Rotator Cuff Lesions with Shoulder Stiffness: Updated Pathomechanisms and Management

Few previous studies have investigated the pathomechanism and managements of rotator cuff lesions with shoulderstiffness. Based on observations by Codman in 1934, frozenshoulder presumably relates to rotator cuff tendenitis. In thepast six decades, tended to discriminate primary frozen shoulder from secondary shoulder stiffness due to shoulder disorders such as rotator cuff lesions or trauma. Intrinsic degeneration and outlet acromial spur impingement are reported aspathogenic causes of rotator cuff lesion. Although patientswith rotator cuff lesions with shoulder stiffness or adhesivecapsulitis (frozen shoulder) may have similar complaintsabout pain and motion limitation, the pathological reactions inthese disorders remain unclear. In our investigation of clinicalvignettes of shoulder stiffness, inflammation-mediated adhesions in the subacromial bursa in rotator cuff lesions, andchanges in inflammatory cytokine levels have been linked to myofibroblast recruitment inthe subacromial bursa. Our study provides the first indication that increased interleukin -1βexpression and myofibroblast recruitment in the subacromial bursa are correlated with rotator cuff lesions with shoulder stiffness. Increased inflammatory cytokine concentrations inthe lesions also provide new molecular insight into the pathological role of the subacromialbursa in the development of shoulder stiffness in rotator cuff lesions. Although rotator cuffrepair is a shoulder-tightening procedure and is not recommended until resolution of theshoulder stiffness in rotator cuff lesions with stiff shoulder, our clinical evidence-based survey suggests that a combined procedure of manipulation, lysis of adhesions, acromioplasty,and rotator cuff repair is a useful procedure if the symptoms do not improve 3 months ofaggressive rehabilitation.