2021 ISAKOS Biennial Congress ePoster
Treatment of Primary Shoulder Stiffness: Results of Survey on Surgeon Practice Patterns
Davide Cucchi, MD, Bonn, Deutschland GERMANY
Silvana de Giorgi, MD, Bari ITALY
Maristella Francesca Saccomanno, MD, PhD, Brescia ITALY
Francesco Mattia Uboldi, MD, Como, Co ITALY
Alessandra Menon, MD, Milano, Milano ITALY
Max Julian Friedrich, MD, Bonn GERMANY
Pietro Simone Randelli, MD, Prof., Milan ITALY
Antonio Marmotti, Torino ITALY
Laura de Girolamo, PhD, Milan ITALY
SIAGASCOT Research Committee, -, ITALY
FDA Status Not Applicable
Summary
Several controversial points regarding the approach to shoulder stiffness emerged from this survey: treatment should be tailored to the patient’s clinical situation and the stage of its shoulder pathology and should aim at pain reduction, restoration of motion, functional regain and shortening of symptoms duration, with conservative therapy remaining is the mainstay of treatment.
ePosters will be available shortly before Congress
Abstract
Background
Shoulder stiffness is a condition of restricted glenohumeral range of motion (ROM), which can arise spontaneously or as consequence of a known cause, including surgical procedures on the shoulder
Several treatment options are available and currently no consensus has been obtained on which treatment algorithm represents the best choice for the patient. The aim of this study was to is investigate surgeon practice patterns in Italy regarding treatment of primary shoulder stiffness
Methods
A review of the literature was performed to identify randomized controlled trials reporting results of shoulder stiffness treatment. From the analysis of the available evidence, the following controversial or critical points in the treatment of primary shoulder stiffness were identified: modalities of physical therapy; indication for oral corticosteroid; indication and frequency for injective corticosteroid; technique and site of injection; indication, timing and technique for surgery. A survey composed by fourteen questions was created and administrated to the members of a national association specialized in orthopaedics and sports traumatology.
Data obtained from the completed questionnaires were entered into a spreadsheet for analysis. Categorical variables are expressed in numbers of cases and frequencies. Response rates were summarized in terms of proportions of respondents.
Results
204 completed questionnaires were collected. Physical therapy was recommended by 98% of the interviewed. The use of oral corticosteroids was considered by 51% of the interviewed, and injections of corticosteroids by 72%. The posterior injection approach was the one preferred and a the number of three was considered the upper limit for repeated injections. Injective therapy with local anaesthetics and hyaluronic acid was considered by more than 20% of the interviewed surgeons. Hydrodilatation and manipulation under anaesthesia were considered, respectively, by 13% and 35% of the surgeons. No consensus on timing for surgical treatment, and surgical approach was obtained. 30% of the interviewed subjects do not treat shoulder stiffness surgically.
Conclusions
Several approaches to shoulder stiffness have been proposed and high-level evidence is available to analyze and discuss their results. However, several controversial points emerged both from literature reviews and from this national survey. Treatment of shoulder stiffness should be tailored to the patient’s clinical situation and the stage of its shoulder pathology and should aim at pain reduction, ROM restoration, functional regain and shortening of symptoms duration, with conservative therapy remaining is the mainstay of treatment. The injection of corticosteroids provides immediate benefits and is recommended in combination to an appropriate rehabilitation. Arthroscopic capsular release can be performed in refractory cases.