Einfluss der präoperativen Schultersteife auf das Ergebnis der arthroskopischen subacromialen Dekompression

摘要

Stiffness of the shoulder can either occur as a primary or as a secondary form. Secondary shoulder stiffness is mainly described as post-trauma or post-surgery. But even in patients with subacromial pathologies, secondary shoulder stiffness is frequently observed. Current literature does rarely investigate on this type of shoulder stiffness. Thus therapy concepts are based on studies focusing on other entities of shoulder stiffness and arthroscopic capsular release is proclaimed the standard procedure. Since stiffness in patients with subacromial pathologies is often described as a moderate form of stiffness, it is important to evaluate whether a less invasive strategy produces an equal outcome. Manipulation under general anaesthesia has shown good results in patients suffering from shoulder stiffness secondary to rotator cuff tear. In contrast to an arthroscopic release, manipulation is a less invasive, time-saving treatment which demands a shorter training curve of the surgeon. In this clinical trial 40 patients with subacromial impingement and concomitant shoulder stiffness were treated with manipulation under general anaesthesia followed by arthroscopic subacromial decompression (ASD). A matched-pairs-analysis with a group of 40 patients suffering from impingement only and treated with ASD alone was carried out. The pre- and postoperative functional assessment included the UCLA as well as the Constant score with a mean follow-up of 4 years. The results of the Constant and UCLA score showed that all patients benefit from the performed therapy. Values for pain, range of motion, muscle-strength and ability to perform daily work improved in both groups. At the end of the follow-up significant differences in motion were only detectable for internal rotation. In comparison to previous studies on arthroscopic release, the patients in this survey reached matchable scores. In summary, manipulation under anaesthesia followed by ASD is a sufficient operative procedure in patients suffering from subacromial impingement and concomitant shoulder stiffness providing results as good as the ones non-stiff patients can expect. The procedure can be performed faster, easier and less invasive than arthroscopic capsular release.