Other Causes of Shoulder Stiffness

  • Harry D. S. Clitherow
  • Gregory I. Bain
  • Augustus D. Mazzocca


There are many possible causes of a stiff shoulder. In this chapter, the authors will discuss some of the secondary causes of shoulder stiffness. This includes factors such as neurological disorders, heterotopic ossification, calcification tendonitis, degenerative arthritis, generalized arthritis, and posttraumatic causes. Each of these factors has a different effect on the presentation and required management of shoulder stiffness.


Stiff shoulder Frozen shoulder Painful shoulder 


  1. 1.
    O’Dwyer NJ, Ada L, Neilson PD. Spasticity and muscle contracture following stroke. Brain. 1996;119(Pt 5):1737–49.CrossRefPubMedGoogle Scholar
  2. 2.
    Farmer SE, James M. Contractures in orthopaedic and neurological conditions: a review of causes and treatment. Disabil Rehabil. 2001;23(13):549–58.CrossRefPubMedGoogle Scholar
  3. 3.
    Elbasiouny SM, Moroz D, Bakr MM, Mushahwar VK. Management of spasticity after spinal cord injury: current techniques and future directions. Neurorehabil Neural Repair. 2010;24(1):23–33.CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Yelnik AP, Colle FM, Bonan IV, Vicaut E. Treatment of shoulder pain in spastic hemiplegia by reducing spasticity of the subscapular muscle: a randomised, double blind, placebo controlled study of botulinum toxin A. J Neurol Neurosurg Psychiatry. 2007;78(8):845–8.CrossRefPubMedCentralPubMedGoogle Scholar
  5. 5.
    Rekand T. Clinical assessment and management of spasticity: a review. Acta Neurol Scand Suppl. 2010;190:62–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Montané E, Vallano A, Laporte JR. Oral antispastic drugs in nonprogressive neurologic diseases: a systematic review. Neurology. 2004;63(8):1357–63.CrossRefPubMedGoogle Scholar
  7. 7.
    Kim YW, Shin JC, Yoon J-G, Kim Y-K, Lee SC. Usefulness of radial extracorporeal shock wave therapy for the spasticity of the subscapularis in patients with stroke: a pilot study. Chin Med J (Engl). 2013;126(24):4638–43.Google Scholar
  8. 8.
    Birch R. Nerve repair. In: Wolfe SW, Hotchkiss R, Pederson WC, Kozin SH, editors. Green’s operative hand surgery. 6th ed. Philadelphia: Churchill Livingstone; 2010. p. 1035–74.Google Scholar
  9. 9.
    Pearl ML. Shoulder problems in children with brachial plexus birth palsy: evaluation and management. J Am Acad Orthop Surg. 2009;17(4):242–54.PubMedGoogle Scholar
  10. 10.
    Sunderland SS. Nerves and nerve injuries. 2nd ed. Edinburgh: Churchill Livingstone; 1978.Google Scholar
  11. 11.
    Oberlin C, Beal D, Leechavengvongs S, Salon A, Dauge MC, Sarcy JJ. Nerve transfer to biceps muscle using a part of ulnar nerve for C5–C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg Am. 1994;19(2):232–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Teboul F, Kakkar R, Ameur N, Beaulieu J-Y, Oberlin C. Transfer of fascicles from the ulnar nerve to the nerve to the biceps in the treatment of upper brachial plexus palsy. J Bone Joint Surg Am. 2004;86-A(7):1485–90.PubMedGoogle Scholar
  13. 13.
    Spinner RJ, Shin AY, Hebert-Blouin M-N, Elhassan BT, Bishop AT. Traumatic brachial plexus injury. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, editors. Green’s operative hand surgery. 2nd ed. Philadelphia: Churchill Livingstone; 2010. p. 1235–92.Google Scholar
  14. 14.
    Levy O, Iyer S, Atoun E, Peter N, Hous N, Cash D, et al. Propionibacterium acnes: an underestimated etiology in the pathogenesis of osteoarthritis? J Shoulder Elbow Surg. 2013;22(4):505–11.CrossRefPubMedGoogle Scholar
  15. 15.
    Walch G, Badet R, Boulahia A, Khoury A. Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplasty. 1999;14(6):756–60.CrossRefPubMedGoogle Scholar
  16. 16.
    Ibarra C, Craig EV. Soft-tissue balancing in total shoulder arthroplasty. Orthop Clin North Am. 1998;29(3):415–22.CrossRefPubMedGoogle Scholar
  17. 17.
    Cleeman E, Brunelli M, Gothelf T, Hayes P, Flatow EL. Releases of subscapularis contracture: an anatomic and clinical study. J Shoulder Elbow Surg. 2003;12(3):231–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Nicholson GP, Twigg S, Blatz B, Sturonas-Brown B, Wilson J. Subscapularis lengthening in shoulder arthroplasty. J Shoulder Elbow Surg. 2010;19(3):427–33.CrossRefPubMedGoogle Scholar
  19. 19.
    Sperling JW, Cofield RH, Rowland CM. Neer hemiarthroplasty and Neer total shoulder arthroplasty in patients fifty years old or less. Long-term results. J Bone Joint Surg Am. 1998;80(4):464–73.PubMedGoogle Scholar
  20. 20.
    Pfahler M, Jena F, Neyton L, Sirveaux F, Molé D. Hemiarthroplasty versus total shoulder prosthesis: results of cemented glenoid components. J Shoulder Elbow Surg. 2006;15(2):154–63.CrossRefPubMedGoogle Scholar
  21. 21.
    Strauss EJ, Verma NN, Salata MJ, McGill KC, Klifto C, Nicholson GP, et al. The high failure rate of biologic resurfacing of the glenoid in young patients with glenohumeral arthritis. J Shoulder Elbow Surg. 2014;23(3):409–19.CrossRefPubMedGoogle Scholar
  22. 22.
    Denard PJ, Walch G. Current concepts in the surgical management of primary glenohumeral arthritis with a biconcave glenoid. J Shoulder Elbow Surg. 2013;22(11):1589–98.CrossRefPubMedGoogle Scholar
  23. 23.
    Bateman E, Donald SM. Reconstruction of massive uncontained glenoid defects using a combined autograft-allograft construct with reverse shoulder arthroplasty: preliminary results. J Shoulder Elbow Surg. 2012;21(7):925–34.CrossRefPubMedGoogle Scholar
  24. 24.
    Clitherow HDS, Frampton CMA, Astley TM. Effect of glenoid cementation on total shoulder arthroplasty for degenerative arthritis of the shoulder: a review of the New Zealand National Joint Registry. J Shoulder Elbow Surg. 2014;23(6):775–81.CrossRefPubMedGoogle Scholar
  25. 25.
    Namdari S, Skelley N, Keener JD, Galatz LM, Yamaguchi K. What is the role of arthroscopic debridement for glenohumeral arthritis? A critical examination of the literature. Arthroscopy. 2013;29(8):1392–8.CrossRefPubMedGoogle Scholar
  26. 26.
    New Zealand Orthopaedic Association. The New Zealand Joint Registry annual report [Internet]. 2013. p. 95–106. Available from: http://www.nzoa.org.nz/system/files/NJR%2014%20Year%20Report.pdf.
  27. 27.
    Gonzalez J-F, Alami GB, Baque F, Walch G, Boileau P. Complications of unconstrained shoulder prostheses. J Shoulder Elbow Surg. 2011;20(4):666–82.CrossRefPubMedGoogle Scholar
  28. 28.
    Sperling JW, Cofield RH, Rowland CM. Minimum fifteen-year follow-up of Neer hemiarthroplasty and total shoulder arthroplasty in patients aged fifty years or younger. J Shoulder Elbow Surg. 2004;13(6):604–13.CrossRefPubMedGoogle Scholar
  29. 29.
    Bohsali KI, Wirth MA, Rockwood CA. Complications of total shoulder arthroplasty. J Bone Joint Surg Am. 2006;88(10):2279–92.CrossRefPubMedGoogle Scholar
  30. 30.
    Wiater BP, Moravek JE, Wiater JM. The evaluation of the failed shoulder arthroplasty. J Shoulder Elbow Surg. 2014;23(5):745–58.Google Scholar
  31. 31.
    Zumstein MA, Pinedo M, Old J, Boileau P. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg. 2011;20(1):146–57.CrossRefPubMedGoogle Scholar
  32. 32.
    Cheung E, Willis M, Walker M, Clark R, Frankle MA. Complications in reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2011;19(7):439–49.PubMedGoogle Scholar
  33. 33.
    Australian Orthopaedic Association. Demographics and outcomes of shoulder arthroplasty [Internet]. Australian National Joint Registry Report No. 6. 2013. p. 1–65. Available from: https://aoanjrr.dmac.adelaide.edu.au/documents/10180/127369/Demographics%20and%20Outcomes%20of%20Shoulder%20Arthroplasty.
  34. 34.
    Sershon RA, Van Thiel GS, Lin EC, McGill KC, Cole BJ, Verma NN, et al. Clinical outcomes of reverse total shoulder arthroplasty in patients aged younger than 60 years. J Shoulder Elbow Surg. 2014;23(3):395–400.CrossRefPubMedGoogle Scholar
  35. 35.
    Busilacchi A, Bottegoni C, Gigante A. Arthroscopic management of heterotopic ossification of the subscapularis tendon in a patient with tuberculosis: a case report. J Shoulder Elbow Surg. 2012;21(1):e1–5.CrossRefGoogle Scholar
  36. 36.
    Pansard E, Schnitzler A, Lautridou C, Judet T, Denormandie P, Genêt F. Heterotopic ossification of the shoulder after central nervous system lesion: indications for surgery and results. J Shoulder Elbow Surg. 2013;22(6):767–74.CrossRefPubMedGoogle Scholar
  37. 37.
    Jayasundara JASB, Punchihewa GL, de Alwis DS. An unusual case of adult onset progressive heterotopic ossification suggesting a variant form of fibrodysplasia ossificans progressiva. Singapore Med J. 2012;53(4):e83–6.PubMedGoogle Scholar
  38. 38.
    Warner JJ, Ejnisman B, Akpinar S. Surgical management of heterotopic ossification of the shoulder. J Shoulder Elbow Surg. 1999;8(2):175–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Aubut J-AL, Mehta S, Cullen N, Teasell RW, ERABI Group, Scire Research Team. A comparison of heterotopic ossification treatment within the traumatic brain and spinal cord injured population: an evidence based systematic review. NeuroRehabilitation. 2011;28(2):151–60.PubMedCentralPubMedGoogle Scholar
  40. 40.
    Ploumis A, Belbasis L, Ntzani E, Tsekeris P, Xenakis T. Radiotherapy for prevention of heterotopic ossification of the elbow: a systematic review of the literature. J Shoulder Elbow Surg. 2013;22(11):1580–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Ahmed SI, Burns TC, Landt C, Hayda R. Heterotopic ossification in high-grade open fractures sustained in combat: risk factors and prevalence. J Orthop Trauma. 2013;27(3):162–9.CrossRefPubMedGoogle Scholar
  42. 42.
    Tanner MW, Cofield RH. Prosthetic arthroplasty for fractures and fracture-dislocations of the proximal humerus. Clin Orthop Relat Res. 1983;179:116–28.CrossRefPubMedGoogle Scholar
  43. 43.
    Kjaersgaard-Andersen P, Frich LH, Søjbjerg JO, Sneppen O. Heterotopic bone formation following total shoulder arthroplasty. J Arthroplasty. 1989;4(2):99–104.CrossRefPubMedGoogle Scholar
  44. 44.
    Sperling JW, Cofield RH, Rowland CM. Heterotopic ossification after total shoulder arthroplasty. J Arthroplasty. 2000;15(2):179–82.CrossRefPubMedGoogle Scholar
  45. 45.
    Grönhagen CM, Abbaszadegan H, Révay SA, Adolphson PY. Medium-term results after primary hemiarthroplasty for comminute proximal humerus fractures: a study of 46 patients followed up for an average of 4.4 years. J Shoulder Elbow Surg. 2007;16(6):766–73.CrossRefPubMedGoogle Scholar
  46. 46.
    Kircher J, Martinek V, Mittelmeier W. Heterotopic ossification after minimally invasive rotator cuff repair. Arthroscopy. 2007;23(12):1359.e1–3.CrossRefGoogle Scholar
  47. 47.
    Matsumoto I, Ito Y, Tomo H, Nakao Y, Takaoka K. Case reports: ossified mass of the rotator cuff tendon in the subacromial bursa. Clin Orthop Relat Res. 2005;437:247–50.CrossRefPubMedGoogle Scholar
  48. 48.
    Genêt F, Jourdan C, Schnitzler A, Lautridou C, Guillemot D, Judet T, et al. Troublesome heterotopic ossification after central nervous system damage: a survey of 570 surgeries. Feany M, editor. PLoS One. 2011;6(1):e16632.CrossRefPubMedCentralPubMedGoogle Scholar
  49. 49.
    da Paz AC, Carod Artal FJ, Kalil RK. The function of proprioceptors in bone organization: a possible explanation for neurogenic heterotopic ossification in patients with neurological damage. Med Hypotheses. 2007;68(1):67–73.CrossRefPubMedGoogle Scholar
  50. 50.
    Isaacson BM, Brown AA, Brunker LB, Higgins TF, Bloebaum RD. Clarifying the structure and bone mineral content of heterotopic ossification. J Surg Res. 2011;167(2):e163–70.CrossRefPubMedGoogle Scholar
  51. 51.
    Bauer AS, Lawson BK, Bliss RL, Dyer GSM. Risk factors for posttraumatic heterotopic ossification of the elbow: case-control study. J Hand Surg Am. 2012;37(7):1422–6.CrossRefPubMedGoogle Scholar
  52. 52.
    Brooker AF, Bowerman JW, Robinson RA, Riley LH. Ectopic ossification following total hip replacement. J Bone Joint Surg Am. 1973;55:1629–32.PubMedGoogle Scholar
  53. 53.
    Knelles D, Barthel T, Karrer A, Kraus U, Eulert J, Kölbl O. Prevention of heterotopic ossification after total hip replacement. A prospective, randomised study using acetylsalicylic acid, indomethacin and fractional or single-dose irradiation. J Bone Joint Surg Br. 1997;79(4):596–602.CrossRefPubMedGoogle Scholar
  54. 54.
    Hamid N, Ashraf N, Bosse MJ, Connor PM, Kellam JF, Sims SH, et al. Radiation therapy for heterotopic ossification prophylaxis acutely after elbow trauma: a prospective randomized study. J Bone Joint Surg Am. 2010;92(11):2032–8.CrossRefPubMedGoogle Scholar
  55. 55.
    Boehm TD, Wallace WA, Neumann L. Heterotopic ossification after primary shoulder arthroplasty. J Shoulder Elbow Surg. 2005;14(1):6–10.CrossRefPubMedGoogle Scholar
  56. 56.
    Mishra MV, Austin L, Parvizi J, Ramsey M, Showalter TN. Safety and efficacy of radiation therapy as secondary prophylaxis for heterotopic ossification of non-hip joints. J Med Imaging Radiat Oncol. 2011;55(3):333–6.CrossRefPubMedGoogle Scholar
  57. 57.
    Berris T, Mazonakis M, Kachris S, Damilakis J. Peripheral organ doses from radiotherapy for heterotopic ossification of non-hip joints: is there a risk for radiation-induced malignancies? Phys Med. 2014;30(3):309–13.CrossRefPubMedGoogle Scholar
  58. 58.
    Lee EK, Namdari S, Hosalkar HS, Keenan MA, Baldwin KD. Clinical results of the excision of heterotopic bone around the elbow: a systematic review. J Shoulder Elbow Surg. 2013;22(5):716–22.CrossRefPubMedGoogle Scholar
  59. 59.
    Brislin KJ, Field LD, Savoie 3rd FH. Complications after arthroscopic rotator cuff repair. Arthroscopy. 2007;23(2):124–8.CrossRefPubMedGoogle Scholar
  60. 60.
    Codman EA. Calcified deposits in the supraspinatus tendon. In: The shoulder: rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. Boston: Thomas Todd; 1934. p. 178–215.Google Scholar
  61. 61.
    McLaughlin HL. Lesions of the musculotendinous cuff of the shoulder: III. Observations on the pathology, course and treatment of calcific deposits. Ann Surg. 1946;124:354–62.CrossRefPubMedCentralGoogle Scholar
  62. 62.
    Uhthoff HK, Loehr JW. Calcific tendinopathy of the rotator cuff: pathogenesis, diagnosis, and management. J Am Acad Orthop Surg. 1997;5(4):183–91.PubMedGoogle Scholar
  63. 63.
    Uhthoff HK, Sarkar K, Maynard JA. Calcifying tendinitis. A new concept of its pathogenesis. Clin Orthop Relat Res. 1976;118:164–8.PubMedGoogle Scholar
  64. 64.
    Bosworth B. Calcium deposits in the shoulder and subacromial bursitis: a survey of 12,122 shoulders. JAMA. 1941;116(22):2477–82.CrossRefGoogle Scholar
  65. 65.
    Comfort TH, Arafiles P. Barbotage of the shoulder with image-intensified fluoroscopic control of needle placement for calcific tendinitis. Clin Orthop Relat Res. 1978;135:171–8.PubMedGoogle Scholar
  66. 66.
    Ebenbichler GR, Erdogmus CB, Resch KL, Funovics MA, Kainberger F, Barisani G, Aringer M, Nicolakis P, Wiesinger GF, Baghestanian M, Preisinger E, Fialka-Moser V, Weinstabl R. Ultrasound therapy for calcific tendinitis of the shoulder. N Engl J Med. 1999;340(20):1533–8.CrossRefPubMedGoogle Scholar
  67. 67.
    Gerdesmeyer L, Wagenpfeil S, Haake M, Maier M, Loew M, Wörtler K, Lampe R, Seil R, Handle G, Gassel S, Rompe JD. Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: a randomized controlled trial. JAMA. 2003;290(19):2573–80.CrossRefPubMedGoogle Scholar
  68. 68.
    Hurt G, Baker Jr CL. Calcific tendinitis of the shoulder. Orthop Clin North Am. 2003;34(4):567–75.CrossRefPubMedGoogle Scholar
  69. 69.
    Albert JD, Meadeb J, Guggenbuhl P, Marin F, Benkalfate T, Thomazeau H, et al. High-energy extracorporeal shock-wave therapy for calcifying tendinitis of the rotator cuff: a randomised trial. J Bone Joint Surg Br. 2007;89(3):335–41.Google Scholar
  70. 70.
    Wittenberg RH, Rubenthaler F, Ludwig J, Willburger RE, Steffen R. Surgical or conservative treatment for chronic rotator cuff calcifying tendinitis – a matched-pair analysis of 100 patients. Arch Orthop Trauma Surg. 2001;121(1–2):56–9.CrossRefPubMedGoogle Scholar

Copyright information

© ISAKOS 2015

Authors and Affiliations

  • Harry D. S. Clitherow
    • 1
    • 2
  • Gregory I. Bain
    • 3
    • 4
    • 5
  • Augustus D. Mazzocca
    • 6
  1. 1.Department of Orthopaedics SurgeryUniversity of AdelaideAdelaideAustralia
  2. 2.Department of Orthopaedics and TraumaRoyal Adelaide HospitalAdelaideAustralia
  3. 3.Department of Orthopaedic SurgeryFlinders University of South AustraliaAdelaideAustralia
  4. 4.Department of Orthopaedics and TraumaFlinders HospitalAdelaideAustralia
  5. 5.Private PracticeNorth AdelaideAustralia
  6. 6.Department of Orthopaedic SurgeryUConn Musculoskeletal InstituteFarmingtonUSA

Personalised recommendations