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Management of the stiff shoulder
B A Goldberg1, M M Scarlat, D T Harryman
1Department of Orthopaedics, Box 356500, University of Washington Medical Center, 1959 N. E. Pacific Street, Seattle, WA 98195, USA.
Summary
Shoulder stiffness, caused by capsule contractures or adhesions, often improves with gentle stretching. If ineffective, surgical release or manipulation can restore motion and relieve pain in most patients.
Area of Science:
- Orthopedics
- Sports Medicine
- Physical Therapy
Background:
- Shoulder stiffness arises from intra-articular capsule or muscle-tendon unit contractures, or extra-articular adhesions.
- These issues can occur independently or in combination, impacting shoulder mobility.
Purpose of the Study:
- To outline the diagnostic approach and treatment algorithm for shoulder stiffness.
- To detail the effectiveness of various interventions, including conservative management and surgical options.
Main Methods:
- Diagnosis relies on thorough patient history and physical examination to identify the cause and location of stiffness.
- Initial treatment involves a home program of gentle passive stretching.
- When conservative measures fail, manipulation or surgical release (arthroscopic or open) is considered.
Main Results:
- A gentle home stretching program is effective for many patients.
- Surgical release, particularly arthroscopic capsular release, offers effective treatment for capsular contractures.
- Combined open and arthroscopic release can efficiently address humeroscapular adhesions, facilitating rehabilitation.
Conclusions:
- Most shoulder stiffness cases can be diagnosed through clinical evaluation.
- A stepwise treatment approach, from conservative stretching to surgical intervention, can significantly relieve pain and restore shoulder function.
- Approximately 90% of patients achieve good outcomes with this comprehensive treatment strategy.