic treatment of rotator cuff tears with shoulder stiffness: a comparison of functional outcomes with and without capsular release. Am J Sports Med. 2012;40(9):2121–7.

    Article  PubMed  Google Scholar 

  14. Chung SW, Huong CB, Kim SH, Oh JH. Shoulder stiffness after rotator cuff repair: risk factors and influence on outcome. Arthroscopy. 2013;29(2):290–300.

    Article  PubMed  Google Scholar 

  15. Cofield RH. Rotator cuff disease of the shoulder. J Bone Joint Surg. 1985;67(6):974–9.

    CAS  PubMed  Google Scholar 

  16. Constant C, Murley A. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–4.

    PubMed  Google Scholar 

  17. Denard PJ, Ladermann A, Burkhart SS. Prevention and management of stiffness after arthroscopic rotator cuff repair: systematic review and implications for rotator cuff healing. Arthroscopy. 2011;27(6):842–8.

    Article  PubMed  Google Scholar 

  18. Elhassan B, Ozbaydar M, Massimini D, Higgins L, Warner JJ. Arthroscopic capsular release for refractory shoulder stiffness: a critical analysis of effectiveness in specific etiologies. J Shoulder Elbow Surg. 2010;19(4):580–7.

    Article  PubMed  Google Scholar 

  19. Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. end-result study of factors influencing reconstruction. J Bone Joint Surg Am. 1986;68(8):1136–44.

    CAS  PubMed  Google Scholar 

  20. Franceschi F, Longo UG, Ruzzini L, Morini S, Battistoni F, Dicuonzo G, Maffulli N, Denaro V. Circulating substance P levels and shoulder joint contracture after arthroscopic repair of the rotator cuff. Br J Sports Med. 2008;42(9):742–5.

    Article  CAS  PubMed  Google Scholar 

  21. Franceschi F, Ruzzini L, Longo UG, Martina FM, Zobel BB, Maffulli N, Denaro V. Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears: a randomized controlled trial. Am J Sports Med. 2007;35(8):1254–60.

    Article  PubMed  Google Scholar 

  22. Gimbel JA, Van Kleunen JP, Lake SP, Williams GR, Soslowsky LJ. The role of repair tension on tendon to bone healing in an animal model of chronic rotator cuff tears. J Biomech. 2007;40(3):561.

    Article  PubMed  Google Scholar 

  23. Gimbel JA, Van Kleunen JP, Mehta S, Perry SM, Williams GR, Soslowsky LJ. Supraspinatus tendon organizational and mechanical properties in a chronic rotator cuff tear animal model. J Biomech. 2004;37(5):739–49.

    Article  PubMed  Google Scholar 

  24. Gimbel JA, Van Kleunen JP, Williams GR, Thomopoulos S, Soslowsky LJ. Long durations of immobilization in the rat result in enhanced mechanical properties of the healing supraspinatus tendon insertion site. J Biomech Eng. 2007;129(3):400–4.

    Article  CAS  PubMed  Google Scholar 

  25. Goldberg BA, Scarlat MM, Harryman 2nd DT. Management of the stiff shoulder. J Orthop Sci. 1999;4(6):462–71.

    Article  CAS  PubMed  Google Scholar 

  26. Grasso A, Milano G, Salvatore M, Falcone G, Deriu L, Fabbriciani C. Single-row versus double-row arthroscopic rotator cuff repair: a prospective randomized clinical study. Arthroscopy. 2009;25(1):4–12.

    Article  PubMed  Google Scholar 

  27. Harryman DT, Lazarus MD, Rozencwaig R. The stiff shoulder. In: Rockwood Jr CA, editor. The shoulder. Philadelphia: WB Saunders; 1998. p. 1064–112.

    Google Scholar 

  28. Harryman 2nd DT, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen 3rd FA. Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am. 1991;73(7):982–9.

    PubMed  Google Scholar 

  29. Holloway GB, Schenk T, Williams GR, Ramsey ML, Iannotti JP. Arthroscopic capsular release for the treatment of refractory postoperative or post-fracture shoulder stiffness. J Bone Joint Surg Am. 2001;83(11):1682–7.

    PubMed  Google Scholar 

  30. Hsu SL, Ko JY, Chen SH, Wu RW, Chou WY, Wang CJ. Surgical results in rotator cuff tears with shoulder stiffness. J Formos Med Assoc. 2007;106(6):452–61.

    Article  PubMed  Google Scholar 

  31. Huberty DP, Schoolfield JD, Brady PC, Vadala AP, Arrigoni P, Burkhart SS. Incidence and treatment of postoperative stiffness following arthroscopic rotator cuff repair. Arthroscopy. 2009;25(8):880–90.

    Article  PubMed  Google Scholar 

  32. Kim Y-S, Chung SW, Kim JY, Ok J-H, Park I, Oh JH. Is early passive motion exercise necessary after arthroscopic rotator cuff repair? Am J Sports Med. 2012;40(4):815–21.

    Article  PubMed  Google Scholar 

  33. Ko JY, Wang FS, Huang HY, Wang CJ, Tseng SL, Hsu C. Increased IL-1beta expression and myofibroblast recruitment in subacromial bursa is associated with rotator cuff lesions with shoulder stiffness. J Orthop Res. 2008;26(8):1090–7.

    Article  CAS  PubMed  Google Scholar 

  34. Koh KH, Lim TK, Shon MS, Park YE, Lee SW, Yoo JC. Effect of immobilization without passive exercise after rotator cuff repair randomized clinical trial comparing four and eight weeks of immobilization. J Bone Joint Surg Am. 2014;96(6):1–9.

    Article  Google Scholar 

  35. Koike Y, Trudel G, Uhthoff HK. Formation of a new enthesis after attachment of the supraspinatus tendon: a quantitative histologic study in rabbits. J Orthop Res. 2005;23(6):1433–40.

    Article  PubMed  Google Scholar 

  36. Koo SS, Parsley BK, Burkhart SS, Schoolfield JD. Reduction of postoperative stiffness after arthroscopic rotator cuff repair: results of a customized physical therapy regimen based on risk factors for stiffness. Arthroscopy. 2011;27(2):155–60.

    Article  PubMed  Google Scholar 

  37. Lafosse L, Brozska R, Toussaint B, Gobezie R. The outcome and structural integrity of arthroscopic rotator cuff repair with use of the double-row suture anchor technique. J Bone Joint Surg Am. 2007;89(7):1533–41.

    Article  PubMed  Google Scholar 

  38. Lee BG, Cho NS, Rhee YG. Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repair: aggressive versus limited early passive exercises. Arthroscopy. 2012;28(1):34–42.

    Article  PubMed  Google Scholar 

  39. Matsen FA. Practical evaluation and management of the shoulder. Philadelphia: Saunders; 1994.

    Google Scholar 

  40. Matsen FA, Lippitt SB, DeBartolo SE. Shoulder surgery: principles and procedures. Philadelphia: Saunders; 2004.

    Google Scholar 

  41. Millett PJ, Wilcox RB, O’Holleran JD, Warner JJP. Rehabilitation of the rotator cuff: an evaluation-based approach. J Am Acad Orthop Surg. 2006;14(11):599–609.

    PubMed  Google Scholar 

  42. Miniaci A. Disorders of the shoulder: sports injuries. Philadelphia: Wolters Kluwer Health; 2013.

    Google Scholar 

  43. Oh JH, Kim SH, Lee HK, Jo KH, Bin SW, Gong HS. Moderate preoperative shoulder stiffness does not alter the clinical outcome of rotator cuff repair with arthroscopic release and manipulation. Arthroscopy. 2008;24(9):983–91.

    Article  PubMed  Google Scholar 

  44. Papalia R, Franceschi F, Vasta S, Gallo A, Maffulli N, Denaro V. Shoulder stiffness and rotator cuff repair. Br Med Bull. 2012;104:163–74.

    Article  PubMed  Google Scholar 

  45. Parsons BO, Gruson KI, Chen DD, Harrison AK, Gladstone J, Flatow EL. Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness? J Shoulder Elbow Surg. 2010;19(7):1034–9.

    Article  PubMed  Google Scholar 

  46. Peltz CD, Dourte LM, Kuntz AF, Sarver JJ, Kim SY, Williams GR, Soslowsky LJ. The effect of postoperative passive motion on rotator cuff healing in a rat model. J Bone Joint Surg Am. 2009;91(10):2421–9.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Pollock RG, Duralde XA, Flatow EL Bigliani LU. The use of arthroscopy in the treatment of resistant frozen shoulder. Clin Orthop Relat Res. 1994;(304):30–6.

    Google Scholar 

  48. Sarver JJ, Peltz CD, Dourte L, Reddy S, Williams GR, Soslowsky LJ. After rotator cuff repair, stiffness–but not the loss in range of motion–increased transiently for immobilized shoulders in a rat model. J Shoulder Elbow Surg. 2008;17(1 Suppl):108S–13.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Seo SS, Choi JS, An KC, Kim JH, Kim SB. The factors affecting stiffness occurring with rotator cuff tear. J Shoulder Elbow Surg. 2012;21(3):304–9.

    Article  PubMed  Google Scholar 

  50. Shinoda T, Shibata Y, Izaki T, Shitama T, Naito M. A comparative study of surgical invasion in arthroscopic and open rotator cuff repair. J Shoulder Elbow Surg. 2009;18(4):596–9.

    Article  PubMed  Google Scholar 

  51. Sonnabend DH, Howlett CR, Young AA. Histological evaluation of repair of the rotator cuff in a primate model. J Bone Joint Surg Br. 2010;92(4):586–94.

    Article  CAS  PubMed  Google Scholar 

  52. Stollsteimer GT, Savoie 3rd FH. Arthroscopic rotator cuff repair: current indications, limitations, techniques, and results. Instr Course Lect. 1998;47:59–65.

    CAS  PubMed  Google Scholar 

  53. Sugaya H, Maeda K, Matsuki K, Moriishi J. Repair Integrity and functional outcome after arthroscopic double-Row rotator cuff repair. A prospective outcome study. J Bone Joint Surg Am. 2007;89(5):953–60.

    Article  PubMed  Google Scholar 

  54. Tauro JC. Stiffness and rotator cuff tears: incidence, arthroscopic findings, and treatment results. Arthroscopy. 2006;22(6):581–6.

    Article  PubMed  Google Scholar 

  55. Tauro JC, Paulson M. Shoulder stiffness. Arthroscopy. 2008;24(8):949–55.

    Article  PubMed  Google Scholar 

  56. Thomopoulos S, Williams GR, Soslowsky LJ. Tendon to bone healing: differences in biomechanical, structural, and compositional properties due to a range of activity levels. J Biomech Eng. 2003;125(1):106–13.

    Article  CAS  PubMed  Google Scholar 

  57. Trenerry K, Walton JR, Murrell GA. Prevention of shoulder stiffness after rotator cuff repair. Clin Orthop Relat Res. 2005;(430):94–9.

    Google Scholar 

  58. Trudel G, Ramachandran N, Ryan SE, Rakhra K, Uhthoff HK. Supraspinatus tendon repair into a bony trough in the rabbit: mechanical restoration and correlative imaging. J Orthop Res. 2010;28(6):710–5.

    PubMed  Google Scholar 

  59. van der Zwaag HM, Brand R, Obermann WR, Rozing PM. Glenohumeral osteoarthrosis after Putti-Platt repair. J Shoulder Elbow Surg. 1999;8(3):252–8.

    Article  PubMed  Google Scholar 

  60. Warner J. Frozen shoulder: diagnosis and management. J Am Acad Orthop Surgs. 1997;5(3):130–40.

    Google Scholar 

  61. Warner JJ, Greis PE. The treatment of stiffness of the shoulder after repair of the rotator cuff. Instr Course Lect. 1998;47:67–75.

    CAS  PubMed  Google Scholar 

  62. Warner JJ, Tetreault P, Lehtinen J, Zurakowski D. Arthroscopic versus mini-open rotator cuff repair: a cohort comparison study. Arthroscopy. 2005;21(3):328–32.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Midlands Orthopaedics, Columbia, SC, USA

    Benjamin Barden MD

  2. Department of Orthopaedic Surgery, UConn Musculoskeletal Institute/University of Connecticut, 263, Farmington Avenue, Farmington, CT, 06030-5456, USA

    Jessica DiVenere BS & Hardeep Singh MD

  3. Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, Farmington, CT, USA

    Augustus D. Mazzocca MS, MD

Authors
  1. Benjamin Barden MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jessica DiVenere BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hardeep Singh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Augustus D. Mazzocca MS, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Augustus D. Mazzocca MS, MD .

Editor information

Editors and Affiliations

  1. Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan

    Eiji Itoi

  2. Department of Orthopaedic Surgery, Instituto Argentino de Diagnóstico y Tratamiento, Buenos Aires, Argentina

    Guillermo Arce

  3. Department of Orthopedics and Trauma, University of Adelaide, Adelaide, South Australia, Australia

    Gregory I. Bain

  4. Dept. of Orthopaedic Surgery, University of Groningen Sports Medicine Center, Groningen, The Netherlands

    Ronald L. Diercks

  5. Taos Orthopaedic Institute Orthopaedic Sports Medicine, Taos, New Mexico, USA

    Dan Guttmann

  6. Orthpaedic Sports Medicine, University of Munich Hospital Rechts der Isar, Munich, Germany

    Andreas B. Imhoff

  7. Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, Farmington, Connecticut, USA

    Augustus D. Mazzocca

  8. Funabashi Orthopaedic Sports Med Cn Shoulder & Elbow Service, Chiba, Japan

    Hiroyuki Sugaya

  9. Dept. of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Gyeonggi-Do, Korea, Republic of (South Korea)

    Yon-Sik Yoo

Rights and permissions

Reprints and permissions

Copyright information

© 2015 ISAKOS

About this chapter

Cite this chapter

Barden, B., DiVenere, J., Singh, H., Mazzocca, A.D. (2015). Postoperative Shoulder Stiffness After Rotator Cuff Repair. In: Itoi, E., et al. Shoulder Stiffness. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-46370-3_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-46370-3_5

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-46369-7

  • Online ISBN: 978-3-662-46370-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation