The shoulder stiffness scale: a validated tool for monitoring stiffness in arthroscopic rotator cuff reconstructions
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By
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Samy Bouaicha
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Matthias Biner
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Farah Selman
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Karl Wieser
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Andreas Marc Müller
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Laurent Audigé
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July 6, 2026
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Clinical Scorecard: Shoulder Stiffness Assessment Scale: A Validated Instrument for Evaluating Stiffness Following Arthroscopic Rotator Cuff Surgery
At a Glance
| Category | Detail |
|---|
| Condition | Postoperative shoulder stiffness |
| Key Mechanisms | Transient stiffness as part of normal recovery; pathological stiffness as a deviation from expected recovery |
| Target Population | Patients undergoing arthroscopic rotator cuff repair (ARCR) |
| Care Setting | Multicenter observational study |
Key Highlights
- Development of the Shoulder Stiffness Scale (SSS) for monitoring stiffness post-ARCR
- SSS includes pain, subjective ROM limitation, and objective ROM restriction
- Prevalence of postoperative stiffness ranges from 5% to 33%
- Study involved 973 primary ARCR patients with follow-up at 6 and 12 months
- Internal consistency of SSS assessed with Cronbach’s alpha
Guideline-Based Recommendations
Diagnosis
- Use SSS to evaluate postoperative shoulder stiffness
Management
- Monitor pain and ROM limitations post-surgery
Monitoring & Follow-up
- Assess SSS at baseline, 6 months, and 12 months post-ARCR
Risks
- Pathological stiffness may lead to prolonged pain and inability to return to activities
Patient & Prescribing Data
Patients undergoing primary ARCR
Postoperative rehabilitation includes 6 weeks of passive followed by 6 weeks of active mobilization
Clinical Best Practices
- Utilize SSS for serial monitoring of stiffness
- Document pain and ROM limitations regularly
- Consider potential risk factors such as diabetes and hypothyroidism
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