Postoperative shoulder stiffness following surgical repair of shoulder instability

Abstract

Shoulder range of motion following instability repair procedures, if decreased, affects patient satisfaction. Contracture and loss of motion occur more frequently with procedures that tighten the anterior glenohumeral capsule, the anterior band of the inferior glenohumeral ligament, or expose the deltopectoral interval. Loss of internal and external rotation has been correlated to a thickened coracohumeral ligament and a thicker capsule when a procedure is performed in conjuction with an open rotator interval closure. Additionally, prolonged postoperative immobilization can contribute to a secondary loss of motion. The first line of treatment of shoulder stiffness following instability repair should always involve conservative treatment. Early restoration of motion particularly in external rotation without stretching the repaired capsule is essential. Nonsteroid anti-inflammatories should be utilized to maximize gains. If conservative management fails, arthroscopic intervention is recommended by an arthroscopic capsular release, rotator interval release, or restoration of anterior transverse sliding (RATS) procedure. Release of the anterior capsule can improve forward flexion and release of the posterior capsule can improve internal rotation, extension, and cross-body adduction. A goal to restore full functional range of motion to promote return to full activities of daily living, work, and sporting activities will lead to execellent patient satisfaction.