Arthroscopic treatment of adhesive capsulitis of the shoulder with minimum follow up of six years

Abstract

OBJECTIVE: To evaluate the results of the arthroscopic treatment of adhesive capsulitis of the shoulder with six to nine years of follow up. METHODS: From August 2002 to December 2004, ten patients underwent arthroscopic capsular release for adhesive capsulitis refractory to conservative treatment. An interscalene catheter was used for postoperative analgesia, before the procedure. All were in stage II, with a minimum follow up of six years. The mean age was of 52.9 years old (range, 39 to 66), with female predominance (90%) and six left shoulders. The time between the onset of symptoms and surgery varied from six to 20 months. There were four patients in the primary form (40%) and six in the secondary (60%). RESULTS: In the preoperative evaluation, the mean active anterior elevation was 92°, 10.5° of external rotation, and internal rotation level L5. Postoperatively, the mean active elevation was 149°, 40° of external rotation and internal level T12, respectively. Thus, the average gains were 57° in forward active elevation, 29.5° in external rotation and six spinous processes, these values being statistically significant (p <0.001). According to the Constant functional score (arc of movements), the value increased from 13.8 (preoperative mean) to 32 points (postoperative mean). CONCLUSION: Arthroscopic treatment of adhesive capsulitis of the shoulder refractory to conservative treatment allows effective gain of range of motion of this joint. Level of Evidence IV, Retrospective Study (Case Series).

Outcomes of Arthroscopic Capsular Release in the Beach-Chair Versus Lateral Decubitus Position: A Systematic Review

“…There were 2 studies (2 LD position) 3,4 that performed ACR by release of only the rotator cuff interval and the contracted coracohumeral ligament, 1 study (1 BC position) 28 by release of the superior edge of the subscapularis, 12 studies (8 BC position, 8,16,17,33,36,42,43,45 4 LD position 5,22,30,41 ) by release of the anterior capsule, 11 studies (6 BC position, 8,16,17,28,33,40 5 LD position 3–5,22,30 ) by release of the posterior capsule, 1 study (1 LD position 6 ) by 270° capsulectomy, and 12 studies (4 BC position, 2,25,26,35 8 LD position 7,12–14,18,19,32,34 ) by 360° capsulectomy.…”

“…This was then followed by gentle manipulation of the shoulder joint in 22 studies (12 BC position, ¶ 10 LD position 3–7,14,22,32,34,41 ). Additionally, 7 studies (2 BC position, 8,25 5 LD position 12,13,19,30,39 ) clearly stated that no concomitant manipulation was performed, while 1 LD study 30 did not clearly state whether concomitant manipulation was performed. In the BC group, no patients underwent an additional surgical intervention to address bone fractures, rotator cuff or biceps tendon tears, loose bodies, subacromial depression, or arthritis.…”

“…A total of 16 studies (8 BC position, 8,17,25,28,33,36,40,42 8 LD position 4–6,14,22,30,34,41 ) reported CMS values. In addition, 3 studies 18,19,39 reported only individual parameters of the CMS. A BC study 42 reported only mean improvement in CMS values, 1 LD study 5 reported only the normalized CMS percentage, and another LD study 12 reported only postoperative outcome scores; these studies were consequently excluded from the analysis.…”

Current Concepts in the Treatment of adhesive capsulitis of the Shoulder

“…Numerous studies have supported the role of arthroscopic release as a safe and effective treatment for recalcitrant frozen shoulder in the short term 23,25,26,27 . There is controversy in the literature as to the optimal method of release.…”

“…There is controversy in the literature as to the optimal method of release. Some authors recommended release of the subscapularis tendon 28 , inferior capsule 29 , posterior capsule 23,25 , or global capsule 26 to improve elevation and internal rotation, as well as external rotation. Some have advocated circumferential release of the capsule or selective posterior release if there is persistent loss of internal rotation after anterior release 27,30 .…”