Risk Factors for Shoulder Stiffness: Current Concepts

AbstractShoulder stiffness is a condition of painful restriction of the glenohumeral range of motion. Numerous risk factors for primary and postoperative shoulder stiffness have been described. This article summarizes the known aspects of the pathophysiology of shoulder stiffness, with special attention to elements of molecular biology and genetics, which could influence the risk of developing shoulder stiffness. Furthermore, the role of hormonal and metabolic factors, medical disorders, drugs, and of other published risk factors for primary and postoperative shoulder stiffness is reviewed and discussed. Finally, aspects related to shoulder surgery and postoperative rehabilitation protocols, which could influence the development of postoperative stiffness are presented.

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Shoulder Stiffness – How to Treat?

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-0853-2128 ◽

2019 ◽

Vol 157 (06) ◽

pp. 668-675

Author(s):

Davide Cucchi ◽

Sebastian Gottfried Walter ◽

Dieter Christian Wirtz ◽

Max Julian Friedrich

Keyword(s):

Risk Factors ◽

Range Of Motion ◽

Low Dose ◽

Conservative Therapy ◽

Clinical Situation ◽

Level Of Evidence ◽

Shoulder Stiffness ◽

Rehabilitation Protocol ◽

Conservative And Operative Treatment ◽

High Level

AbstractShoulder stiffness is a condition of restricted glenohumeral range of motion, which can arise spontaneously or as consequence of a known cause, including surgical procedures on the shoulder. Several approaches to shoulder stiffness have been proposed and high-level evidence is available to analyze and discuss their results. The aim of this review was to summarize the current concepts on conservative and operative treatment of shoulder stiffness and discuss the results of the available studies with a high level of evidence, which should be considered to guide clinical practice. Treatment of shoulder stiffness should be tailored to the patientʼs clinical situation and the stage of its shoulder pathology and should aim at pain reduction, restoration of range of motion, functional regain and shortening of symptoms duration. When possible, known risk factors for primary shoulder stiffness and causes of secondary shoulder stiffness should be addressed to avoid relapse. Conservative therapy is the mainstay of treatment for shoulder stiffness and should include a multimodal and activity-oriented program. Intra-articular injection of a low dose of corticosteroid is safe and effective, provides immediate benefits, and is recommended in combination to an appropriate rehabilitation protocol. In conservative refractory cases, arthrolysis and capsular release can be performed with an arthroscopic approach.

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Variability of United States Online Rehabilitation Protocols for Proximal Hamstring Tendon Repair

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118755116 ◽

2018 ◽

Vol 6 (2) ◽

pp. 232596711875511 ◽

Cited By ~ 7

Author(s):

Harry M. Lightsey ◽

David E. Kantrowitz ◽

Hasani W. Swindell ◽

David P. Trofa ◽

Christopher S. Ahmad ◽

...

Keyword(s):

United States ◽

Range Of Motion ◽

Tendon Repair ◽

Hamstring Tendon ◽

Search Term ◽

Postoperative Rehabilitation ◽

Professional Literature ◽

Rehabilitation Protocol ◽

Rehabilitation Protocols ◽

Proximal Hamstring

Background: The optimal postoperative rehabilitation protocol following repair of complete proximal hamstring tendon ruptures is the subject of ongoing investigation, with a need for more standardized regimens and evidence-based modalities. Purpose: To assess the variability across proximal hamstring tendon repair rehabilitation protocols published online by United States (US) orthopaedic teaching programs. Study Design: Cross-sectional study. Methods: Online proximal hamstring physical therapy protocols from US academic orthopaedic programs were reviewed. A web-based search using the search term complete proximal hamstring repair rehabilitation protocol provided an additional 14 protocols. A comprehensive scoring rubric was developed after review of all protocols and was used to assess each protocol for both the presence of various rehabilitation components and the point at which those components were introduced. Results: Of 50 rehabilitation protocols identified, 35 satisfied inclusion criteria and were analyzed. Twenty-five protocols (71%) recommended immediate postoperative bracing: 12 (34%) prescribed knee bracing, 8 (23%) prescribed hip bracing, and 5 (14%) did not specify the type of brace recommended. Fourteen protocols (40%) advised immediate nonweightbearing with crutches, while 16 protocols (46%) permitted immediate toe-touch weightbearing. Advancement to full weightbearing was allowed at a mean of 7.1 weeks (range, 4-12 weeks). Most protocols (80%) recommended gentle knee and hip passive range of motion and active range of motion, starting at a mean 1.4 weeks (range, 0-3 weeks) and 4.0 weeks (range, 0-6 weeks), respectively. However, only 6 protocols (17%) provided specific time points to initiate full hip and knee range of motion: a mean 8.0 weeks (range, 4-12 weeks) and 7.8 weeks (range, 0-12 weeks), respectively. Considerable variability was noted in the inclusion and timing of strengthening, stretching, proprioception, and cardiovascular exercises. Fifteen protocols (43%) required completion of specific return-to-sport criteria before resuming training. Conclusion: Marked variability is found in both the composition and timing of rehabilitation components across the various complete proximal hamstring repair rehabilitation protocols published online. This finding mirrors the variability of proposed rehabilitation protocols in the professional literature and represents an opportunity to improve patient care.

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Rehabilitation Protocols After Isolated Meniscal Repair: A Systematic Review

The American Journal of Sports Medicine ◽

10.1177/0363546516667578 ◽

2016 ◽

Vol 45 (7) ◽

pp. 1687-1697 ◽

Cited By ~ 19

Author(s):

Kevin O’Donnell ◽

Kevin B. Freedman ◽

Fotios P. Tjoumakaris

Keyword(s):

Systematic Review ◽

Range Of Motion ◽

Significant Variation ◽

Clinical Success ◽

Meniscal Repair ◽

Postoperative Rehabilitation ◽

Treatment Groups ◽

Rehabilitation Protocols ◽

Outcome Scores ◽

The Ideal

Background: Current postoperative rehabilitation protocols after isolated meniscal repair vary widely. No consensus exists with regard to the optimal amount of weightbearing, range of motion, or speed at which the patient progresses through the rehabilitation phases. Confounding factors including concomitant ligamentous or cartilaginous injuries have made studying isolated meniscal tears problematic. Purpose: To systematically review and evaluate the influence of range of motion and weightbearing status during the postoperative rehabilitation period after isolated meniscal repair on clinical efficacy and outcome scores. Study Design: Systematic review. Methods: A search of PubMed, Scopus, and Cochrane Central Register of Controlled Trials was conducted. The selection criteria for inclusion were English-language in vivo clinical studies reporting on isolated meniscal repairs utilizing an arthroscopically assisted technique that outlined the postoperative rehabilitation protocol and included at least a 2-year follow-up. Titles, abstracts, and articles were reviewed, and data concerning patient demographics, tear type, repair technique, postoperative protocol details, clinical failures, and outcome scores were extracted from the eligible studies. Rehabilitation protocols were divided into “accelerated,” “motion restricted,” “weight restricted,” and “dual restricted” according to the limitations placed on the treatment groups. Results: Fifteen studies, containing 17 different treatment groups, met the inclusion criteria. The 2 accelerated groups, 2 motion-restricted groups, 4 weight-restricted groups, and 9 dual-restricted groups showed similar efficacy in terms of clinical success and postoperative outcome scores. Early range of motion and weightbearing status showed no influence over clinical outcomes. Of the 17 groups, 13 reported a greater than 70% clinical success rate with significant variation in the tear type, fixation technique, and postoperative restrictions. Conclusion: Early range of motion and immediate postoperative weightbearing appear to have no detrimental effect on the chances for clinical success after isolated meniscal repair. Significant variation exists between postoperative protocols, with no current consensus on the ideal parameters for weightbearing and range of motion. Studies reporting outcomes regarding isolated meniscal repair are limited. Future research should include determining the ideal combination of weightbearing and range of motion for specific tear types.

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Postoperative stiff shoulder after open rotator cuff repair: a 3- to 20-year follow-up study

Scandinavian Journal of Surgery ◽

10.1177/1457496913514383 ◽

2014 ◽

Vol 103 (4) ◽

pp. 263-270 ◽

Cited By ~ 16

Author(s):

H. Vastamäki ◽

M. Vastamäki

Keyword(s):

Rotator Cuff ◽

Range Of Motion ◽

Rotator Cuff Repair ◽

External Rotation ◽

Long Term Results ◽

Shoulder Stiffness ◽

Stiff Shoulder ◽

Cuff Repair ◽

Postoperative Shoulder

Background and Aims: Stiffness after a rotator cuff tear is common. So is stiffness after an arthroscopic rotator cuff repair. In the literature, however, postoperative restriction of passive range of motion after open rotator cuff repair in shoulders with free passive range of motion at surgery has seldom been recognized. We hypothesize that this postoperative stiffness is more frequent than recognized and slows the primary postoperative healing after a rotator cuff reconstruction. We wondered how common is postoperative restriction of both active and passive range of motion after open rotator cuff repair in shoulders with free passive preoperative range of motion, how it recovers, and whether this condition influences short- and long-term results of surgery. We also explored factors predicting postoperative shoulder stiffness. Material and Methods: We retrospectively identified 103 postoperative stiff shoulders among 416 consecutive open rotator cuff repairs, evaluating incidence and duration of stiffness, short-term clinical results and long-term range of motion, pain relief, shoulder strength, and functional results 3–20 (mean 8.7) years after surgery in 56 patients. Results: The incidence of postoperative shoulder stiffness was 20%. It delayed primary postoperative healing by 3–6 months and resolved during a mean 6.3 months postoperatively. External rotation resolved first, corresponding to that of the controls at 3 months; flexion and abduction took less than 1 year after surgery. The mean summarized range of motion (flexion + abduction + external rotation) increased as high as 93% of the controls’ range of motion by 6 months and 100% by 1 year. Flexion, abduction, and internal rotation improved to the level of the contralateral shoulders as did pain, strength, and function. Age at surgery and condition of the biceps tendon were related to postoperative stiffness. Conclusions: Postoperative stiff shoulder after open rotator cuff repair is a common complication resolving in 6–12 months with good long-term results.

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Facets of neuroticism and musculoskeletal symptoms. A study of middle-aged twins

Norsk Epidemiologi ◽

10.5324/nje.v26i1-2.2015 ◽

2016 ◽

Vol 26 (1-2) ◽

Cited By ~ 1

Author(s):

Olav Vassend Vassend ◽

Benedicte Humborstad Orvik ◽

Nikolai Olavi Czajkowski ◽

Espen Røysamb

Keyword(s):

Risk Factors ◽

Sex Education ◽

Environmental Influences ◽

Epidemiological Studies ◽

Musculoskeletal Symptoms ◽

Depression Symptoms ◽

Emotional Symptoms ◽

Health Indices ◽

Medical Disorders

Clinical and epidemiological studies have shown that both site-specific and more widespread musculoskeletal (MS) conditions are linked to anxiety and depression symptoms. However, the nature of this relationship is poorly understood, particularly in terms of underlying genetic and environmental influences. Furthermore, the personality trait neuroticism has been shown to be related to common emotional symptoms and somatic distress as well as to more serious psychiatric and medical disorders. In modern personality theory, the broad neuroticism domain is conceptualized as consisting of a set of lower-order facets, such as anxiety, hostility, and depression, which may be differentially related to various health outcome measures. So far, the role of neuroticism facets as risk factors for MS conditions has not been explored in genetically informative designs. In the current study, the relationship between MS symptoms and six neuroticism facets was investigated in bivariate analyses and in regression models including sex, education level, and general health indices as control variables. Using multivariate twin modeling, genetic and environmental influences on the phenotypes and the associations among them were determined. The sample consisted of 746 monozygotic (MZ) and 770 dizygotic (DZ) twins in the age group of 50-65 (mean = 57.11 years, SD = 4.5). The results showed that a single factor accounted for about 50% of the overall variance in MS symptom reporting. Two neuroticism facets, N1: anxiety and N3: depression, appeared as significant in the regression analyses. Both these facets and MS symptoms were strongly influenced by genetic factors [heritability (h2) = 0.46-0.54]. While there was a considerable overlap in genetic risk factors between the three phenotypes, a large proportion (71%) of the genetic variance in MS symptoms was unique to the phenotype, and not shared with the neuroticism facets.

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Effects of Compliance With Procedure-Specific Postoperative Rehabilitation Protocols on Initial Outcomes After Osteochondral and Meniscal Allograft Transplantation in the Knee

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119884291 ◽

2019 ◽

Vol 7 (11) ◽

pp. 232596711988429 ◽

Cited By ~ 11

Author(s):

Kylee Rucinski ◽

James L. Cook ◽

Cory R. Crecelius ◽

Renée Stucky ◽

James P. Stannard

Keyword(s):

Risk Factors ◽

Postoperative Management ◽

Modifiable Risk Factors ◽

Failure Rates ◽

Meniscal Allograft Transplantation ◽

Postoperative Rehabilitation ◽

Allograft Transplantation ◽

Meniscal Allograft ◽

Management Protocol ◽

Rehabilitation Protocols

Background: Osteochondral and meniscal allograft transplantation have been performed in the knee for more than 40 years, with the number of patients treated each year growing as allograft quantity and quality increase. To date, the effects of postoperative management on outcomes after these procedures have received relatively little focus in the peer-reviewed literature. Hypothesis: Compliance with the recommended postoperative management protocol will be associated with significantly higher initial success and significantly lower revision and failure rates for patients undergoing osteochondral and/or meniscal allograft transplantation in the knee. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were prospectively enrolled into a dedicated registry designed to follow outcomes after osteochondral and/or meniscal allograft transplantation. Patients were included when at least 1 year of follow-up data were available, including data on complications and reoperations, patient-reported outcome measures, compliance with rehabilitation, revisions, or failures, based on the electronic medical record and communication logs with patients’ outpatient physical therapists. Results: For patients meeting the inclusion criteria (N = 162), compliance with the prescribed procedure-specific postoperative management protocol was associated with significantly higher 1- to 3-year success and significantly lower revision and failure rates. Specifically, patients who were compliant were 6.3 times less likely to need allograft revision or total knee arthroplasty and 7.5 times more likely to have a successful outcome at 1 to 3 years after osteochondral and/or meniscal allograft transplantation. In addition to noncompliance, older patient age and higher body mass index were associated with inferior short-term outcomes in this cohort. Conclusion: These data suggest that compliance with procedure-specific postoperative rehabilitation protocols is associated with higher success, lower revision, and lower failure rates for patients undergoing osteochondral and meniscal allograft transplantation. Given these results showing the importance of these modifiable risk factors, our center has devoted resources to preoperative patient assessment and communication to provide education, set appropriate expectations, identify and address modifiable risk factors, impediments, and noncompliance, and monitor and adjust postoperative care as indicated.

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Treatment of partial rotator cuff lesions is associated with a higher frequency of post-operative shoulder stiffness. A prospective investigation on the role of surgery-related risk factors for this complication

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04285-1 ◽

2021 ◽

Author(s):

Davide Cucchi ◽

Alessandra Menon ◽

Sonia Maggi ◽

Francesca Maria Feroldi ◽

Annalisa De Silvestri ◽

...

Keyword(s):

Risk Factors ◽

Rotator Cuff ◽

Pain Perception ◽

Young Patients ◽

Special Focus ◽

Surgical Trauma ◽

Shoulder Stiffness ◽

Related Risk ◽

Duration Of Surgery

Abstract Purpose Post-operative shoulder stiffness (SS) is a common complication after arthroscopic rotator cuff (RC) repair. The aim of this prospective study is to evaluate the role of surgical risk factors in the development of this complication, with special focus on the characteristics of the RC tears. Methods Two-hundred and twenty patients who underwent arthroscopic RC repair for degenerative posterosuperior RC tears were included. Surgery-related risk factors for development of post-operative SS belonging to the following five categories were documented and analyzed: previous surgery, RC tear characteristics, hardware and repair type, concomitant procedures, time and duration of surgery. The incidence of post-operative SS was evaluated according to the criteria described by Brislin and colleagues. Results The incidence of post-operative SS was 8.64%. The treatment of partial lesions by tear completion and repair technique was significantly associated with development of post-operative SS (p = 0.0083, pc = 0.04). A multivariate analysis revealed that treatment of partial lesions in patients younger than 60 years was associated to a higher risk of developing post-operative SS (p = 0.007). Previously known pre-operative risk factors such as female sex and younger age were confirmed. No other significant associations were documented. Conclusion The treatment of partial lesions of the RC may lead to a higher risk of post-operative SS than the treatment of complete lesions, in particular in patients younger than 60 years. Possible explanations of this finding are the increased release of pro-inflammatory cytokines caused by the additional surgical trauma needed to complete the lesion and the different pain perception of the subgroup of patients who require surgical treatment already for partial tears. Evidence A higher risk of post-operative SS should be expected after tear completion and repair of partial lesions, especially in young patients. Appropriate pre-operative counseling and post-operative rehabilitation should be considered when approaching this subgroup of RC tears. Level of evidence Prognostic study, level II.

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Role of acquired and hereditary thrombotic risk factors in patients with ischemic colitis

Gastroenterology ◽

10.1016/s0016-5085(01)81398-6 ◽

2001 ◽

Vol 120 (5) ◽

pp. A282-A282

Author(s):

I KOUTROUBAKIS ◽

A SFIRIDAKI ◽

A THEODOROPOULOU ◽

A LIVADIOTAKI ◽

P DIMOULIOS ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Colitis ◽

Thrombotic Risk

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Psychological Resilience Provides No Independent Protection From Suicidal Risk

Crisis ◽

10.1027/0227-5910/a000364 ◽

2016 ◽

Vol 37 (2) ◽

pp. 130-139 ◽

Cited By ~ 9

Author(s):

Danica W. Y. Liu ◽

A. Kate Fairweather-Schmidt ◽

Richard Burns ◽

Rachel M. Roberts ◽

Kaarin J. Anstey

Keyword(s):

Risk Factors ◽

Well Being ◽

Current Status ◽

Psychological Resilience ◽

Cross Sectional ◽

Life Project ◽

Resilience Factors ◽

First Time

Abstract. Background: Little is known about the role of resilience in the likelihood of suicidal ideation (SI) over time. Aims: We examined the association between resilience and SI in a young-adult cohort over 4 years. Our objectives were to determine whether resilience was associated with SI at follow-up or, conversely, whether SI was associated with lowered resilience at follow-up. Method: Participants were selected from the Personality and Total Health (PATH) Through Life Project from Canberra and Queanbeyan, Australia, aged 28–32 years at the first time point and 32–36 at the second. Multinomial, linear, and binary regression analyses explored the association between resilience and SI over two time points. Models were adjusted for suicidality risk factors. Results: While unadjusted analyses identified associations between resilience and SI, these effects were fully explained by the inclusion of other suicidality risk factors. Conclusion: Despite strong cross-sectional associations, resilience and SI appear to be unrelated in a longitudinal context, once risk/resilience factors are controlled for. As independent indicators of psychological well-being, suicidality and resilience are essential if current status is to be captured. However, the addition of other factors (e.g., support, mastery) makes this association tenuous. Consequently, resilience per se may not be protective of SI.

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Protective Factors and Suicidality in Members of Arab Kindred

Crisis ◽

10.1027/0227-5910/a000116 ◽

2012 ◽

Vol 33 (2) ◽

pp. 80-86 ◽

Cited By ~ 6

Author(s):

Sami Hamdan ◽

Nadine Melhem ◽

Israel Orbach ◽

Ilana Farbstein ◽

Mohammad El-Haib ◽

...

Keyword(s):

Risk Factors ◽

Protective Factors ◽

Suicidal Behavior ◽

Composite International Diagnostic Interview ◽

Diagnostic Interview ◽

Suicidal Risk ◽

Arab Population ◽

Psychiatric Interview ◽

History Of

Background: Relatively little is known about the role of protective factors in an Arab population in the presence of suicidal risk factors. Aims: To examine the role of protective factors in a subsample of in large Arab Kindred participants in the presence of suicidal risk factors. Methods: We assessed protective and risk factors in a sample of 64 participants (16 suicidal and 48 nonsuicidal) between 15 and 55 years of age, using a comprehensive structured psychiatric interview, the Composite International Diagnostic Interview (CIDI), self-reported depression, anxiety, hopelessness, impulsivity, hostility, and suicidal behavior in first-degree and second-relatives. We also used the Religiosity Questionnaire and suicide attitude (SUIATT) and multidimensional perceived support scale. Results: Suicidal as opposed to nonsuicidal participants were more likely to have a lifetime history of major depressive disorder (MDD) (68.8% vs. 22.9% χ2 = 11.17, p = .001), an anxiety disorder (87.5% vs. 22.9, χ2 = 21.02, p < .001), or posttraumatic stress disorder (PTSD) (25% vs. 0.0%, Fisher’s, p = .003). Individuals who are otherwise at high risk for suicidality have a much lower risk when they experience higher perceived social support (3.31 ± 1.36 vs. 4.96 ± 1.40, t = 4.10, df = 62, p < .001), and they have the view that suicide is somehow unacceptable (1.83 ± .10 vs. 1.89 ± .07, t = 2.76, df = 60, p = .008). Conclusions: Taken together with other studies, these data suggest that the augmentation of protective factors could play a very important role in the prevention of incidental and recurrent suicidal behavior in Arab populations, where suicidal behavior in increasing rapidly.

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