Original article
Stiffness and Rotator Cuff Tears: Incidence, Arthroscopic Findings, and Treatment Results

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Purpose: Although stiffness of the shoulder has been evaluated after rotator cuff repair, it has not been studied in patients with cuff tears that occurred before repair. The primary purpose of this study was to determine whether preoperative stiffness persists after cuff repair. We also evaluated the incidence and possible causes of stiffness in patients who underwent arthroscopic rotator cuff repair. Methods: This was a retrospective evaluation of 72 arthroscopic patients who underwent rotator cuff repair. Preoperative range-of-motion (ROM) deficits in abduction, forward flexion, external rotation, and internal rotation were recorded and were added together to determine the total ROM deficit (TROMD). Patients were then divided into 3 groups on the basis of TROMD. Group 1 comprised 42 patients with 0° to 20° TROMD. Group 2 consisted of 24 patients with 25° to 70° TROMD, and group 3 included 6 patients with a TROMD greater than 70°. Preoperative medical history, intraoperative condition of the capsule and bursa, and cuff tear size were recorded. Results: Capsular and bursal abnormalities were more common in stiffer patients, but arthroscopic evidence of adhesive capsulitis was found only in group 3 (3 of 6 patients). Postoperatively, average TROMD deficit decreased from 10° to 4° in group 1, from 36° to 12° in group 2, and from 89° to 31° in group 3. No reoperations or postoperative manipulations were reported in group 1 or 2. In group 3, 3 patients (the only 3 with adhesive capsulitis) showed no or minimal improvement in postoperative ROM. These 3 patients required a secondary arthroscopic capsular release. After all 3 repairs had completely healed, the TROMD averaged 35° in this subgroup. Conclusions: Preoperative stiffness is common in patients who undergo rotator cuff repair. Mild and moderate stiffness generally resolve after surgery followed by routine therapy. Patients with a TROMD of 70° or more may have adhesive capsulitis as well as a cuff tear and may not do well with cuff repair alone. Level of Evidence: Level IV, case series.

Section snippets

Methods

This study was a retrospective evaluation of 74 consecutive patients with arthroscopically confirmed full-thickness tears of the rotator cuff who underwent arthroscopic rotator cuff repair. Two patients were lost to follow-up, leaving 72 patients who were followed up for 2 years. Because we specifically wanted to determine loss of passive ROM (PROM) of the glenohumeral joint only, the scapular was stabilized in each patient with a single examining hand while PROM was measured. This approach

Results

No cases of deltoid morbidity, infection, or vascular or neurologic injury were identified in this study group.

The CTI in group 1 was 3.7, in group 2, 7.7, and in group 3, 12.3 (Fig 4). ANOVA indicated that CTI was significant (P < .0001, with a power of 100). Fisher’s PLSD indicated that CTI was highly significantly different among all groups (P < .001). The average preoperative modified UCLA score was 24.7 for group 1, 21.6 for group 2, and 16.8 for group 3. The average postoperative modified

Discussion

Loss of ROM can occur after rotator cuff repair is performed.8 It was reassuring to note that patients who underwent arthroscopic rotator cuff repair in this study did not experience loss of motion as a result of the surgery. Grouping patients on the basis of degree of stiffness makes sense for study purposes. Our rationale for the exact cutoff for each group is admittedly subjective. Our preliminary studies seemed to indicate that patients with TROMD of 20° or less essentially did not have a

Conclusions

Patients with TROMD of 70° or less will be helped by an arthroscopic rotator cuff repair and routine postoperative rehabilitation. Patients with TROMD greater than 70° have a significant chance of experiencing concomitant adhesive capsulitis and should be treated nonoperatively, at least until they are out of the acute phase of capsulitis. We cannot conclude from our data the exact cause of capsulitis in these patients, but an association has been noted with the usual causes that have been

Acknowledgment

The author thanks Russell Parsons, Ph.D., for statistical advice and assistance with analysis.

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