Pain, depression and the postoperative stiff shoulder

Nathaniel Hiscock, Simon Bell, Jennifer Coghlan, Nathaniel Hiscock, Simon Bell, Jennifer Coghlan

Abstract

Background: The surgical repair of shoulder pathologies, including rotator cuff disease and acromio-clavicular joint arthritis, have undergone many technical advances. However the debilitating postoperative stiff shoulder remains a common and significant complication of these surgeries, occurring in 4.9 to 23.2 % of patients undergoing rotator cuff repairs. The pathology of the pathological postoperative stiff shoulder and its associated condition "frozen shoulder" are poorly understood and both lack formal objective clinical diagnostic criteria. Additionally, although factors associated with the development of idiopathic frozen shoulder have been well described, multiple studies looking at predictors of postoperative stiff shoulder have produced conflicting results. It has been hypothesised that increased pain in the postoperative period, and depression may be predictors of the development of postoperative stiff shoulder.

Method: A prospective cohort study involving 132 consecutive participants. Preoperatively, participants undergoing arthroscopic subacromial decompression and/or excision of the distal clavicle and/or rotator cuff repair will complete questionnaires about their levels of shoulder pain using a numerical rating scale from 0 to 10, and answer a Patient Health Questionnaire - 9 depression questionnaire. Postoperatively, the participants' pain levels will be self-assessed at two, five and seven days and weeks four, seven and ten. They will complete the depression questionnaire twice, at the time of their routine first and final postoperative appointments with the treating surgeon. At the final appointment, approximately three months postoperatively, the treating surgeon will clinically diagnose participants as having a postoperative stiff shoulder or not. Their shoulders' range of motion will be measured. The incidence of postoperative stiff shoulder will be determined, both pain and depression will be analysed as predictors for its development and incidences determined by different objective criteria will be compared.

Discussion: This trial will add to clinical understanding of the postoperative stiff shoulder by providing further insight into the incidence of this condition following shoulder surgery and assessing whether perioperative pain and depression can be used as clinical predictors of postoperative stiff shoulder or markers for possible early intervention. This study will also allow the comparison of incidences determined by different objective criteria in the same cohort.

Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12613001271796. 17-11-2013.

References

    1. Duplay S. De la peri-arthrite scapulo-humerale et des raideurs de l’epaule qui en sont la consequence. Arch Gen Med. 1872;20:513–4.
    1. Codman E. The shoulder. Boston: Thomas Toff; 1934.
    1. Zuckerman JD, Rokito A. Frozen shoulder: a consensus definition. . J Shoulder Elbow Surg. 2011;2:322–5. doi: 10.1016/j.jse.2010.07.008.
    1. Schellingerhout JM, Verhagen AP, Thomas S, Koes BW. Lack of uniformity in diagnostic labeling of shoulder pain: time for a different approach. Man Ther. 2008;13(6):478–83. doi: 10.1016/j.math.2008.04.005.
    1. Brislin KJ, Field LD, Savoie FH., 3rd Complications after arthroscopic rotator cuff repair. Arthroscopy. 2007;23(2):124–8. doi: 10.1016/j.arthro.2006.09.001.
    1. Buchbinder R, Green S, Forbes A, Hall S, Lawler G. Arthrographic joint distension with saline and steroid improves function and reduces pain in patients with painful stiff shoulder: results of a randomised, double blind, placebo controlled trial. Ann Rheum Dis. 2004;63(3):302–9. doi: 10.1136/ard.2002.004655.
    1. Buchbinder R, Hoving JL, Green S, Hall S, Forbes A, Nash P. Short course prednisolone for adhesive capsulitis (frozen shoulder or stiff painful shoulder): a randomised, double blind, placebo controlled trial. Ann Rheum Dis. 2004;63(11):1460–9. doi: 10.1136/ard.2003.018218.
    1. Bunker TD, Anthony PP. The pathology of frozen shoulder A dupuytren-like disease. J Bone Joint Surg. 1995;77B:677–83.
    1. Carette S, Moffet H, Tardif J, Bessette L, Morin F, Fremont P, et al. Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial. Arthritis Rheum. 2003;48(3):829–38. doi: 10.1002/art.10954.
    1. Chung SW, Huong CB, Kim SH, Oh JH. Shoulder stiffness after rotator cuff repair: risk factors and influence on outcome. Arthroscopy. 2013;29(2):290–300. doi: 10.1016/j.arthro.2012.08.023.
    1. Gleyze P, Flurin PH, Laprelle E, Katz D, Toussaint B, Benkalfate T, et al. Pain management in the rehabilitation of stiff shoulder: prospective multicenter comparative study of 193 cases. Orthop Traumatol Surg Res. 2011;97(8 Suppl):S195–203. doi: 10.1016/j.otsr.2011.09.006.
    1. Griggs SM, Ahn A, Green A. Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment. J Bone Joint Surg. 2000;82-A(10):1398–407.
    1. Parsons BO, Gruson KI, Chen DD, Harrison AK, Gladstone J, Flatow EL. Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness? J Shoulder Elbow Surg. 2010;19(7):1034–9. doi: 10.1016/j.jse.2010.04.006.
    1. Ryans I, Montgomery A, Galway R, Kernohan WG, McKane R. A randomized controlled trial of intra-articular triamcinolone and/or physiotherapy in shoulder capsulitis. Rheumatology (Oxford) 2005;44(4):529–35. doi: 10.1093/rheumatology/keh535.
    1. Seo SS, Choi JS, An KC, Kim JH, Kim SB. The factors affecting stiffness occurring with rotator cuff tear. J Shoulder Elbow Surg. 2012;21(3):304–9. doi: 10.1016/j.jse.2011.04.011.
    1. Tauro JC. Stiffness and rotator cuff tears: incidence, arthroscopic findings, and treatment results. Arthroscopy. 2006;22(6):581–6. doi: 10.1016/j.arthro.2006.03.004.
    1. Thomas SJ, McDougall C, Brown ID, Jaberoo MC, Stearns A, Ashraf R, et al. Prevalence of symptoms and signs of shoulder problems in people with diabetes mellitus. J Shoulder Elbow Surg. 2007;16(6):748–51. doi: 10.1016/j.jse.2007.02.133.
    1. Tuten HR, Young DC, Douoguih WA, Lenhardt KM, Wilkerson JP, Adelaar RS. Adhesive capsulitis of the shoulder in male cardiac surgery patients. Orthopedics. 2000;23(7):693–6.
    1. Shaffer B, Tibone JE, Kerlan RK. Frozen shoulder a long term follow-up. J Bone Joint Surg. 1992;74-A(5):738–45.
    1. Bennett WF. Addressing glenohumeral stiffness while treating the painful and stiff shoulder arthroscopically. Arthroscopy. 2000;16(2):142–50. doi: 10.1016/S0749-8063(00)90027-6.
    1. Fleming A, Dodman S, Beer TC, Crown S. Personality in frozen shoulder. Ann Rheum Dis. 1975;35(5):456–7. doi: 10.1136/ard.35.5.456.
    1. Namdari S, Green A. Range of motion limitation after rotator cuff repair. J Shoulder Elbow Surg. 2010;19(2):290–6. doi: 10.1016/j.jse.2009.07.009.
    1. Tanishima T, Yoshimasu N. Development and prevention of frozen shoulder after acute aneurysm surgery. Surg Neurol. 1997;48(1):19–22. doi: 10.1016/S0090-3019(97)00120-1.
    1. van der Windt DA, Koes BW, de Jong BA, Bouter LM. Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis. 1995;54(12):959–64. doi: 10.1136/ard.54.12.959.
    1. Wright V, Haq AMMM. Periarthritis of the shoulder I. Aetiological considerations with particular reference to personality factors. Ann Rheum Dis. 1976;35:213–8. doi: 10.1136/ard.35.3.213.
    1. Huberty DP, Schoolfield JD, Brady PC, Vadala AP, Arrigoni P, Burkhart SS. Incidence and treatment of postoperative stiffness following arthroscopic rotator cuff repair. Arthroscopy. 2009;25(8):880–90. doi: 10.1016/j.arthro.2009.01.018.
    1. Arnow BA, Hunkeler EM, Blasey CM, Lee J, Constantino MJ, Fireman B, et al. Comorbid depression, chronic pain, and disability in primary care. Psychosom Med. 2006;68(2):262–8. doi: 10.1097/01.psy.0000204851.15499.fc.
    1. Trenerry K, Walton JR, Murrell GA. Prevention of shoulder stiffness after rotator cuff repair. Clin Orthop Relat Res. 2005;430:94–9. doi: 10.1097/01.blo.0000137564.27841.27.
    1. Coventry M. Problem of painful shoulder. JANA. 1953;151:177–85.
    1. Bruckner FE, Nye CJ. A prospective study of adhesive capsulitis of the shoulder (“frozen shoulder”) in a high risk population. Q J Med. 1981;50(198):191–204.
    1. Debeer P, Franssens F, Roosen I, Dankaerts W, Claes L. Frozen shoulder and the big five personality traits. J Shoulder Elbow Surg. 2014;23:221–6. doi: 10.1016/j.jse.2013.07.049.
    1. Gartsman GM, Brinker MR, Khan M, Karahan M. Self-assessment of general health status in patients with five common shoulder conditions. J Shoulder Elbow Surg. 1998;7(3):228–37. doi: 10.1016/S1058-2746(98)90050-7.
    1. Harris AH, Youd J, Buchbinder R. A comparison of directly elicited and pre-scored preference-based measures of quality of life: the case of adhesive capsulitis. Qual Life Res Int J Qual Life Asp Treat Care Rehab. 2013;22(10):2963–71. doi: 10.1007/s11136-013-0415-8.
    1. Oesterreicher W, Van DAM. Social psychological researches into Brachialgia and Periarthritis. Arthritis Rheum. 1964;7:670–83. doi: 10.1002/art.1780070607.
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13. doi: 10.1046/j.1525-1497.2001.016009606.x.
    1. Lowe B, Spitzer RL, Grafe K, Kroenke K, Quenter A, Zipfel S, et al. Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnoses. J Affect Disord. 2004;78(2):131–40. doi: 10.1016/S0165-0327(02)00237-9.
    1. Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain. 2004;8(4):283–91. doi: 10.1016/j.ejpain.2003.09.004.
    1. Kelly A-M. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J. 2001;18(3):205–7. doi: 10.1136/emj.18.3.205.
    1. Coghlan JA, Forbes A, McKenzie D, Bell SN, Buchbinder R. Efficacy of subacromial ropivacaine infusion for rotator cuff surgery. A randomized trial. J Bone Joint Surg Am. 2009;91(7):1558–67. doi: 10.2106/JBJS.H.00948.
    1. Buchbinder R, Youd JM, Green S, Stein A, Forbes A, Harris A, et al. Efficacy and cost-effectiveness of physiotherapy following glenohumeral joint distension for adhesive capsulitis: a randomized trial. Arthritis Rheum. 2007;57(6):1027–37. doi: 10.1002/art.22892.
    1. Ludbrook J. Multiple comparisons procedures updated. Clin Exp Pharmacol Physiol. 1998;25:1032–7. doi: 10.1111/j.1440-1681.1998.tb02179.x.

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