Stiffness No Obstacle to Shoulder Surgery

Glenohumeral joint capsule release at time of rotator cuff surgery may lead to better outcomes than rotator cuff surgery alone

(RxWiki News) When dealing with torn shoulder tendons, surgery may be the best option to lessen pain and improve function. Although doctors must consider several factors before recommending surgery, relieving shoulder stiffness can be part of the solution rather than the problem.

Surgical repair of rotator cuff tears need not wait until shoulder stiffness is resolved, according to a new study.

Jordan McGrath, of the Orthopaedic Research Institute in Sydney, Australia, and colleagues studied nearly 200 patients who needed rotator cuff repair surgery. Just over 10 percent of those patients also had shoulder stiffness.

Patients who had an extra procedure to relieve stiffness at the time of the surgery had similar recovery to those without shoulder stiffness, McGrath and team found.

Two years after surgery, both groups had less pain and better range of motion and function than before the procedures. Patients who received both procedures had no re-tear of the shoulder at the two-year checkup, as compared to 20 percent re-tears among those who had only rotator cuff repairs.

"Physicians may be inclined to postpone surgery on patients with shoulder stiffness, but our research suggests that may not be the best treatment approach," McGrath said in a press release.

A rotator cuff tear is a common cause of pain and disability among adults. Nearly 2 million people in the US saw their doctors for rotator cuff problems in 2008, according to the American Academy of Orthopaedic Surgeons.

The rotator cuff, which keeps the arm in the shoulder socket, is a network of four muscles that come together as tendons to cover the head of the upper arm bone. These tendons attach the upper arm to the shoulder blade and help lift and rotate the arm. Partial or complete tears of the tendons weaken the shoulder and can make daily activities painful.

The procedure designed to relieve shoulder stiffness, known as glenohumeral joint capsule release, involves manipulation of a patient's shoulder under anesthesia.

"The good outcomes of rotator cuff repair with glenohumeral joint capsule release suggest that there is no advantage in delaying surgical repair of a rotator cuff tear to allow for stiffness to resolve," McGrath and team wrote. "In contradistinction, the data presented in this paper suggests that shoulder stiffness with glenohumeral joint capsule release confers an advantage in terms of repair integrity."

This research was presented March 28 at the American Orthopaedic Society for Sports Medicine's 2015 Specialty Day. Research presented at conferences may not have been peer-reviewed.

The authors disclosed no funding sources or conflicts of interest.

Review Date: 
March 27, 2015