Shoulder Stiffness (Adhesive Capsulitis) With A Rotator Cuff Tear: How to Manage

Chapter 28

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.

Patient History

Patient Examination

  1. • Patients with advanced adhesive capsulitis may have lost the natural arm swing that occurs with walking. Moreover, muscle atrophy of the shoulder girdle may be present. As a result of impaired motion in the glenohumeral joint, abnormal scapular movement may be observed with active forward flexion of the affected shoulder.
  2. • A vague, diffuse tenderness over the anterior and posterior shoulder regions could be yielded by palpation. Some authors noted that in adhesive capsulitis, digital pressure on the area of the coracoid process elicits local pain (coracoid pain test) and could be considered as a pathognomonic sign of adhesive capsulitis. This could also be applied to patients with a stiff shoulder and rotator cuff tear.
  3. • Loss of motion with forward flexion, abduction, and external and internal rotation should raise suspicion for typical adhesive capsulitis. The amount of inflammation all over the capsule is depicted in Fig. 28.2. With frozen shoulder, examination of the shoulder typically reveals significant limitation of both active and passive elevation, usually less than 120 degrees.
  4. • As described above regarding global limitation of ROM, when the patient has severe limitation of ROM, no physical examination is useful. All movement that stretches the capsule causes pain. Therefore the impingement test is usually useless. If the patient has mild terminal limitation of ROM, the impingement test result might be positive, and the results of the belly press, bear-hug, and lift-off tests, with the last of these a special test for subscapularis tendon tear, can be positive.
  5. • In this chapter, routine rotator cuff physical examination is not mentioned because it is dealt with in Ch. 5.


Treatment Options: Nonoperative and Operative

Surgical Anatomy

Surgical Indications

  1. • There are still debates about whether to operate on those who have typical frozen shoulder and rotator cuff tear, especially with partial-thickness rotator cuff tear. Some argue that the frozen shoulder should be treated first, and the rotator cuff tear should be dealt with later, whereas others recently advocated otherwise.
  2. • Among the three general groups described below, the surgical indications may differ.

Surgical Technique Setup


Mar 28, 2020 | Posted by in ORTHOPEDIC | Comments Off on Shoulder Stiffness (Adhesive Capsulitis) With A Rotator Cuff Tear: How to Manage
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