Complex shoulder disorders: evaluation and treatment

J Am Acad Orthop Surg. 2009 Mar;17(3):125-36. doi: 10.5435/00124635-200903000-00002.


Evaluation of patients with shoulder disorders often presents challenges. Among the most troublesome are revision surgery in patients with massive rotator cuff tear, atraumatic shoulder instability, revision arthroscopic stabilization surgery, adhesive capsulitis, and bicipital and subscapularis injuries. Determining functional status is critical before considering surgical options in the patient with massive rotator cuff tear. When nonsurgical treatment of atraumatic shoulder stability is not effective, inferior capsular shift is the treatment of choice. Arthroscopic revision of failed arthroscopic shoulder stabilization procedures may be undertaken when bone and tissue quality are good. Arthroscopic release is indicated when idiopathic adhesive capsulitis does not respond to nonsurgical treatment; however, results of both nonsurgical and surgical treatment of posttraumatic and postoperative adhesive capsulitis are often disappointing. Patients not motivated to perform the necessary postoperative therapy following subscapularis repair are best treated with arthroscopic débridement and biceps tenotomy.

MeSH terms

  • Aged
  • Arthroscopy / methods
  • Bursitis / diagnosis
  • Bursitis / rehabilitation
  • Bursitis / surgery
  • Cartilage, Articular / injuries
  • Cartilage, Articular / surgery
  • Debridement / methods
  • Exercise Therapy / instrumentation
  • Exercise Therapy / methods
  • Female
  • Humans
  • Joint Instability / diagnostic imaging
  • Joint Instability / rehabilitation
  • Joint Instability / surgery*
  • Radiography
  • Range of Motion, Articular
  • Recovery of Function
  • Reoperation / methods
  • Rotator Cuff / surgery
  • Rotator Cuff Injuries
  • Shoulder Dislocation / diagnostic imaging
  • Shoulder Dislocation / rehabilitation
  • Shoulder Dislocation / surgery
  • Shoulder Joint / injuries*
  • Shoulder Joint / surgery*
  • Splints
  • Tendon Injuries / diagnosis
  • Tendon Injuries / rehabilitation
  • Tendon Injuries / surgery
  • Treatment Outcome