Management of the stiff shoulder. A prospective multicenter comparative study of the six main techniques in use: 235 cases

• Published in: Orthopaedics & traumatology, surgery & research Vol. 97; no. 8; pp. S167 - S181
• Main Authors: Gleyze, P, Clavert, P, Flurin, P.-H, Laprelle, E, Katz, D, Toussaint, B, Benkalfate, T, Charousset, C, Joudet, T, Georges, T, Hubert, L, Lafosse, L, Hardy, P, Solignac, N, Lévigne, C
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.12.2011
• Subjects: Adhesive capsulitis; Adolescent; Adult; Aged; Algodystrophy; Arthrodistension; Capsulotomy; Female; Follow-Up Studies; Frozen shoulder; Humans; Joint Capsule - surgery; Joint Diseases - physiopathology; Joint Diseases - therapy; Male; Middle Aged; Orthopedic Procedures - methods; Orthopedics; Pain management; Prospective Studies; Range of Motion, Articular; Rehabilitation; Self-rehabilitation; Shoulder Joint - physiopathology; Shoulder Joint - surgery; Stiff shoulder; Surgery; Therapeutic education; Time Factors; Treatment; Treatment Outcome; Young Adult; Arthrodistension; Treatment; Capsulotomy; Pain management; Therapeutic education; Stiff shoulder; Rehabilitation; Self-rehabilitation; Frozen shoulder; Algodystrophy; Adhesive capsulitis
• ISSN: 1877-0568; 1877-0568
• DOI: 10.1016/j.otsr.2011.09.004

Summary Introduction Stiffness in the shoulder is a frequent symptom associated with a number of clinical entities whose management remains inadequately defined. Patients and methods This prospective study of 235 cases of stiffness in the shoulder compared six therapeutic techniques with a mean follow-up of 13 months (range, 3–28 months) (T1: 58 cases, conventional rehabilitation under the pain threshold, T2: 59 cases, self-rehabilitation over the pain threshold, T3: 31 cases, T2 + supervision, T4: 11 cases, T1 + capsular distension, T5: 31 cases, T1 + locoregional anesthesia, T6: 45 cases, T1 + T5 + capsulotomy). The therapeutic power of each technique and its impact on the result were assessed at each self-rehabilitation and rehabilitation session during the first 6 weeks and then at 3 months, 6 months, and at the final revision depending on subjective criteria (pain, discomfort, and morale) and objective criteria (Constant score, goniometric measurements). Results Conventional rehabilitation (T1) is less effective than self-rehabilitation over the pain threshold (T2 & T3) during the first 6 weeks ( P < 0.05). Self-rehabilitation stagnates between the 6th and 12th week except when it is supervised by a therapist (T3). Anesthesia (T4) and capsular distension (T5) do not lead to significantly different progression beyond 6 months. Capsulotomy does not demonstrate greater therapeutic power but its failure rate (persisting stiffness at 1 year) is 0% versus 14–17% for the other techniques ( P < 0.05). Discussion The techniques are complementary and therapeutic success stems from an algorithm adapted to the individual patient with, over the first 3 months, successive self-rehabilitation and conventional rehabilitation, possibly completed by capsular distension or anesthesia between the 3rd and 6th months. In case of failure at 6 months, endoscopic capsulotomy can be proposed. Therapeutic patient education and active participation are the key to treatment success or failure. Level of evidence Level III, case–control, prospective comparative.