Management of shoulder stiffness following rotator cuff repair: a systematic review and meta-analysis

Abstract

The purpose was to systematically review and synthesize the literature on treatment modalities for shoulder stiffness following rotator cuff repair (RCR) and investigate which modality provides the greatest postoperative range of motion (ROM). A search was performed on PubMed, Embase, and Cochrane. Clinical case series and comparative studies that report pre- and posttreatment ROM of shoulder stiffness following RCR were included. Studies that exclusively assess idiopathic frozen shoulder or primary shoulder stiffness were excluded. Five eligible studies that reported on a total of 177 patients who underwent treatment for shoulder stiffness following RCR were included. The ranges of postoperative ROM following arthroscopic capsular release were 158°-166° for active forward elevation (AFE) and 53°-59° for external rotation (ER). The ranges of postoperative ROM following infiltration were 146°-163° for AFE and 34°-35° for ER. The ranges of postoperative ROM following rehabilitation were 166° for AFE and 62° for ER. For AFE, 4 studies (5 data sets) were eligible for meta-analysis, which indicated better AFE when treated with a mean difference (MD) of 5.10° with no heterogeneity (I2 = 0%, CI, 0.83-9.38). For ER, 3 studies (4 data sets) were eligible for meta-analysis, which indicated better ER without treatment with an MD of 4.59° with no heterogeneity (I2 = 0%, CI, −7.04 to −2.13). For the treatment of shoulder stiffness following RCR, all included treatments improved the ROM, resulting in comparable AFE and ER compared to the comparative group. Among the treatment modalities, arthroscopic capsular release granted the greatest posttreatment AFE, while rehabilitation granted the greatest posttreatment ER. The purpose was to systematically review and synthesize the literature on treatment modalities for shoulder stiffness following rotator cuff repair (RCR) and investigate which modality provides the greatest postoperative range of motion (ROM). A search was performed on PubMed, Embase, and Cochrane. Clinical case series and comparative studies that report pre- and posttreatment ROM of shoulder stiffness following RCR were included. Studies that exclusively assess idiopathic frozen shoulder or primary shoulder stiffness were excluded. Five eligible studies that reported on a total of 177 patients who underwent treatment for shoulder stiffness following RCR were included. The ranges of postoperative ROM following arthroscopic capsular release were 158°-166° for active forward elevation (AFE) and 53°-59° for external rotation (ER). The ranges of postoperative ROM following infiltration were 146°-163° for AFE and 34°-35° for ER. The ranges of postoperative ROM following rehabilitation were 166° for AFE and 62° for ER. For AFE, 4 studies (5 data sets) were eligible for meta-analysis, which indicated better AFE when treated with a mean difference (MD) of 5.10° with no heterogeneity (I2 = 0%, CI, 0.83-9.38). For ER, 3 studies (4 data sets) were eligible for meta-analysis, which indicated better ER without treatment with an MD of 4.59° with no heterogeneity (I2 = 0%, CI, −7.04 to −2.13). For the treatment of shoulder stiffness following RCR, all included treatments improved the ROM, resulting in comparable AFE and ER compared to the comparative group. Among the treatment modalities, arthroscopic capsular release granted the greatest posttreatment AFE, while rehabilitation granted the greatest posttreatment ER. Rotator cuff pathology is one of the most common causes of shoulder pain, with an overall incidence of 3.7 patients per 100,000.4Bhatia S. Mather 3rd, R.C. Hsu A.R. Ferry A.T. Romeo A.A. Nicholson G.P. et al.Arthroscopic management of recalcitrant stiffness following rotator cuff repair: a retrospective analysis.Indian J Orthop. 2013; 47: 143-149https://doi.org/10.4103/0019-5413.108892Crossref PubMed Scopus (7) Google Scholar,7Clayton R.A. Court-Brown C.M. The epidemiology of musculoskeletal tendinous and ligamentous injuries.Injury. 2008; 39: 1338-1344https://doi.org/10.1016/j.injury.2008.06.021Abstract Full Text Full Text PDF PubMed Scopus (530) Google Scholar Results of both open and arthroscopic rotator cuff repairs (RCRs) have proven adequate pain relief, increased shoulder function, and improved patient satisfaction.1Anderson K. Boothby M. Aschenbrener D. van Holsbeeck M. Outcome and structural integrity after arthroscopic rotator cuff repair using 2 rows of fixation: minimum 2-year follow-up.Am J Sports Med. 2006; 34: 1899-1905https://doi.org/10.1177/0363546506290187Crossref PubMed Scopus (181) Google Scholar,3Baysal D. Balyk R. Otto D. Luciak-Corea C. Beaupre L. Functional outcome and health-related quality of life after surgical repair of full-thickness rotator cuff tear using a mini-open technique.Am J Sports Med. 2005; 33: 1346-1355https://doi.org/10.1177/0363546505275130Crossref PubMed Scopus (82) Google Scholar,6Burkhart S.S. Lo I.K. Arthroscopic rotator cuff repair.J Am Acad Orthop Surg. 2006; 14: 333-346https://doi.org/10.5435/00124635-200606000-00003Crossref PubMed Scopus (158) Google Scholar,26Wolf E.M. Pennington W.T. Agrawal V. Arthroscopic rotator cuff repair: 4- to 10-year results.Arthroscopy. 2004; 20: 5-12https://doi.org/10.1016/j.arthro.2003.11.001Abstract Full Text Full Text PDF PubMed Scopus (140) Google Scholar Postoperative shoulder stiffness is a known complication of both open and arthroscopic surgery and is believed to result from an intra-articular inflammatory process that leads to thickening and fibrosis of the joint capsule.5Brislin K.J. Field L.D. Savoie 3rd, F.H. Complications after arthroscopic rotator cuff repair.Arthroscopy. 2007; 23: 124-128https://doi.org/10.1016/j.arthro.2006.09.001Abstract Full Text Full Text PDF PubMed Scopus (237) Google Scholar,25Weber S.C. Abrams J.S. Nottage W.M. Complications associated with arthroscopic shoulder surgery.Arthroscopy. 2002; 18: 88-95https://doi.org/10.1053/jars.2002.31801Abstract Full Text Full Text PDF PubMed Scopus (195) Google Scholar The prevalence of postoperative resistant stiffness (defined as permanent range of motion [ROM] loss) or transient stiffness (defined as [ROM] loss which responds to nonoperative treatment) following arthroscopic surgery is considerable and ranges from 3% to 23%,8Denard P.J. Lädermann A. Burkhart S.S. Prevention and management of stiffness after arthroscopic rotator cuff repair: systematic review and implications for rotator cuff healing.Arthroscopy. 2011; 27: 842-848https://doi.org/10.1016/j.arthro.2011.01.013Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar,21Parsons B.O. Gruson K.I. Chen D.D. Harrison A.K. Gladstone J. Flatow E.L. Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness?.J Shoulder Elbow Surg. 2010; 19: 1034-1039https://doi.org/10.1016/j.jse.2010.04.006Abstract Full Text Full Text PDF PubMed Scopus (145) Google Scholar and may cause patients to be dissatisfied with surgery even though their rotator cuff tear is successfully repaired. Furthermore, it is important to identify risk factors which are associated with shoulder stiffness, a recent study found a greater prevalence in women, in shoulders with partial tears, low-baseline passive abduction, nondegenerative tears, and in those treated without acromioplasty.2Audige L. Aghlmandi S. Grobet C. Stojanov T. Muller A.M. Felsch Q. et al.Prediction of shoulder stiffness after arthroscopic rotator cuff repair.Am J Sports Med. 2021; 49: 3030-3039https://doi.org/10.1177/03635465211028980Crossref PubMed Scopus (9) Google Scholar Treatments of postoperative shoulder stiffness include conservative and operative modalities, both of which can be challenging. To the authors knowledge there is no consensus regarding the best treatment for postoperative shoulder stiffness following RCR. Over 10 years ago, Denard et al8Denard P.J. Lädermann A. Burkhart S.S. Prevention and management of stiffness after arthroscopic rotator cuff repair: systematic review and implications for rotator cuff healing.Arthroscopy. 2011; 27: 842-848https://doi.org/10.1016/j.arthro.2011.01.013Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar performed a systematic review, including 2 studies,15Koo S.S. Parsley B.K. Burkhart S.S. Schoolfield J.D. Reduction of postoperative stiffness after arthroscopic rotator cuff repair: results of a customized physical therapy regimen based on risk factors for stiffness.Arthroscopy. 2011; 27: 155-160https://doi.org/10.1016/j.arthro.2010.07.007Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar,21Parsons B.O. Gruson K.I. Chen D.D. Harrison A.K. Gladstone J. Flatow E.L. Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness?.J Shoulder Elbow Surg. 2010; 19: 1034-1039https://doi.org/10.1016/j.jse.2010.04.006Abstract Full Text Full Text PDF PubMed Scopus (145) Google Scholar on treatment of postoperative shoulder stiffness and found that the best improvement was achieved by a capsular release. However, since then, several new clinical studies were published,4Bhatia S. Mather 3rd, R.C. Hsu A.R. Ferry A.T. Romeo A.A. Nicholson G.P. et al.Arthroscopic management of recalcitrant stiffness following rotator cuff repair: a retrospective analysis.Indian J Orthop. 2013; 47: 143-149https://doi.org/10.4103/0019-5413.108892Crossref PubMed Scopus (7) Google Scholar,14Kim I.B. Jung D.W. An Intra-articular steroid injection at 6 weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair does not affect repair integrity.Am J Sports Med. PubMed Scopus Google of injection after arthroscopic rotator cuff repair: Orthop Surg. 2011; PubMed Scopus Google Scholar and their are to be an systematic the purpose of the systematic review was to synthesize the literature on treatment modalities for shoulder stiffness following RCR and investigate which modality provides the greatest postoperative The for systematic review was to to and to the in the of the D. et for risk of in 2011; Scopus Google Scholar with the by the for and D. et for a systematic review and of the PubMed Scopus Google Scholar The authors a literature search on using the PubMed, Embase, and of the in The search was to and to a systematic review, in of of surgical of of the and to the for the review using the following case series and comparative studies on of treatments for shoulder stiffness following that report and of patient the most was studies that exclusively assess idiopathic frozen shoulder or primary shoulder that not report and or systematic case case or to in or review of studies the in the was performed by and was the when a was The of studies for review were and an on the was to identify studies that may not have by the was performed by and their results were compared to there was in the the was by review of the data in by both The following data were from the included of of study was of and were including of patients in and Furthermore, clinical Shoulder and Elbow the pain on and ROM forward elevation and external rotation quality of the eligible studies was by to the to the quality there was the consensus was achieved by and the of studies were not comparable to results were in a and the T. C. A. including studies of a PubMed Scopus Google Scholar was by of the and using the to a of the of the in PubMed Scopus Google Scholar of with were using a were performed using for using the The systematic search of which were for A total of studies were by their and a studies were after eligible S. Mather 3rd, R.C. Hsu A.R. Ferry A.T. Romeo A.A. Nicholson G.P. et al.Arthroscopic management of recalcitrant stiffness following rotator cuff repair: a retrospective analysis.Indian J Orthop. 2013; 47: 143-149https://doi.org/10.4103/0019-5413.108892Crossref PubMed Scopus (7) Google Schoolfield J.D. Burkhart S.S. and treatment of postoperative stiffness following arthroscopic rotator cuff repair.Arthroscopy. Full Text Full Text PDF PubMed Scopus Google Scholar,14Kim I.B. Jung D.W. An Intra-articular steroid injection at 6 weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair does not affect repair integrity.Am J Sports Med. PubMed Scopus Google of injection after arthroscopic rotator cuff repair: Orthop Surg. 2011; PubMed Scopus Google Scholar,21Parsons B.O. Gruson K.I. Chen D.D. Harrison A.K. Gladstone J. Flatow E.L. Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness?.J Shoulder Elbow Surg. 2010; 19: 1034-1039https://doi.org/10.1016/j.jse.2010.04.006Abstract Full Text Full Text PDF PubMed Scopus (145) Google Scholar which reported on a total of 177 patients that underwent treatment for shoulder stiffness following RCR for patients in the 4 studies were eligible for et of injection after arthroscopic rotator cuff repair: Orthop Surg. 2011; PubMed Scopus Google Scholar injection and in the treatment and compared to a while 3 Schoolfield J.D. Burkhart S.S. and treatment of postoperative stiffness following arthroscopic rotator cuff repair.Arthroscopy. Full Text Full Text PDF PubMed Scopus Google Scholar,14Kim I.B. Jung D.W. An Intra-articular steroid injection at 6 weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair does not affect repair integrity.Am J Sports Med. PubMed Scopus Google Scholar,21Parsons B.O. Gruson K.I. Chen D.D. Harrison A.K. Gladstone J. Flatow E.L. Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness?.J Shoulder Elbow Surg. 2010; 19: 1034-1039https://doi.org/10.1016/j.jse.2010.04.006Abstract Full Text Full Text PDF PubMed Scopus (145) Google Scholar shoulders treated for stiffness as treatment shoulders that no stiffness as and for shoulder et S. Mather 3rd, R.C. Hsu A.R. Ferry A.T. Romeo A.A. Nicholson G.P. et al.Arthroscopic management of recalcitrant stiffness following rotator cuff repair: a retrospective analysis.Indian J Orthop. 2013; 47: 143-149https://doi.org/10.4103/0019-5413.108892Crossref PubMed Scopus (7) Google J capsular comparative et B.O. Gruson K.I. Chen D.D. Harrison A.K. Gladstone J. Flatow E.L. Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness?.J Shoulder Elbow Surg. 2010; 19: 1034-1039https://doi.org/10.1016/j.jse.2010.04.006Abstract Full Text Full Text PDF PubMed Scopus (145) Google with stiffness, without et of injection after arthroscopic rotator cuff repair: Orthop Surg. 2011; PubMed Scopus Google in injection of et I.B. Jung D.W. An Intra-articular steroid injection at 6 weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair does not affect repair integrity.Am J Sports Med. PubMed Scopus Google steroid injection 6 weeks after steroid injection weeks stiffness, without et Schoolfield J.D. Burkhart S.S. and treatment of postoperative stiffness following arthroscopic rotator cuff repair.Arthroscopy. Full Text Full Text PDF PubMed Scopus Google capsular with stiffness, without RCR, rotator cuff of of Shoulder and Elbow of Sports not in a new RCR, rotator cuff of of Shoulder and Elbow of Sports not the included 3 were performed in the S. Mather 3rd, R.C. Hsu A.R. Ferry A.T. Romeo A.A. Nicholson G.P. et al.Arthroscopic management of recalcitrant stiffness following rotator cuff repair: a retrospective analysis.Indian J Orthop. 2013; 47: 143-149https://doi.org/10.4103/0019-5413.108892Crossref PubMed Scopus (7) Google Schoolfield J.D. Burkhart S.S. and treatment of postoperative stiffness following arthroscopic rotator cuff repair.Arthroscopy. Full Text Full Text PDF PubMed Scopus Google Scholar,21Parsons B.O. Gruson K.I. Chen D.D. Harrison A.K. Gladstone J. Flatow E.L. Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness?.J Shoulder Elbow Surg. 2010; 19: 1034-1039https://doi.org/10.1016/j.jse.2010.04.006Abstract Full Text Full Text PDF PubMed Scopus (145) Google Scholar and 2 were performed in I.B. Jung D.W. An Intra-articular steroid injection at 6 weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair does not affect repair integrity.Am J Sports Med. PubMed Scopus Google of injection after arthroscopic rotator cuff repair: Orthop Surg. 2011; PubMed Scopus Google Scholar studies compared to a that underwent no treatment Schoolfield J.D. Burkhart S.S. and treatment of postoperative stiffness following arthroscopic rotator cuff repair.Arthroscopy. Full Text Full Text PDF PubMed Scopus Google Scholar,14Kim I.B. Jung D.W. An Intra-articular steroid injection at 6 weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair does not affect repair integrity.Am J Sports Med. PubMed Scopus Google Scholar study compared to treatment of injection after arthroscopic rotator cuff repair: Orthop Surg. 2011; PubMed Scopus Google Scholar and was a case series S. Mather 3rd, R.C. Hsu A.R. Ferry A.T. Romeo A.A. Nicholson G.P. et al.Arthroscopic management of recalcitrant stiffness following rotator cuff repair: a retrospective analysis.Indian J Orthop. 2013; 47: 143-149https://doi.org/10.4103/0019-5413.108892Crossref PubMed Scopus (7) Google Scholar The case studies not identify Schoolfield J.D. Burkhart S.S. and treatment of postoperative stiffness following arthroscopic rotator cuff repair.Arthroscopy. Full Text Full Text PDF PubMed Scopus Google Scholar,14Kim I.B. Jung D.W. An Intra-articular steroid injection at 6 weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair does not affect repair integrity.Am J Sports Med. PubMed Scopus Google of injection after arthroscopic rotator cuff repair: Orthop Surg. 2011; PubMed Scopus Google Scholar,21Parsons B.O. Gruson K.I. Chen D.D. Harrison A.K. Gladstone J. Flatow E.L. Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness?.J Shoulder Elbow Surg. 2010; 19: 1034-1039https://doi.org/10.1016/j.jse.2010.04.006Abstract Full Text Full Text PDF PubMed Scopus (145) Google Scholar and study not and Schoolfield J.D. Burkhart S.S. and treatment of postoperative stiffness following arthroscopic rotator cuff repair.Arthroscopy. Full Text Full Text PDF PubMed Scopus Google Scholar Furthermore, the case series not the in a S. Mather 3rd, R.C. Hsu A.R. Ferry A.T. Romeo A.A. Nicholson G.P. et al.Arthroscopic management of recalcitrant stiffness following rotator cuff repair: a retrospective analysis.Indian J Orthop. 2013; 47: 143-149https://doi.org/10.4103/0019-5413.108892Crossref PubMed Scopus (7) Google Scholar for case in a new for case in a new studies reported the ROM and after treatment for shoulder 2 arthroscopic capsular S. Mather 3rd, R.C. Hsu A.R. Ferry A.T. Romeo A.A. Nicholson G.P. et al.Arthroscopic management of recalcitrant stiffness following rotator cuff repair: a retrospective analysis.Indian J Orthop. 2013; 47: 143-149https://doi.org/10.4103/0019-5413.108892Crossref PubMed Scopus (7) Google Schoolfield J.D. Burkhart S.S. and treatment of postoperative stiffness following arthroscopic rotator cuff repair.Arthroscopy. Full Text Full Text PDF PubMed Scopus Google Scholar 2 intra-articular or I.B. Jung D.W. An Intra-articular steroid injection at 6 weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair does not affect repair integrity.Am J Sports Med. PubMed Scopus Google of injection after arthroscopic rotator cuff repair: Orthop Surg. 2011; PubMed Scopus Google Scholar and B.O. Gruson K.I. Chen D.D. Harrison A.K. Gladstone J. Flatow E.L. Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness?.J Shoulder Elbow Surg. 2010; 19: 1034-1039https://doi.org/10.1016/j.jse.2010.04.006Abstract Full Text Full Text PDF PubMed Scopus (145) Google Scholar The ranges of ROM following arthroscopic capsular release were 158°-166° for AFE and 53°-59° for S. Mather 3rd, R.C. Hsu A.R. Ferry A.T. Romeo A.A. Nicholson G.P. et al.Arthroscopic management of recalcitrant stiffness following rotator cuff repair: a retrospective analysis.Indian J Orthop. 2013; 47: 143-149https://doi.org/10.4103/0019-5413.108892Crossref PubMed Scopus (7) Google Schoolfield J.D. Burkhart S.S. and treatment of postoperative stiffness following arthroscopic rotator cuff repair.Arthroscopy. Full Text Full Text PDF PubMed Scopus Google Scholar The ranges of ROM following infiltration were 146°-163° for AFE and 34°-35° for I.B. Jung D.W. An Intra-articular steroid injection at 6 weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair does not affect repair integrity.Am J Sports Med. PubMed Scopus Google of injection after arthroscopic rotator cuff repair: Orthop Surg. 2011; PubMed Scopus Google Scholar The ROM following rehabilitation were 166° for AFE and 62° for B.O. Gruson K.I. Chen D.D. Harrison A.K. Gladstone J. Flatow E.L. Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness?.J Shoulder Elbow Surg. 2010; 19: 1034-1039https://doi.org/10.1016/j.jse.2010.04.006Abstract Full Text Full Text PDF PubMed Scopus (145) Google Scholar For AFE, 4 studies (5 were eligible for meta-analysis, which indicated better AFE in the treatment to with a mean difference (MD) of and no heterogeneity (I2 = 0%, CI, For ER, 3 studies (4 were eligible for meta-analysis, which indicated better ER in to treatment with a MD of and no heterogeneity (I2 = 0%, CI, −7.04 to et S. Mather 3rd, R.C. Hsu A.R. Ferry A.T. Romeo A.A. Nicholson G.P. et al.Arthroscopic management of recalcitrant stiffness following rotator cuff repair: a retrospective analysis.Indian J Orthop. 2013; 47: 143-149https://doi.org/10.4103/0019-5413.108892Crossref PubMed Scopus (7) Google comparative et B.O. Gruson K.I. Chen D.D. Harrison A.K. Gladstone J. Flatow E.L. Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness?.J Shoulder Elbow Surg. 2010; 19: 1034-1039https://doi.org/10.1016/j.jse.2010.04.006Abstract Full Text Full Text PDF PubMed Scopus (145) Google with stiffness, without et of injection after arthroscopic rotator cuff repair: Orthop Surg. 2011; PubMed Scopus Google et I.B. Jung D.W. An Intra-articular steroid injection at 6 weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair does not affect repair integrity.Am J Sports Med. PubMed Scopus Google stiffness, without et Schoolfield J.D. Burkhart S.S. and treatment of postoperative stiffness following arthroscopic rotator cuff repair.Arthroscopy. Full Text Full Text PDF PubMed Scopus Google with stiffness, without in are in a new forward mean mean et S. Mather 3rd, R.C. Hsu A.R. Ferry A.T. Romeo A.A. Nicholson G.P. et al.Arthroscopic management of recalcitrant stiffness following rotator cuff repair: a retrospective analysis.Indian J Orthop. 2013; 47: 143-149https://doi.org/10.4103/0019-5413.108892Crossref PubMed Scopus (7) Google comparative et B.O. Gruson K.I. Chen D.D. Harrison A.K. Gladstone J. Flatow E.L. Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness?.J Shoulder Elbow Surg. 2010; 19: 1034-1039https://doi.org/10.1016/j.jse.2010.04.006Abstract Full Text Full Text PDF PubMed Scopus (145) Google with stiffness, et of injection after arthroscopic rotator cuff repair: Orthop Surg. 2011; PubMed Scopus Google et I.B. Jung D.W. An Intra-articular steroid injection at 6 weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair does not affect repair integrity.Am J Sports Med. PubMed Scopus Google at 6 weeks at weeks stiffness, without et Schoolfield J.D. Burkhart S.S. and treatment of postoperative stiffness following arthroscopic rotator cuff repair.Arthroscopy. Full Text Full Text PDF PubMed Scopus Google with stiffness, without no AFE, forward ER, external ROM, range of in to the as to comparative and in a new of external mean CI, in are no AFE, forward ER, external ROM, range of in to the as to comparative and studies reported the and after treatment for shoulder S. Mather 3rd, R.C. Hsu A.R. Ferry A.T. Romeo A.A. Nicholson G.P. et al.Arthroscopic management of recalcitrant stiffness following rotator cuff repair: a retrospective analysis.Indian J Orthop. 2013; 47: 143-149https://doi.org/10.4103/0019-5413.108892Crossref PubMed Scopus (7) Google Scholar,14Kim I.B. Jung D.W. An Intra-articular steroid injection at 6 weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair does not affect repair integrity.Am J Sports Med. PubMed Scopus Google of injection after arthroscopic rotator cuff repair: Orthop Surg. 2011; PubMed Scopus Google Scholar The postoperative following arthroscopic capsular release were for for and for S. Mather 3rd, R.C. Hsu A.R. Ferry A.T. Romeo A.A. Nicholson G.P. et al.Arthroscopic management of recalcitrant stiffness following rotator cuff repair: a retrospective analysis.Indian J Orthop. 2013; 47: 143-149https://doi.org/10.4103/0019-5413.108892Crossref PubMed Scopus (7) Google Scholar The postoperative following infiltration were for and for I.B. Jung D.W. An Intra-articular steroid injection at 6 weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair does not affect repair integrity.Am J Sports Med. PubMed Scopus Google of injection after arthroscopic rotator cuff repair: Orthop Surg. 2011; PubMed Scopus Google Scholar The postoperative following rehabilitation were for for and for B.O. Gruson K.I. Chen D.D. Harrison A.K. Gladstone J. Flatow E.L. Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness?.J Shoulder Elbow Surg. 2010; 19: 1034-1039https://doi.org/10.1016/j.jse.2010.04.006Abstract Full Text Full Text PDF PubMed Scopus (145) Google Scholar was not performed on the clinical to heterogeneity in reported on mean treatment mean mean treatment mean mean mean mean mean et S. Mather 3rd, R.C. Hsu A.R. Ferry A.T. Romeo A.A. Nicholson G.P. et al.Arthroscopic management of recalcitrant stiffness following rotator cuff repair: a retrospective analysis.Indian J Orthop. 2013; 47: 143-149https://doi.org/10.4103/0019-5413.108892Crossref PubMed Scopus (7) Google comparative et B.O. Gruson K.I. Chen D.D. Harrison A.K. Gladstone J. Flatow E.L. Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness?.J Shoulder Elbow Surg. 2010; 19: 1034-1039https://doi.org/10.1016/j.jse.2010.04.006Abstract Full Text Full Text PDF PubMed Scopus (145) Google with stiffness, without et of injection after arthroscopic rotator cuff repair: Orthop Surg. 2011; PubMed Scopus Google et I.B. Jung D.W. An Intra-articular steroid injection at 6 weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair does not affect repair integrity.Am J Sports Med. PubMed Scopus Google at 6 weeks at weeks stiffness, without et Schoolfield J.D. Burkhart S.S. and treatment of postoperative stiffness following arthroscopic rotator cuff repair.Arthroscopy. Full Text Full Text PDF PubMed Scopus Google with stiffness, without no Shoulder and Elbow in to the as to comparative and in a new no Shoulder and Elbow in to the as to comparative and The most important of systematic review are for the treatment of shoulder stiffness following RCR, all included treatments improved the ROM, resulting in AFE and ER compared to the Among the treatment modalities, arthroscopic capsular release granted the greatest AFE, while rehabilitation granted the greatest ER. was considerable heterogeneity the in of at which were it to on the best treatment for shoulder stiffness following RCR. clinical studies are to better on the best treatment for postoperative shoulder stiffness, which to and Shoulder stiffness is a common and important complication after arthroscopic K.J. Field L.D. Savoie 3rd, F.H. Complications after arthroscopic rotator cuff repair.Arthroscopy. 2007; 23: 124-128https://doi.org/10.1016/j.arthro.2006.09.001Abstract Full Text Full Text PDF PubMed Scopus (237) Google Schoolfield J.D. Burkhart S.S. and treatment of postoperative stiffness following arthroscopic rotator cuff repair.Arthroscopy. Full Text Full Text PDF PubMed Scopus Google Scholar and even though postoperative pain and of ROM to shoulder stiffness may without of injection after arthroscopic rotator cuff repair: Orthop Surg. 2011; PubMed Scopus Google K. Prevention of shoulder stiffness after rotator cuff Orthop 2005; PubMed Scopus Google Scholar postoperative shoulder stiffness may cause pain that can Furthermore, shoulder stiffness following RCR may not with and physical to or capsular and Am Acad Orthop Surg. PubMed Google Scholar nonoperative treatment for stiffness following RCR may be a for in which surgical may be the systematic review, 2 of the included studies the of arthroscopic capsular release. et S. Mather 3rd, R.C. Hsu A.R. Ferry A.T. Romeo A.A. Nicholson G.P. et al.Arthroscopic management of recalcitrant stiffness following rotator cuff repair: a retrospective analysis.Indian J Orthop. 2013; 47: 143-149https://doi.org/10.4103/0019-5413.108892Crossref PubMed Scopus (7) Google Scholar found arthroscopic capsular release of and physical to be and for shoulder motion in with stiffness and that AFE and ER improved in recalcitrant et Schoolfield J.D. Burkhart S.S. and treatment of postoperative stiffness following arthroscopic rotator cuff repair.Arthroscopy. Full Text Full Text PDF PubMed Scopus Google Scholar found in a series of arthroscopic postoperative stiffness, that arthroscopic capsular release ROM in all et Schoolfield J.D. Burkhart S.S. and treatment of postoperative stiffness following arthroscopic rotator cuff repair.Arthroscopy. Full Text Full Text PDF PubMed Scopus Google Scholar found that risk factors for postoperative stiffness following RCR were cuff and Intra-articular injection is a common treatment for primary frozen with long-term results by improvement of ROM and of K. C. R. D. D. management of of the intra-articular Shoulder Elbow Surg. 2010; 19: Full Text Full Text PDF PubMed Scopus Google Scholar and the of intra-articular steroid for can results in an in AFE postoperative Among the studies included in the systematic review, et I.B. Jung D.W. An Intra-articular steroid injection at 6 weeks postoperatively for shoulder stiffness after arthroscopic rotator cuff repair does not affect repair integrity.Am J Sports Med. PubMed Scopus Google Scholar found that injection of intra-articular pain and et of injection after arthroscopic rotator cuff repair: Orthop Surg. 2011; PubMed Scopus Google Scholar of as an and found a for improvement in forward at 2 weeks The and of reported in and S. C. S. et of postoperative and by a Google V. T. Reduction of postoperative with an in a 2006; PubMed Scopus Google Scholar The of as a conservative treatment of rotator cuff and shoulder pain An of treatment for shoulder J Orthop 2005; 34: Google K. M. Clinical of for the treatment of patients with rotator cuff Shoulder Elbow Surg. Full Text Full Text PDF PubMed Scopus Google Scholar that stiffness is one of the important after shoulder there is to no data on the of in the shoulder after RCR. The results of the systematic review be with the following in The comparative studies found of with injection and and the 3 studies shoulders treated for stiffness shoulders that no stiffness was considerable heterogeneity the in of at which were it to on the best treatment for shoulder stiffness following RCR. the overall of quality was to for the of 4 were comparative while was a case Furthermore, included studies which reported of even though as of the patient are it is that since the systematic review, studies have in recent a for new studies and on For the treatment of shoulder stiffness following RCR, all included treatments improved the ROM, resulting in AFE and ER compared to the Among the treatment modalities, the 2 studies that AFE arthroscopic capsular while the study that ER

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