title: Subclinical hypothyroidism and diabetes as risk factors for postoperative stiff shoulder.
abstract: OBJECTIVE
  Postoperative stiffness can be a disabling condition after arthroscopic shoulder surgery. The purpose of this study was to analyse the potential contribution of subclinical forms of hypothyroidism and diabetes in the development of postoperative shoulder stiffness.
  
  
  METHODS
  A prospective study was conducted on 65 consecutive patients scheduled for arthroscopic subacromial decompression or rotator cuff tear repair. Patients with preoperative stiffness were excluded. Preoperative measurements of free thyroxine, free triiodothyronine, thyroid-stimulating hormone and fasting glycaemia were taken in all patients to detect subclinical forms of diabetes and hypothyroidism. A follow-up was planned at 30, 60, 90 and 180 days after surgery. According to range of motion measurements, postoperative stiffness was classified as severe or moderate at follow-up. Univariate and logistic regression analyses were performed for the assessment of risk factors for stiffness.
  
  
  RESULTS
  The overall incidence of postoperative stiffness was 29 % (19/65) in our cohort. Considering only the arthroscopic rotator cuff repairs, this incidence was 23 % (7/31). A new diagnosis of subclinical forms of diabetes or hypothyroidism was made in five cases. All five of these cases developed postoperative stiffness. The logistic regression analysis demonstrated that hypothyroidism was a risk factor for severe stiffness (RR = 25; p = 0.001) and that diabetes was a risk factor for moderate stiffness (RR = 5.7; p = 0.03).
  
  
  CONCLUSIONS
  The postoperative stiffness in the majority of patients can be predicted by a careful analysis of past medical history and by detecting subclinical forms of hypothyroidism and diabetes.
  
  
  METHODS
  Prognostic study, Level II.
authors.affiliation: Department of Orthopedics and Traumatology, Mauriziano "Umberto I" Hospital, University of Turin Medical School, Largo Turati, 62, 10128, Turin, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Blonna
authors.affiliation: Department of Orthopedics and Traumatology, Mauriziano "Umberto I" Hospital, University of Turin Medical School, Largo Turati, 62, 10128, Turin, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Fissore
authors.affiliation: Department of Orthopedics and Traumatology, Mauriziano "Umberto I" Hospital, University of Turin Medical School, Largo Turati, 62, 10128, Turin, Italy. bellatoenrico@gmail.com.
authors.forename: Enrico
authors.initials: E
authors.lastname: Bellato
authors.affiliation: Department of Orthopedics and Traumatology, Mauriziano "Umberto I" Hospital, University of Turin Medical School, Largo Turati, 62, 10128, Turin, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: La Malfa
authors.affiliation: CTO-Maria Adelaide Hospital, University of Turin Medical School, Turin, Italy.
authors.forename: Michel
authors.initials: M
authors.lastname: Calò
authors.affiliation: CTO-Maria Adelaide Hospital, University of Turin Medical School, Turin, Italy.
authors.forename: Davide Edoardo
authors.initials: DE
authors.lastname: Bonasia
authors.affiliation: Department of Orthopedics and Traumatology, Mauriziano "Umberto I" Hospital, University of Turin Medical School, Largo Turati, 62, 10128, Turin, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rossi
authors.affiliation: CTO-Maria Adelaide Hospital, University of Turin Medical School, Turin, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Castoldi
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000009:adverse effects*; D019299:Decompression, Surgical; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000150:complications*; D007592:Joint Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012307:Risk Factors; D000070636:Rotator Cuff Injuries / Q000601:surgery; D012782:Shoulder / Q000601:surgery*; D012785:Shoulder Joint / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome
keywords: Arthroscopy; Diabetes; Hyperthyroidism; Risk factors; Rotator cuff tear repair; Stiff shoulder; Subacromial decompression