Stiffness and Rotator Cuff Tears: Incidence, Arthroscopic Findings, and Treatment Results

Purpose: Although stiffness of the shoulder has been evaluated after rotator cuff repair, it has not been studied in patients with cuff tears that occurred before repair. The primary purpose of this study was to determine whether preoperative stiffness persists after cuff repair. We also evaluated the incidence and possible causes of stiffness in patients who underwent arthroscopic rotator cuff repair. Methods: This was a retrospective evaluation of 72 arthroscopic patients who underwent rotator cuff repair. Preoperative range-of-motion (ROM) deficits in abduction, forward flexion, external rotation, and internal rotation were recorded and were added together to determine the total ROM deficit (TROMD). Patients were then divided into 3 groups on the basis of TROMD. Group 1 comprised 42 patients with 0° to 20° TROMD. Group 2 consisted of 24 patients with 25° to 70° TROMD, and group 3 included 6 patients with a TROMD greater than 70°. Preoperative medical history, intraoperative condition of the capsule and bursa, and cuff tear size were recorded. Results: Capsular and bursal abnormalities were more common in stiffer patients, but arthroscopic evidence of adhesive capsulitis was found only in group 3 (3 of 6 patients). Postoperatively, average TROMD deficit decreased from 10° to 4° in group 1, from 36° to 12° in group 2, and from 89° to 31° in group 3. No reoperations or postoperative manipulations were reported in group 1 or 2. In group 3, 3 patients (the only 3 with adhesive capsulitis) showed no or minimal improvement in postoperative ROM. These 3 patients required a secondary arthroscopic capsular release. After all 3 repairs had completely healed, the TROMD averaged 35° in this subgroup. Conclusions: Preoperative stiffness is common in patients who undergo rotator cuff repair. Mild and moderate stiffness generally resolve after surgery followed by routine therapy. Patients with a TROMD of 70° or more may have adhesive capsulitis as well as a cuff tear and may not do well with cuff repair alone. Level of Evidence: Level IV, case series.