Shoulder stiffness following distal radius open reduction and internal fixation: Natural course and effect of structured postoperative exercise
Joonha Lee1#
, Yohan Lee2#, Donghyun Lee3, Yeongcheol Shin4, SeongJu Choi5
1Department of Orthopaedic Surgery, Yeson Hospital, Bucheon, Gyeonggi-do, Republic of Korea
2Department of Orthopaedic Surgery, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
3Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
439th Infantry Brigade, 15th Infantry Division, Republic of Korea Armed Forces
5Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
Keywords: Distal radius fracture, hand, quick disabilities of the arm, range of motion, shoulder, shoulder stiffness.
Abstract
Objectives: This study aims to investigate the effect of a structured postoperative shoulder exercise program on shoulder range of motion (ROM) recovery and the development of postoperative shoulder stiffness following surgical fixation of distal radius fractures (DRFs).
Patients and methods: This non-randomized, time-based cohort study included a total of 64 patients who underwent volar plate fixation of DRF between October 2022 and March 2023. Patients were allocated into two groups based on calendar periods and basic demographic factors were evaluated. Group 1 (exercise group, n = 33) was educated on pre-designed shoulder exercise to prevent shoulder stiffness after surgical treatment. Group 2 (control group, n = 31) was instructed to use their shoulders freely without an arm sling. Shoulder ROM and Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) scores were evaluated and compared at postoperative Weeks 2, 4, 8, 12, and 24. Shoulder stiffness was defined as passive ROM restricted by 30° or more compared to the contralateral side (or difference of two or more Constant-Murley scores in internal rotation) in two or more planes of movement.
Results: Of the patients, 12 were male and 52 were female with a mean age of 65.7 ± 8.9 (range, 42 to 85) years. The mean follow-up was 6.8 ± 1.6 months. Shoulder ROM markedly decreased between postoperative Weeks 2 and 4, but continuously improved until the final follow-up in both groups. A transient improvement in internal rotation at postoperative Weeks 4 and 8 was observed in Group 1 compared to Group 2. No significant difference in internal rotation was observed at the other time points. At the final follow-up, 7.8% of all patients continued to experience shoulder stiffness.
Conclusion: Structured shoulder exercise may facilitate earlier recovery of shoulder internal rotation after volar plate fixation of DRFs. However, this advantage can be transient and cannot be maintained beyond eight weeks postoperatively, suggesting that shoulder ROM often recovers spontaneously even in the absence of a routine rehabilitation protocol. Furthermore, secondary shoulder stiffness following DRF fixation peaks at approximately four weeks after surgery and subsequently resolves more rapidly than the typical natural history of primary frozen shoulder. These findings indicate that structured shoulder exercises may provide short-term benefits in postoperative recovery, while the long-term clinical significance of routine shoulder rehabilitation remains uncertain.
#They contributed equally to this work.
Citation: Lee J, Lee Y, Lee D, Shin Y, Choi S. Shoulder stiffness following distal radius open reduction and internal fixation: Natural course and effect of structured postoperative exercise. Jt Dis Relat Surg 2026;37(x):i-ix. doi: 10.52312/jdrs.2026.2737.