Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Rome, Italy.
Br Med Bull. 2012;104:163-74. doi: 10.1093/bmb/lds006. Epub 2012 Feb 14.
Shoulder stiffness is a frequent complication of surgical repair of rotator cuff tears. Post-operative stiffness negatively affects surgical outcomes leading to a substantial comorbidity and to the failure of surgical treatment. Also, a stiff shoulder could commonly be concomitant with an rotator cuff tear (RCT).
We performed a comprehensive search of CINAHL, Embase, Medline and the Cochrane Central Registry of Controlled Trials, from inception of the database to 31 July 2011. Sixteen articles published in peer-reviewed journals were included in this comprehensive review.
The management of shoulder stiffness is still controversial. The role of rehabilitation programs (standard versus early passive mobilization) after RCT repair on the development of stiffness is not clear, while the role of arthroscopic capsular release for post-operative stiffness is better defined, although a threshold of decreased the range of movement for which capsular release is advised has not been identified.
Several factors have been identified to predispose the development of shoulder stiffness. There is also evidence in favor of surgical management of RCTs even when accompanied by shoulder stiffness, and there are strong evidences that arthroscopic capsular release is reliable and effective in managing shoulder stiffness.
The post-operative rehabilitation protocol remains controversial. We are still far from definitive guidelines for the management of pre- and post-operative stiffness, and prospective double-blinded randomized clinical trials are needed to obtain evidence allowing to establish a reliable and effective management plan for shoulder stiffness.
肩部僵硬是肩袖撕裂手术修复后的常见并发症。术后僵硬会对手术结果产生负面影响，导致严重的合并症和手术治疗失败。此外，肩部僵硬通常与肩袖撕裂（RCT）同时存在。
我们对 CINAHL、Embase、Medline 和 Cochrane 对照试验中心注册库进行了全面检索，检索时间从数据库建立到 2011 年 7 月 31 日。这项全面综述共纳入了 16 篇发表在同行评议期刊上的文章。
肩部僵硬的治疗仍然存在争议。RCT 修复后康复方案（标准与早期被动活动）对僵硬发展的作用尚不清楚，而关节镜下囊松解术治疗术后僵硬的作用则更为明确，尽管尚未确定建议行囊松解术的活动范围降低阈值。
已经确定了一些导致肩部僵硬发展的因素。此外，即使伴有肩部僵硬，也有证据支持对 RCT 进行手术治疗，而且有强有力的证据表明关节镜下囊松解术在治疗肩部僵硬方面是可靠和有效的。
术后康复方案仍然存在争议。我们仍然远未确定术前和术后僵硬的管理指南，需要进行前瞻性双盲随机临床试验，以获得证据，从而制定出可靠有效的肩部僵硬管理计划。
