Identification of prognostic factors for the nonoperative treatment of stiff shoulder
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ORIGINAL PAPER
Identification of prognostic factors for the nonoperative treatment of stiff shoulder Akira Ando & Hiroyuki Sugaya & Yoshihiro Hagiwara & Norimasa Takahashi & Takashi Watanabe & Kenji Kanazawa & Eiji Itoi
Received: 16 November 2012 / Accepted: 26 February 2013 / Published online: 17 March 2013 # Springer-Verlag Berlin Heidelberg 2013
Abstract Purpose This study evaluated prognostic factors for the nonoperative treatment of stiff shoulder. Methods Between June 2005 and May 2010, 497 stiff shoulders treated at our institute were included in this study. Multivariable analysis for recovery with Cox proportional hazard model was performed. The chief determining variable was pathogenesis (idiopathic, diabetic, post-traumatic) and confounding variables were age (49 or less, 50–59, 60 and above), sex, onset to visit interval (three months or less, four months or more), and external rotation (under 0°, 0° or more) or forward flexion (less than 90°, 90° or more) or internal rotation on the first visit. Results There were 356 idiopathic, 61 diabetic, and 80 posttraumatic stiff shoulders. Hazard ratio (HR) and 95 % confidence interval (CI) for recovery (lower HR means poor prognosis) was 0.54 (0.36–0.96) in the diabetic group (p=0.007), and 0.92 (0.67–1.25) in the post-traumatic group (p=0.58) compared with the idiopathic group. A positive correlation was observed in ages of 60 or over (HR 1.46, 95 % CI 0.86– 1.65, p-value 0.02) and external rotation under 0° on the first Level of evidence Treatment Study Level III (Retrospective comparative study). A. Ando : Y. Hagiwara (*) : K. Kanazawa : E. Itoi Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Japan e-mail: [email protected] H. Sugaya : N. Takahashi Funabashi Orthopaedic Sports Medicine Center, 1-833 Hazama, Funabashi, Japan T. Watanabe Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University School of Medicine, 2-1 Seiryomachi, Aobaku, Sendai, Japan
visit (0.71, 0.53–0.96, 0.03). No correlations were observed in sex (p=0.78) or onset to visit interval (p=0.99). Similar results were obtained when forward flexion or internal rotation was used as a confounding variable. Conclusions Diabetes mellitus and severely restricted joint motion on the first visit were poor prognostic factors and ages of 60 or over was a better prognostic factor.
Introduction Stiff shoulder is a common disease and disturbs the activities of daily living in the middle aged population. It affects females more often than males and typically develops in the fifth and sixth decades [1]. The prevalence of stiff shoulder in the general population has been reported to be 2–5 % [2]. The diagnosis of stiff shoulder is clinically made by pain, especially at night, and restricted active and passive motion in all planes [3]. Stiff shoulder is subdivided into idiopathic (primary) frozen shoulder and acquired (secondary) stiff shoulder [4]. Idiopathic frozen shoulder is a condition that shows global st
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