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01.12.2015 | Study protocol | Ausgabe 1/2015 Open Access

BMC Musculoskeletal Disorders 1/2015

Pain, depression and the postoperative stiff shoulder

BMC Musculoskeletal Disorders > Ausgabe 1/2015
Nathaniel Hiscock, Simon Bell, Jennifer Coghlan
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12891-015-0841-6) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

NH, SB and JC conceived and designed the trial protocol. NH and JC drafted the manuscript. All authors read and approved the final manuscript.



The surgical repair of shoulder pathologies, including rotator cuff disease and acromio-clavicular joint arthritis, have undergone many technical advances. However the debilitating postoperative stiff shoulder remains a common and significant complication of these surgeries, occurring in 4.9 to 23.2 % of patients undergoing rotator cuff repairs.
The pathology of the pathological postoperative stiff shoulder and its associated condition “frozen shoulder” are poorly understood and both lack formal objective clinical diagnostic criteria. Additionally, although factors associated with the development of idiopathic frozen shoulder have been well described, multiple studies looking at predictors of postoperative stiff shoulder have produced conflicting results. It has been hypothesised that increased pain in the postoperative period, and depression may be predictors of the development of postoperative stiff shoulder.


A prospective cohort study involving 132 consecutive participants. Preoperatively, participants undergoing arthroscopic subacromial decompression and/or excision of the distal clavicle and/or rotator cuff repair will complete questionnaires about their levels of shoulder pain using a numerical rating scale from 0 to 10, and answer a Patient Health Questionnaire – 9 depression questionnaire. Postoperatively, the participants’ pain levels will be self-assessed at two, five and seven days and weeks four, seven and ten. They will complete the depression questionnaire twice, at the time of their routine first and final postoperative appointments with the treating surgeon. At the final appointment, approximately three months postoperatively, the treating surgeon will clinically diagnose participants as having a postoperative stiff shoulder or not. Their shoulders’ range of motion will be measured. The incidence of postoperative stiff shoulder will be determined, both pain and depression will be analysed as predictors for its development and incidences determined by different objective criteria will be compared.


This trial will add to clinical understanding of the postoperative stiff shoulder by providing further insight into the incidence of this condition following shoulder surgery and assessing whether perioperative pain and depression can be used as clinical predictors of postoperative stiff shoulder or markers for possible early intervention. This study will also allow the comparison of incidences determined by different objective criteria in the same cohort.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR).
Additional file 1: Participant Questionnaire – Demographics and History of Depression. Preoperative demographics and history of depression questionnaire. (DOCX 69 kb)
Additional file 2: Participant Questionnaire – Preoperative Pain, Sleep and Analgesia. Preoperative pain, sleep and analgesia questionnaire. (DOCX 88 kb)
Additional file 3: Participant Questionnaire – Postoperative Pain, Sleep and Analgesia. Postoperative Pain, Sleep and Analgesia. (DOCX 102 kb)
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