Risk Factors for Shoulder Stiffness: Current Concepts

Abstract

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.

Shoulder Stiffness – How to Treat?

“…The etiology of primary shoulder stiffness has not been finally elucidated, but several risk factors have been described. Hormonal and metabolic disorders such as diabetes and hyper-and hypothyroidism play a significant role in the development of shoulder stiffness and results of the most recent studies suggest that an underlying aspecific pro-inflammatory condition could predispose to development of the disease [6]. The treatment of shoulder stiffness is guided by the patientʼs clinical situation and the disease stage, which is usually classified according to Reeves, although classifications based on histopathological findings are also available [7,8].…”

Donuk Omuzda Konvansi̇yonel Ultrason İle Yüksek Güçte Ağri Sinirinda Ultrasonun Etki̇nli̇ği̇ni̇n Karşilaştirilmasi Donuk Omuzda İki̇ Farkli Ultrason Uygulama Tekni̇ği̇

“…Donuk omuzun etiyolojisi ve doğal seyri hakkında kesin bir bilgi yoktur (4). Bazı çalışmalarda donuk omuz etiyolojisi, diabetes mellitus, otoimmün hastalıklar, tiroid disfonksiyonu, dupuytren kontraktürü ve meme kanseri ile ilişkili bulunmuştur (5)(6)(7)(8). Spontan olarak gelişen primer donuk omuz, klinik olarak üç evrede incelenmektedir (9).…”

Clinical effectiveness of non-surgical interventions for primary frozen shoulder: A systematic review

“…A definitive understanding of the pathogenesis of FS remains elusive (11). Inflammation, fibrosis and contraction of the glenohumeral joint capsule are suggested to explain the symptoms (12) and may be triggered by increased expression of cytokines and neuropeptides (11).…”

“…A definitive understanding of the pathogenesis of FS remains elusive (11). Inflammation, fibrosis and contraction of the glenohumeral joint capsule are suggested to explain the symptoms (12) and may be triggered by increased expression of cytokines and neuropeptides (11). However, capsular contraction may not be the only explanation; a small pilot study (n = 5) by Hollmann et al (13) reported that, when given a general anaesthetic, people presenting with FS exhibited increased range of movement in shoulder elevation (minimum increase 55°, maximum 110°), suggesting that muscle guarding may partly explain the movement restriction in a percentage of people with FS.…”

“…However, capsular contraction may not be the only explanation; a small pilot study (n = 5) by Hollmann et al (13) reported that, when given a general anaesthetic, people presenting with FS exhibited increased range of movement in shoulder elevation (minimum increase 55°, maximum 110°), suggesting that muscle guarding may partly explain the movement restriction in a percentage of people with FS. FS appears to be most common in people aged in their 50s and 60s (14), and so may relate to genetic (15) or endocrine disorders, such as diabetes and thyroid problems that may become more prevalent at this time (11). FS has been described to occur in 3 transitionary phases: increasing pain and progressive stiffness, ongoing stiffness and decreasing pain, and a resolution phase, in which the remaining pain settles, and movement improves (2,8,16).…”