Arthroscopic capsular release to treat idiopathic frozen shoulder: How much release is needed?

Sivasubramanian, Harish; Chua, Chen; Lim, Siak Piang; Manohara, Ruben; Ng, Zhao Wen Dennis; Kumar, Patricia; Poh, Keng Soon

doi:10.1016/j.otsr.2020.102766

Cited by 14 publications

(12 citation statements)

References 30 publications

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“…Another important finding in our study was the increased humeral head translation in all directions after violating the inferior capsule, which was significant after 70˚ of abduction. This seems to confirm the hypothesis that the inferior capsular redundancy disappears after 70˚, and that the inferior capsular tightness, which is remarkable at this degree of abduction, reduces humeral head translation in superior, lateral, and spatial directions [ 50 , 51 ]. Therefore, we hypothesize that there is a relationship between IAP, capsular tightness, GH abduction, GH external rotation, and RC load not fully captured by this study that defines the role of each on a joint translation during motion.…”

Section: Discussionsupporting

confidence: 78%

Effect of intraarticular pressure on glenohumeral kinematics during a simulated abduction motion: a cadaveric study

Williamson

Momenzadeh

Hanna

et al. 2023

BMC Musculoskelet Disord

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Background The current understanding of glenohumeral joint stability is defined by active restrictions and passive stabilizers including naturally-occurring negative intraarticular pressure. Cadaveric specimens have been used to evaluate the role of intraarticular pressure on joint stability, although, while the shoulder’s negative intraarticular pressure is universally acknowledged, it has been inconsistently accounted for. Hypothesis During continuous, passive humeral abduction, releasing the native intraarticular pressure increases joint translation, and restoring this pressure decreases joint translations. Study design Descriptive Laboratory Study. Methods A validated shoulder testing system was used to passively abduct the humerus in the scapular plane and measure joint translations for seven (n = 7) cadaveric specimens. The pressure within the glenohumeral joint was measured via a 25-gauge needle during passive abduction of the arm, which was released and subsequently restored. During motion, the rotator cuff muscles were loaded using stepper motors in a force feedback loop and electromagnetic sensors were used to continuously measure the position of the humerus and scapula. Joint translation was defined according to the instant center of rotation of the glenohumeral head according to the recommendations by the International Society of Biomechanics. Results Area under the translation versus abduction angle curve suggests that releasing the pressure within the capsule results in significantly less posterior translation of the glenohumeral head as compared to intact (85–90˚, p < 0.05). Posterior and superior translations were reduced after 70˚ of abduction when the pressure within the joint was restored. Conclusion With our testing system employing a smooth continuous passive motion, we were able to show that releasing intraarticular pressure does not have a major effect on the path of humeral head motion during glenohumeral abduction. However, both violating the capsule and restoring intraarticular pressure after releasing alter glenohumeral translations. Future studies should study the effect of simultaneous external rotation and abduction on the relationship between joint motion and IAP, especially in higher degrees of abduction. Clinical relevance Thoroughly simulating the glenohumeral joint environment in the cadaveric setting may strengthen the conclusions that can be translated from this setting to the clinic.

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Section: Discussionsupporting

confidence: 78%

Effect of intraarticular pressure on glenohumeral kinematics during a simulated abduction motion: a cadaveric study

Williamson

Momenzadeh

Hanna

et al. 2023

BMC Musculoskelet Disord

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“…Regarding the arthroscopic capsular release technique, it remains debatable whether the release of the joint capsule should be circumferential or partial. In the latest 2021 systematic review including 811 shoulders (629 patients) from 18 eligible articles, the outcomes of three techniques—anterior–inferior capsular release, anterior–inferior–posterior capsular release, and 360-degree capsular release—were investigated [ 41 ]. The results suggested that anterior–inferior capsular release, which has a less extensive release, may improve function and pain.…”

Section: Discussionmentioning

confidence: 99%

Sex Is Associated with the Success or Failure of Manipulation Alone for Joint Stiffness Associated with Rotator Cuff Repair

Yamaura

Mifune

Inui

et al. 2022

JCM

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Purpose: One-stage arthroscopic rotator cuff repair with manipulation has been recently performed for rotator cuff tears with shoulder stiffness, whereas some patients require capsular release due to severe stiffness that is difficult to treat with manipulation. The purpose of this study was to analyze patient backgrounds and related factors of success or failure of manipulation alone for the treatment of shoulder stiffness associated with rotator cuff tears. Methods: This study included 64 patients with rotator cuff tears and shoulder stiffness who underwent arthroscopic rotator cuff repair with manipulation alone or with manipulation and capsular release of the glenohumeral joint at our institution between January 2015 and September 2019. The patients were divided into two groups: those whose shoulder stiffness could be improved by manipulation alone (Manipulation group) and those whose stiffness could not be improved by manipulation alone and required capsular release (Capsular release addition group). Analysis was performed between the two groups regarding patient backgrounds and related factors, including rotator cuff tear morphology and range of motions pre- and postoperatively. Results: Exactly 45 patients and 19 patients were included in Manipulation group and Capsular release addition group, respectively. A comparison between the two groups showed that patient age (p = 0.0040), sex (p = 0.0005), and injury due to trauma (p = 0.0018) were significantly related to the success or failure of manipulation alone. Multivariate logistic regression analysis on these three factors showed that sex (odds ratio, 5.5; p = 0.048) was significantly associated with the success or failure of manipulation alone. In both groups, the passive ROM of all patients improved at the last postoperative follow-up compared to their pre-operative values (p < 0.001), except for internal rotation in the Capsular release addition group (p = 0.49). Conclusion: Young male patients who have shoulder stiffness associated with rotator cuff tears should be considered for arthroscopic capsular release rather than manipulation.

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“…Adezif kapsülitte literatürde tanımlanmış tedavi modaliteleri arasında non-steroid anti-inflamatuar ilaçlar (NSAİİ), oral kısa dönem kortikosteroid, eklem-içi kortikosteroid, fizyoterapi, akupunktur, botulinum toksini uygulaması, hidrodilatasyon, ESWT (ekstracorporeal shock wave therapy), anestezi altında manipülasyon (AAM) ve artroskopik gevşetme yer almaktadır (7)(8)(9)(10)(11). Tedavi protokolleri öncesi yapılan VAS ve CMS değerlendirilmesinde 2 grup arasında istatistiksel olarak anlamlı fark tespit edilmemiştir (VAS p=0.322, CMS p=0.663) (Tablo 1 ve 2).…”

Section: Introductionunclassified

Adezif Kapsülit Tedavisinde Anestezi Altında Manipülasyon Sonrası Fizyoterapinin Etkinliği

Ilyas

GÖKALP

2023

Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi

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Amaç: Bu çalışmada omuzun adezif kapsülit hastalığı tedavisinde, fizyoterapinin izole uygulanması ile anestezi altında manipülasyon sonrasında uygulanması karşılaştırılmıştır. Gereç ve Yöntem: Primer adezif kapsülit olup, dışlanma kriterlerine sahip olmayan 32 hasta, izole fizyoterapi (İF) alan ve anestezi altında manipülasyon (AAM) sonrası erken dönem fizyoterapi alanlar olmak üzere 2 gruba ayrılarak ağrı ve fonksiyon skorları retrospektif karşılaştırmalı olarak değerlendirildi. Bulgular: İF grubuna kıyasla, fizyoterapinin AAM sonrası uygulanması, erken dönemde istatistiksel olarak daha etkin bir modalite olarak görülmüştür. İstatistiksel analizde Mann-Whitney-U testinin kullanıldığı çalışmamızda tedaviler öncesi, tedaviler sonrası 1. hafta, 6. hafta ve 6. ayda Vizüel Analog Skala (VAS) ve Constant Murley Skoru (CMS) değerlendirilmeleri yapılmıştır. Tedaviler öncesi değerlendirmelerde; istatistiksel anlamlı fark yokken (sırasıyla; p=0.322, p=0.663), tedaviler sonrası 1. haftada (sırasıyla; p

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Arthroscopic capsular release to treat idiopathic frozen shoulder: How much release is needed?

Cited by 14 publications

References 30 publications

Effect of intraarticular pressure on glenohumeral kinematics during a simulated abduction motion: a cadaveric study

Effect of intraarticular pressure on glenohumeral kinematics during a simulated abduction motion: a cadaveric study

Sex Is Associated with the Success or Failure of Manipulation Alone for Joint Stiffness Associated with Rotator Cuff Repair

Adezif Kapsülit Tedavisinde Anestezi Altında Manipülasyon Sonrası Fizyoterapinin Etkinliği

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