The Brisement Procedure for Shoulder Stiffness associated with Rotator Cuff Tears

Abstract

The purpose of this study was to investigate the effectiveness of brisement procedures for preoperative shoulder stiffness associated with rotator cuff tears. Sixty-six shoulders of 66 patients were followed up over one year. There were 50 males and 16 females, aged from 37 to 75 years old (the mean 57 years old). They were followed up at 40 months on average (18- 61 months). The size of tear was a small or incomplete tear in all the cases. There were 49 small,6 bursal side,6 articular side and 5 intratendinous tears. They were repaired by tendon to bone sutures in all cases. Those cases were divided into 2 groups, Group S (34 shoulders): with the presence of shoulder stiffness which received brisement procedures prior to cuff reconstructions, Group C (32shoulders): with the absence of preoperative stiffness. The outcome was assessed with the JOA score and the transition of ranges of motion. Each parameter was statistically analyzed by paired t-test, Student's t-tset and Mann-Whitney's U-test. The postoperative shoulder functions improved significantly in both groups. The average total JOA score increased from 58.7 to 89.6 (p<0.001) in Group S and from 74.3 to 92.4 (p<0.001) in Group C. The range of abduction improved from 77.6° to 163.4° in Group S (p<0.001), while it improved from 148.0°to 173.4° in Group C (p<0.01). There was no statistical difference of the postoperative range of abduction between the two groups (p=0.06). The most significant difference between Group S and Group C was found in the range of external rotation, which improved from 28.2° to 35.3° (p=0.07) in Group S, while it decreased from 58.3 to 48.1° (p<0.01) in Group C. We conclude that the preoperative brisement procedures for shoulder stiffness associated with rotator cuff tears had satisfactory clinical outcomes.