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Year : 2008  |  Volume : 42  |  Issue : 2  |  Page : 182-187

Comparison of surgical outcome in impingement syndrome with and without stiff shoulder

1 Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea
2 Department of Orthopedic Surgery, Pohang St. Mary's Hospital, Korea
3 Department of Orthopedic Surgery, Dankook University College of Medicine, Korea

Correspondence Address:
Dilbans Singh Pandher
Department of Orthopedic Surgery, Konkuk University School of Medicine 4-12 Hwayang-Dong, Gwangjin-Gu, Seoul 143729
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Source of Support: The authors did not recieve any direct or indirect benefit in cash or credit from any organization or individual., Conflict of Interest: This study was conducted to compare the results of acrcomioplasty for impingement syndrome in patients with and without stiff shoulder. We believe that associated stiff shoulder does not affect the final outcome of acromioplasty for impingement syndrome. And thus manipulation under anaesthesia can be combined with arthroscopic acromioplasty for impingment syndrome, with final clinical results similar to acromioplasty for impingement syndrome alone.

DOI: 10.4103/0019-5413.40255

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Background: In impingment syndrome with associated stiff shoulder the general protocol of management is to conservatively treat the stiff shoulder followed by operative treatment of the impingement syndrome. This consecutive prospective study was carried out to evaluate the functional outcome of surgical management for impingement syndrome associated with stiff shoulder and to compare the results with surgical management of impingement syndrome alone. Materials and Methods: We evaluated a total of 100 patients with impingement syndrome, consisting of 76 patients with impingement syndrome alone (Group A) and 24 patients of stiff shoulder associated with impingement syndrome (Group B). Group A patients were treated by subacromial decompression alone and Group B patients were treated by closed manipulation under anesthesia followed by subacromial decompression. Results: According to the American Shoulder and Elbow Surgeons (ASES) evaluation score satisfactory results were obtained in 80% patients of Group A and 67% patients of Group B, while for patients with diabetes [( n = 18), Group A (n = 11), Group B (n = 7)] satisfactory results were achieved in 82% of patients of Group A(9/11) and 43% of Group B(3/7). Overall, Group B patients had a lower range of motion for external rotation postoperatively, thus indicating that procedures to improve the external rotation, such as a release of the rotator interval or anterior capsule, might be considered in conjunction with other surgical procedures in patients with impingement syndrome with associated stiffness to further improve functional outcome. Conclusion: Acromioplasty can be performed in stiff shoulder associated with impingement syndrome without fears of further worsening of stiffness from adhesions with the exposed raw undersurface of acromian. Patients with diabetes mellitus and shoulder stiffness tend to have poor clinical outcomes and must receive appropriate counseling preoperatively.

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