Management of the stiff shoulder. A prospective multicenter comparative study of the six main techniques in use: 235 cases

Orthop Traumatol Surg Res. 2011 Dec;97(8 Suppl):S167-81. doi: 10.1016/j.otsr.2011.09.004. Epub 2011 Oct 28.


Introduction: Stiffness in the shoulder is a frequent symptom associated with a number of clinical entities whose management remains inadequately defined.

Patients and methods: This prospective study of 235 cases of stiffness in the shoulder compared six therapeutic techniques with a mean follow-up of 13 months (range, 3-28 months) (T1: 58 cases, conventional rehabilitation under the pain threshold, T2: 59 cases, self-rehabilitation over the pain threshold, T3: 31 cases, T2 + supervision, T4: 11 cases, T1 + capsular distension, T5: 31 cases, T1 + locoregional anesthesia, T6: 45 cases, T1 + T5 + capsulotomy). The therapeutic power of each technique and its impact on the result were assessed at each self-rehabilitation and rehabilitation session during the first 6 weeks and then at 3 months, 6 months, and at the final revision depending on subjective criteria (pain, discomfort, and morale) and objective criteria (Constant score, goniometric measurements).

Results: Conventional rehabilitation (T1) is less effective than self-rehabilitation over the pain threshold (T2 & T3) during the first 6 weeks (P<0.05). Self-rehabilitation stagnates between the 6th and 12th week except when it is supervised by a therapist (T3). Anesthesia (T4) and capsular distension (T5) do not lead to significantly different progression beyond 6 months. Capsulotomy does not demonstrate greater therapeutic power but its failure rate (persisting stiffness at 1 year) is 0% versus 14-17% for the other techniques (P<0.05).

Discussion: The techniques are complementary and therapeutic success stems from an algorithm adapted to the individual patient with, over the first 3 months, successive self-rehabilitation and conventional rehabilitation, possibly completed by capsular distension or anesthesia between the 3rd and 6th months. In case of failure at 6 months, endoscopic capsulotomy can be proposed. Therapeutic patient education and active participation are the key to treatment success or failure.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Female
  • Follow-Up Studies
  • Humans
  • Joint Capsule / surgery
  • Joint Diseases / physiopathology
  • Joint Diseases / therapy*
  • Male
  • Middle Aged
  • Orthopedic Procedures / methods*
  • Prospective Studies
  • Range of Motion, Articular
  • Shoulder Joint / physiopathology
  • Shoulder Joint / surgery*
  • Time Factors
  • Treatment Outcome
  • Young Adult