In spite of the high prevalence of shoulder stiffness during rotator cuff repair, optimal management remains unclear. To identify the effect of capsular release during rotator cuff repair on the outcomes of patients with both shoulder stiffness and a rotator cuff tear, based on subgroup analyses. Cohort study; Level of evidence, 3. Forty-nine consecutive patients (mean age, 61.5 ± 8.3 years) were enrolled who underwent arthroscopic repair of a small- to large-sized full-thickness rotator cuff tear and manipulation for concomitant shoulder stiffness (passive forward flexion ≤120°, external rotation at the side ≤45°). The first 21 consecutive patients underwent manipulation alone to treat stiffness; the second 28 consecutive patients underwent capsular release with manipulation. Among the 49 patients, 25 showed severe stiffness (forward flexion ≤100°, external rotation at the side ≤30°; 11 in the first series and 14 in the second series), and 15 had diabetes mellitus (30.6%; 6 in the first series and 9 in the second series). Shoulder range of motion was measured 6 weeks, 3 months, 6 months, and 1 year postoperatively and at final follow-up visit. Simultaneously, functional outcome was evaluated by visual analog scale for pain, American Shoulder and Elbow Surgeons score, Constant score, and muscle strength ratio (involved/uninvolved), and cuff integrity was assessed ultrasonographically at least 1 year postoperatively. All range of motion measurements, functional scores, and muscle strength ratios significantly improved postoperatively regardless of the treatment method of stiffness. No outcome measure differed significantly between patients who did and did not undergo capsular release, regardless of the severity of stiffness, except for a temporary improvement in external rotation at side 3 months postoperatively in favor of those who underwent capsular release in cases with severe stiffness. Among patients with diabetes mellitus however, those who underwent capsular release showed greater improvement in forward flexion after 3 months and 1 year and in external rotation at the side for all time points (all P < .05), except for 6 weeks postoperatively; these patients also had a significantly higher final American Shoulder and Elbow Surgeons score (P = .03). Of 21 patients who underwent manipulation alone and of 28 who underwent capsular release and manipulation, 2 and 1 developed retears, respectively. Both manipulation and capsular release with manipulation significantly improved range of motion and produced satisfactory functional outcomes. The outcomes did not differ between treatment methods for stiffness regardless of the severity of stiffness. In patients with diabetes mellitus however, capsular release at the time of rotator cuff repair seems to be beneficial, especially for external rotation and final postoperative function.

Introduction: Pigmented villous nodular synovitis is an uncommon proliferative disease of the joints, and rarely reported in the shoulder. It can become symptomatic when proliferating soft tissue infiltrates a joint, causing arthritic changes including bone erosion. The literature has described the disease progression as indolent. Here we report on a case of PVNS of the shoulder joint which rapidly lead to significant bone damage and was subsequently treated by shoulder arthroplasty. Presentation of case: We report here on a 71-year old female patient who presented with a 6 month history of aggravating shoulder pain. Radiography imaging over a one month period indicated rapid joint destruction. Magnetic resonance imaging suggested the presence of PVNS of the shoulder joint and significant bone erosion. The patient was subsequently treated by shoulder arthroplasty performed by authors. Histological examination confirmed the PVNS diagnosis. Shoulder pain significantly decreased during the follow up period, and the patient was able to resume daily activities. Discussion: Comparing to Milwaukee shoulder syndrome or a joint infection, PVNS is known to progress indolently. However, our case clearly showed that PVNS could also cause radical destruction of the joint. Previous reports showed the high recurrence rate of PVNS after joint preserving surgery. In our experience hemiarthroplasty could be the choice of treatment with the low recurrence rate and high functional outcome. Conclusions: Physicians should include PVNS in the differential diagnosis when they are presented with evidence of rapid destruction of the shoulder joint. Hemiarthroplasty could be treatment option for PVNS of shoulder joint. Highlights: