Management of the stiff shoulder. A prospective multicenter comparative study of the six main techniques in use: 235 cases, 2011
Topics: Stiff shoulder;Treatment, Rehabilitation;Self-rehabilitation, Arthrodistension;Capsulotomy, Pain management, Adhesive capsulitis, Frozen shoulder, Algodystrophy, Therapeutic education
Authors: P. Gleyzea, P Clavert, P.-H. Flurin, E. Laprelle, D. Katz, B. Toussaint, T. Benkalfate, C. Charousset, T. Joudet, T. Georges, L. Hubert, L. Lafosse, P. Hardy, N. Solignac and C. Lévigne
Abstract
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
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