Shoulder Stiffness (Adhesive Capsulitis) With A Rotator Cuff Tear
How to Manage
Treatment Options: Nonoperative and Operative
Surgical Technique Setup
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Shoulder Stiffness (Adhesive Capsulitis) With A Rotator Cuff Tear: How to Manage
Jae Chul Yoo, Jeung Yeol Jeong, and Yeong Seok Lee
Most shoulder surgeons recognize that many patients with rotator cuff tear have some shoulder stiffness preoperatively. In general, these patients are managed with a shoulder mobilization program before surgical treatment; however, the ideal treatment for rotator cuff tears with shoulder stiffness remains controversial. Recently, simultaneous early treatment of the stiffness with rotator cuff repair has become popular because of several studies stating that there was no difference in final outcome compared with delayed treatment of the rotator cuff repair.
Although there is some debate whether to do manipulation before the arthroscopic capsular release or just do capsular release, our experience shows that most gentle manipulation is not harmful just before arthroscopic surgery. However, on rare occasion one sees some avulsion of the anterior glenoid rim with the labrum. After complete capsular release, especially the anteroinferior capsule (called the inferior glenohumeral ligament [IGHL]), the rotator cuff repair is performed. Rotator cuff repair should be checked in two perspectives: the biceps long head pathology, and subscapularis tendon tear and posterosuperior tear. In this chapter, we discuss some different and crucial aspects of rotator cuff repair and our personal opinions on it.
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