Comparison of surgical outcome in impingement syndrome with and without stiff shoulder

In impingment syndrome with associated stiff shoulder the general protocol of management is to conservatively treat the stiff shoulder followed by operative treatment of the impingement syndrome. This consecutive prospective study was carried out to evaluate the functional outcome of surgical management for impingement syndrome associated with stiff shoulder and to compare the results with surgical management of impingement syndrome alone.

We evaluated a total of 100 patients with impingement syndrome, consisting of 76 patients with impingement syndrome alone (Group A) and 24 patients of stiff shoulder associated with impingement syndrome (Group B). Group A patients were treated by subacromial decompression alone and Group B patients were treated by closed manipulation under anesthesia followed by subacromial decompression.

According to the American Shoulder and Elbow Surgeons (ASES) evaluation score satisfactory results were obtained in 80% patients of Group A and 67% patients of Group B, while for patients with diabetes [(n = 18), Group A (n = 11), Group B (n = 7)] satisfactory results were achieved in 82% of patients of Group A(9/11) and 43% of Group B(3/7). Overall, Group B patients had a lower range of motion for external rotation postoperatively, thus indicating that procedures to improve the external rotation, such as a release of the rotator interval or anterior capsule, might be considered in conjunction with other surgical procedures in patients with impingement syndrome with associated stiffness to further improve functional outcome.

Acromioplasty can be performed in stiff shoulder associated with impingement syndrome without fears of further worsening of stiffness from adhesions with the exposed raw undersurface of acromian. Patients with diabetes mellitus and shoulder stiffness tend to have poor clinical outcomes and must receive appropriate counseling preoperatively.