Post-operative stiffness is a relatively common complication following rotator cuff repair. Studies suggest that approximately 4-30% of patients may experience varying degrees of stiffness after the procedure. This condition, often referred to as “frozen shoulder” or adhesive capsulitis, can arise due to a variety of factors, including the extent of the surgical repair, patient adherence to rehabilitation protocols, and the individual’s baseline shoulder mobility.  In a study on post-operative stiffness after rotator cuff repair published by Burkhart et al in Arthroscopy “24 patients (4.9%) were dissatisfied with the result of their procedure because of the development of postoperative stiffness, which was more likely to develop in patients with Workers’ Compensation insurance (8.6%), patients younger than 50 years of age (8.6%), those with a coexisting diagnosis of calcific tendonitis (16.7%) or adhesive capsulitis (15.0%)”.  At Total Orthopedics Dr Ruotolo published a study in the Journal of Shoulder and Elbow Surgery International in 2021 showing the incidence of stiffness for his own series of patients was highest after rotator cuff repair at 12 weeks, with 7.3% of patients presenting with stiffness. The rate of stiffness decreased with continued follow-up. Stiffness was found in 3.3% of patients at 16-24 weeks and in 1.6% of patients at 1 year.  No patients in this study required an additional surgery. 

Treatment Options

Physical Therapy: A structured rehabilitation program is crucial. Physical therapy typically begins with passive range-of-motion exercises, progressing to active range-of-motion and strengthening exercises as tolerated. Early mobilization is essential to prevent stiffness.  Daily stretching for patients with persistent stiffness is also crucial for improvement. 

Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain medications may be prescribed to help manage discomfort, which can facilitate more effective participation in physical therapy.

Corticosteroid Injections: If stiffness persists and is painful, corticosteroid injections into the shoulder joint may help reduce inflammation and improve mobility.  This can be performed up to three times depending on the results of prior injections and the level of persistent stiffness.  

Joint Distension: In some cases, joint distension with saline or corticosteroids can be performed to help stretch the joint capsule.

Surgical Intervention: If conservative treatments fails after a significant duration (often six months or longer), arthroscopic release of the adhesions or capsular contracture may be considered.  In Burkhart’s study on post-operative stiffness from Arthroscopy in 2009, 24 of 489 patients who had persistent stiffness underwent arthroscopy and lysis of adhesions.  All 24 patients had resolution with normal motion after this surgery.  

It’s essential for patients to communicate with their healthcare providers about any stiffness they experience post-operatively, as early intervention can significantly improve outcomes. Regular follow-up appointments to monitor recovery and adjust rehabilitation protocols are also recommended.  At Total Orthopedics and Sports Medicine we have experts in rotator cuff repair and post-operative treatment helping you get back to you.