title: Shoulder stiffness and rotator cuff repair.
abstract: BACKGROUND
  Shoulder stiffness is a frequent complication of surgical repair of rotator cuff tears. Post-operative stiffness negatively affects surgical outcomes leading to a substantial comorbidity and to the failure of surgical treatment. Also, a stiff shoulder could commonly be concomitant with an rotator cuff tear (RCT).
  
  
  METHODS
  We performed a comprehensive search of CINAHL, Embase, Medline and the Cochrane Central Registry of Controlled Trials, from inception of the database to 31 July 2011. Sixteen articles published in peer-reviewed journals were included in this comprehensive review.
  
  
  RESULTS
  The management of shoulder stiffness is still controversial. The role of rehabilitation programs (standard versus early passive mobilization) after RCT repair on the development of stiffness is not clear, while the role of arthroscopic capsular release for post-operative stiffness is better defined, although a threshold of decreased the range of movement for which capsular release is advised has not been identified.
  
  
  RESULTS
  Several factors have been identified to predispose the development of shoulder stiffness. There is also evidence in favor of surgical management of RCTs even when accompanied by shoulder stiffness, and there are strong evidences that arthroscopic capsular release is reliable and effective in managing shoulder stiffness.
  
  
  CONCLUSIONS
  The post-operative rehabilitation protocol remains controversial. We are still far from definitive guidelines for the management of pre- and post-operative stiffness, and prospective double-blinded randomized clinical trials are needed to obtain evidence allowing to establish a reliable and effective management plan for shoulder stiffness.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Rome, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Papalia
authors.forename: Francesco
authors.initials: F
authors.lastname: Franceschi
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Vasta
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallo
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Denaro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D057913:Joint Capsule Release; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016059:Range of Motion, Articular / Q000502:physiology*; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012782:Shoulder / Q000601:surgery; D000070599:Shoulder Injuries; D016896:Treatment Outcome; D055815:Young Adult