Abstract
Purpose
Postoperative stiffness can be a disabling condition after arthroscopic shoulder surgery. The purpose of this study was to analyse the potential contribution of subclinical forms of hypothyroidism and diabetes in the development of postoperative shoulder stiffness.
Methods
A prospective study was conducted on 65 consecutive patients scheduled for arthroscopic subacromial decompression or rotator cuff tear repair. Patients with preoperative stiffness were excluded. Preoperative measurements of free thyroxine, free triiodothyronine, thyroid-stimulating hormone and fasting glycaemia were taken in all patients to detect subclinical forms of diabetes and hypothyroidism. A follow-up was planned at 30, 60, 90 and 180 days after surgery. According to range of motion measurements, postoperative stiffness was classified as severe or moderate at follow-up. Univariate and logistic regression analyses were performed for the assessment of risk factors for stiffness.
Results
The overall incidence of postoperative stiffness was 29 % (19/65) in our cohort. Considering only the arthroscopic rotator cuff repairs, this incidence was 23 % (7/31). A new diagnosis of subclinical forms of diabetes or hypothyroidism was made in five cases. All five of these cases developed postoperative stiffness. The logistic regression analysis demonstrated that hypothyroidism was a risk factor for severe stiffness (RR = 25; p = 0.001) and that diabetes was a risk factor for moderate stiffness (RR = 5.7; p = 0.03).
Conclusion
The postoperative stiffness in the majority of patients can be predicted by a careful analysis of past medical history and by detecting subclinical forms of hypothyroidism and diabetes.
Level of evidence
Prognostic study, Level II.
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References
American Diabetes Association (2005) Diagnosis and classification of diabetes mellitus. Diabetes Care 28(1):S37–S42
Blanchard V, Barr S, Cerisola FL (2010) The effectiveness of corticosteroid injections compared with physiotherapeutic interventions for adhesive capsulitis: a systematic review. Physiotherapy 96:95–107
Blonna D, Lee GC, O’Driscoll SW (2010) Arthroscopic restoration of terminal elbow extension in high-level athletes. Am J Sports Med 38:2509–2515. doi:10.1177/0363546510376727
Brislin KJ, Field LD, Savoie FH (2007) Complications after arthroscopic rotator cuff repair. Arthroscopy 23:124–128
Chung SW, Huong CB, Kim SH, Oh JH (2013) Shoulder stiffness after rotator cuff repair: risk factors and influence on outcome. Arthroscopy 29:290–300
Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164
Dawson J, Fitzpatrick R, Carr A (1999) The assessment of shoulder instability. The development and validation of a questionnaire. J Bone Joint Surg Br 81:420–426
Dayan CM (2001) Interpretation of thyroid function tests. Lancet 357:619–624
Finkbone PR, O’Driscoll SW (2015) Box-loop ligament reconstruction of the elbow for medial and lateral instability. J Shoulder Elbow Surg 24:647–654
Gilbart MK, Gerber C (2007) Comparison of the subjective shoulder value and the Constant score. J Shoulder Elbow Surg 16:717–721
Hand GC, Athanasou NA, Matthews T, Carr AJ (2007) The pathology of frozen shoulder. J Bone Joint Surg Br 89:928–932
Huang SW, Lin JW, Wang WT, Wu CW, Liou TH, Lin HW (2014) Hyperthyroidism is a risk factor for developing adhesive capsulitis of the shoulder: a nationwide longitudinal population-based study. Sci Rep 4:4183
Huberty DP, Schoolfield JD, Brady PC, Vadala AP, Arrigoni P, Burkhart SS (2009) Incidence and treatment of postoperative stiffness following arthroscopic rotator cuff repair. Arthroscopy 25:880–890
Koo SS, Parsley BK, Burkhart SS, Schoolfield JD (2011) Reduction of postoperative stiffness after arthroscopic rotator cuff repair: results of a customized physical therapy regimen based on risk factors for stiffness. Arthroscopy 27:155–160
Milgrom C, Novack V, Weil Y, Jaber S, Radeva-Petrova DR, Finestone A (2008) Risk factors for idiopathic frozen shoulder. Isr Med Assoc J 10:361–364
Neviaser RJ, Neviaser TJ (1987) The frozen shoulder. Diagnosis and management. Clin Orthop Relat Res 223:59–64
Parsons BO, Gruson KI, Chen DD, Harrison AK, Gladstone J, Flatow EL (2010) Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness? J Shoulder Elbow Surg 19:1034–1039
Song A, Higgins LD, Newman J, Jain NB (2014) Glenohumeral corticosteroid injections in adhesive capsulitis: a systematic search and review. PM&R 6:1143–1156
Tasto JP, Elias DW (2007) Adhesive capsulitis. Sports Med Arthrosc 15:216–221
Tauro JC (2006) Stiffness and rotator cuff tears: incidence, arthroscopic findings, and treatment results. Arthroscopy 22:581–586
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Blonna, D., Fissore, F., Bellato, E. et al. Subclinical hypothyroidism and diabetes as risk factors for postoperative stiff shoulder. Knee Surg Sports Traumatol Arthrosc 25, 2208–2216 (2017). https://doi.org/10.1007/s00167-015-3906-z
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DOI: https://doi.org/10.1007/s00167-015-3906-z