LYON, France — Patients who had preoperative shoulder stiffness and those who developed stiffness at 6 weeks and 12 weeks postoperatively after rotator cuff repair were less likely to experience a re-tear compared with patients who had no stiffness, according to results presented here.
“Our study has shown that a stiff shoulder is more painful and has greater loss of function,” medical student William McNamara said. “Shoulders that are stiff preoperatively are more likely to be stiff postoperatively. Shoulders that are stiff postoperatively are less likely to re-tear and more likely to have better outcomes at 6 months post-surgery.”
McNamara and his colleagues included patients who had a primary rotator cuff tear with subsequent arthroscopic rotator cuff repair and an ultrasound examination at 6 months postoperatively to determine cuff integrity. The primary outcomes included the effect of preoperative and postoperative shoulder stiffness or repair integrity at 6 months post-surgery. The researchers’ primary measurement of shoulder stiffness was examiner-ranked passive range of shoulder motion in external rotation, internal rotation, forward flexion and abduction. Measurements were recorded preoperatively and at 6 weeks, 12 weeks and 6 months postoperatively.
Investigators found a 15% re-tear rate among the 1,500 shoulders examined in the study. McNamara noted a 17% loss of shoulder motion at 6 weeks with partial recovery at 12 weeks post-surgery and a full recovery at 6 months across all range of motion measurements.
“We found no association between preoperative and 6 months postoperative range of motion and re-tear,” McNamara said. “However, when we looked at 6 [weeks] and 12 weeks post-surgery, we found a significant correlation across all four range of motions, whereby stiff shoulders at 6 weeks and 12 weeks were less likely to re-tear at 6 months.”
McNamara also noted shoulders that were stiff preoperatively were more likely to be stiff postoperatively and a decrease in shoulder range of motion was associated with increased reports of pain with decreased function and lower patient satisfaction.
Post hoc analysis
In a post hoc analysis, McNamara and his colleagues categorized patients into stiff and non-stiff shoulder groups based on examiner-ranked external rotation 6 weeks post-surgery. Patients in the non-stiff group had a range of motion greater than 20° and patients in the stiff shoulder group had a range of motion less than 20°, according to study results. McNamara noted a significant difference between the groups at 6 weeks and 12 weeks postsurgery across all ranges of motion.
“Looking at our re-tear rate, in non-stiff shoulders there was a 15% re-tear rate, which reflects that of our total group,” McNamara said. “Then we look at our stiff shoulders, they have half the re-tear rate of the non-stiff group at a highly significant level.” – by Casey Tingle
- McNamara W, et al. Paper #12. Presented at: International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Biennial Congress; June 7-11, 2015; Lyon, France.
- For more information:
- William McNamara can be reached at St. George Hospital Orthopaedic Research Institute, 4-10 South St., Kogarah NSW 2217, Australia; email: firstname.lastname@example.org.
Disclosure: McNamara reports no relevant financial disclosures.