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Management of the stiff shoulder. A prospective multicenter comparative study of the six main techniques in use: 235 cases.
- Source :
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Orthopaedics & traumatology, surgery & research : OTSR [Orthop Traumatol Surg Res] 2011 Dec; Vol. 97 (8 Suppl), pp. S167-81. Date of Electronic Publication: 2011 Oct 28. - Publication Year :
- 2011
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Abstract
- Introduction: Stiffness in the shoulder is a frequent symptom associated with a number of clinical entities whose management remains inadequately defined.<br />Patients and Methods: This 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).<br />Results: Conventional 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).<br />Discussion: The 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.<br /> (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)
- Subjects :
- Adolescent
Adult
Aged
Female
Follow-Up Studies
Humans
Joint Capsule surgery
Joint Diseases physiopathology
Male
Middle Aged
Prospective Studies
Range of Motion, Articular
Shoulder Joint physiopathology
Time Factors
Treatment Outcome
Young Adult
Joint Diseases therapy
Orthopedic Procedures methods
Shoulder Joint surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1877-0568
- Volume :
- 97
- Issue :
- 8 Suppl
- Database :
- MEDLINE
- Journal :
- Orthopaedics & traumatology, surgery & research : OTSR
- Publication Type :
- Academic Journal
- Accession number :
- 22036993
- Full Text :
- https://doi.org/10.1016/j.otsr.2011.09.004