34 research outputs found
Preoperative planning of calcium deposit removal in calcifying tendinitis of the rotator cuff - possible contribution of computed tomography, ultrasound and conventional X-Ray
Patient information in orthopedic and trauma surgery. Fundamental knowledge, legal aspects and practical recommendations
Patient information in orthopedic and trauma surgery. Fundamental knowledge, legal aspects and practical recommendations
International audienc
Effect of Hypercholesterolemia on Fatty Infiltration and Quality of Tendon-to-Bone Healing in a Rabbit Model of a Chronic Rotator Cuff Tear
Comparison and critical evaluation of rehabilitation and home-based exercises for treating shoulder stiffness: Prospective, multicenter study with 148 cases
Effect of Capsular Release in the Treatment of Shoulder Stiffness Concomitant With Rotator Cuff Repair
Management of the stiff shoulder. A prospective multicenter comparative study of the six main techniques in use: 235 cases
SummaryIntroductionStiffness in the shoulder is a frequent symptom associated with a number of clinical entities whose management remains inadequately defined.Patients and methodsThis 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).ResultsConventional 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).DiscussionThe 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 evidenceLevel III, case–control, prospective comparative