Incidence and prognostic factors for postoperative frozen shoulder after shoulder surgery: a prospective cohort study

Koorevaar, Rinco C.T.; Riet, Esther van't; Ipskamp, Marcel; Bulstra, Sjoerd K.

doi:10.1007/s00402-016-2589-3

Cited by 41 publications

(27 citation statements)

References 27 publications

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“… 41 Finally, a frozen shoulder is considered a potential complication of the treatment of patients with shoulder impingement syndrome, particularly of shoulder arthroscopy. 42 However, at the early stages of the disease, the clinical presentation of a slowly developing frozen shoulder can mimic subacromial impingement, so a legitimate concern exists that some of the participants we labelled as having developed a frozen shoulder as a complication of treatment might actually initially have been misdiagnosed as having shoulder impingement syndrome while actually having a frozen shoulder in the first place. In the end, the number of patients labelled having developed a frozen shoulder was small in all groups (two, three, and one in the exercise therapy, ASD, and diagnostic arthroscopy groups, respectively).…”

Section: Discussionmentioning

confidence: 99%

Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial

Paavola

Malmivaara

Taimela

et al. 2018

BMJ

144

159

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ObjectiveTo assess the efficacy of arthroscopic subacromial decompression (ASD) by comparing it with diagnostic arthroscopy, a placebo surgical intervention, and with a non-operative alternative, exercise therapy, in a more pragmatic setting.DesignMulticentre, three group, randomised, double blind, sham controlled trial.SettingOrthopaedic departments at three public hospitals in Finland.Participants210 patients with symptoms consistent with shoulder impingement syndrome, enrolled from 1 February 2005 with two year follow-up completed by 25 June 2015.InterventionsASD, diagnostic arthroscopy (placebo control), and exercise therapy.Main outcome measuresShoulder pain at rest and on arm activity (visual analogue scale (VAS) from 0 to 100, with 0 denoting no pain), at 24 months. The threshold for minimal clinically important difference was set at 15.ResultsIn the primary intention to treat analysis (ASD versus diagnostic arthroscopy), no clinically relevant between group differences were seen in the two primary outcomes at 24 months (mean change for ASD 36.0 at rest and 55.4 on activity; for diagnostic arthroscopy 31.4 at rest and 47.5 on activity). The observed mean difference between groups (ASD minus diagnostic arthroscopy) in pain VAS were −4.6 (95% confidence interval −11.3 to 2.1) points (P=0.18) at rest and −9.0 (−18.1 to 0.2) points (P=0.054) on arm activity. No between group differences were seen between the ASD and diagnostic arthroscopy groups in the secondary outcomes or adverse events. In the secondary comparison (ASD versus exercise therapy), statistically significant differences were found in favour of ASD in the two primary outcomes at 24 months in both VAS at rest (−7.5, −14.0 to −1.0, points; P=0.023) and VAS on arm activity (−12.0, −20.9 to −3.2, points; P=0.008), but the mean differences between groups did not exceed the pre-specified minimal clinically important difference. Of note, this ASD versus exercise therapy comparison is not only confounded by lack of blinding but also likely to be biased in favour of ASD owing to the selective removal of patients with likely poor outcome from the ASD group, without comparable exclusions from the exercise therapy group.ConclusionsIn this controlled trial involving patients with a shoulder impingement syndrome, arthroscopic subacromial decompression provided no benefit over diagnostic arthroscopy at 24 months.Trial registrationClinicaltrials.gov NCT00428870.

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Section: Discussionmentioning

confidence: 99%

Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial

Paavola

Malmivaara

Taimela

et al. 2018

BMJ

144

159

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“… 78 Therefore, a specialized shoulder physiotherapy, carefully instructed to focus on the development of postoperative SS and its immediate recognition and treatment, is recommended. 79 …”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Shoulder Stiffness: Current Concepts

Cucchi

Marmotti

Giorgi

et al. 2017

Joints

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Shoulder stiffness is a condition of painful restriction of the glenohumeral range of motion. Numerous risk factors for primary and postoperative shoulder stiffness have been described. This article summarizes the known aspects of the pathophysiology of shoulder stiffness, with special attention to elements of molecular biology and genetics, which could influence the risk of developing shoulder stiffness. Furthermore, the role of hormonal and metabolic factors, medical disorders, drugs, and of other published risk factors for primary and postoperative shoulder stiffness is reviewed and discussed. Finally, aspects related to shoulder surgery and postoperative rehabilitation protocols, which could influence the development of postoperative stiffness are presented.

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“…This is probably due to the presence of associated injuries in traumatic RC tear, such as acromioclavicular joint injury, labral injuries, bruise or fracture of shoulder bones, strain of intrinsic and extrinsic shoulder muscles, and neurologic injuries to the axillary and/or suprascapular nerve. Several studies have investigated the risk factors of SS after arthroscopic RC repair [24][25][26]; however, studies exploring the role of postoperative pain in the onset of SS are lacking. Basic science research has investigated the role of different inflammation mediators in genesis of pain in the case of SS‫‬ .…”

Section: Discussionmentioning

confidence: 99%

Early postoperative pain as a risk factor of shoulder stiffness after arthroscopic rotator cuff repair

2021

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Background The role of postoperative pain in incidence of shoulder stiffness (SS) after shoulder arthroscopy has not been thoroughly investigated. The present study was conducted to assess the effects of early postoperative pain (EPOP) on onset of SS after arthroscopic rotator cuff (RC) repair. Materials and methods In a retrospective analysis of a prospectively collected database, 335 patients who underwent arthroscopic RC repair were evaluated. RC tendons were sutured to the bone using the double-row technique. EPOP was evaluated 1 week after surgery using the visual analog scale (VAS). SS was assessed 3 months after surgery and was categorized into moderate or severe based on shoulder range of motion (ROM). Each type of complication including SS was identified and recorded. Results Postoperative shoulder stiffness (POSS) was identified in 121 patients (36.2%) that was moderate in 86 patients (70.1%) and severe in 35 patients (28.9%). After 1 week, VAS pain score was equal to 7.7 ± 3.1 and 4.5 ± 2.1 in the patients with and without stiffness, respectively (p < 0.001). Diabetes and traumatic tear were found to be associated with postoperative stiffness (p = 0.046 and p < 0.001, respectively). Similar associations were found on multivariate analysis of data. VAS pain score was higher in the patients with severe stiffness compared with those with moderate stiffness (p < 0.001). Conclusions Our findings revealed that EPOP is associated with shoulder stiffness after arthroscopic RC repair. Therefore, strategies to ameliorate EPOP could be opted to decrease rate of POSS. Level of evidence Level IV

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Incidence and prognostic factors for postoperative frozen shoulder after shoulder surgery: a prospective cohort study

Abstract: Level II, prospective cohort study.

Cited by 41 publications

References 27 publications

Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial

Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial

Risk Factors for Shoulder Stiffness: Current Concepts

Early postoperative pain as a risk factor of shoulder stiffness after arthroscopic rotator cuff repair

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