Treating Rotator Cuff Tears in a Stiff ShoulderRotator cuff tears can be difficult to treat. When surgery is delayed, severe pain can cause the shoulder capsule to tighten up. The result is a stiff shoulder with loss of motion.
What's the best way to treat this? Should the shoulder be manipulated surgically first? Then repaired later? Or is it better to do both the manipulation and the repair at the same time? In this study from Korea, results of surgery are compared for patients with and without shoulder stiffness.
Everyone had an arthroscopic rotator cuff repair with the same surgeon. Pain, motion, and strength were the measures of outcome. Results were compared at three and six weeks, three and six months, and one year post-operatively. It was expected that the group with the stiff shoulders would have a slower recovery and poorer clinical results after the operation.
Patients in both groups attended the same clinic for rehab. They all followed the same rehab program in the clinic and at home. There was no difference in pain levels between the two groups. Both groups had significant pain reduction after surgery.
Likewise, function returned equally for patients in both groups. But the manipulation group had a slower recovery. It took much longer (up to one full year) to regain shoulder flexion in particular. Other motions were slower to return in the manipulation group but only for the first six weeks.
The authors concluded that rotator cuff tears with stiffness can be treated all at the same time. A single operation can save money and reduce the overall time the patient's life is disrupted. Patients have a good result but should expect a slower recovery.
Nam Su Cho, MD, and Yong Girl Rhee, MD. Functional Outcome of Arthroscopic Repair with Concomitant Manipulation in Rotator Cuff Tears with Stiff Shoulder. In The American Journal of Sports Medicine. July 2008. Vol. 36. No. 7. Pp. 1323-1329.
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