Management of the Stiff Shoulder With Arthroscopic Circumferential Capsulotomy and Axillary Nerve Release

Abstract

Management of the stiff shoulder is a common and frequently daunting clinical scenario. Arthroscopic capsular release is usually an option for management of severe, chronic glenohumeral joint contractures when conservative treatment fails. Technical hurdles including a thickened capsule, reduction in joint volume, and difficulty with positioning the shoulder intraoperatively can make this procedure challenging. In addition, incomplete release and recalcitrant stiffness are frequent issues. We believe a complete release of the capsule entails special attention to the axillary pouch and requires identification and protection of the axillary nerve. We present a technique for a complete arthroscopic circumferential capsulotomy and detail our approach to safely dissect and protect the axillary nerve under arthroscopic visualization.

Outcomes of arthroscopic capsular release for the diabetic frozen shoulder in Asian patients

“…23 Axillary nerve palsy is a known complication following arthroscopic capsular release, and this is in view of its close proximity to the axillary pouch. 24 Ogilvie-Harris et al described their technique which included a rotator interval release, an inferior capsular release and a release of the tendinous portion of the subscapularis tendon. 8,25 In our series, we did not encounter any patients with axillary nerve palsy, as we avoid releasing the inferior-most portion of the capsule, as advised in most surgical techniques on arthroscopic capsular release.…”

Experience of endoscopic transcapsular axillary nerve decompression: а series of clinical cases

“…После вмешательства во всех случаях (100%) болевой синдром уменьшился. Эндоскопия подмышечного нерва стала логическим продолжением развития артроскопической парартикулярной хирургии плечевого сустава, которая преобразовалась в концепцию комплексного артроскопического вмешательства на плечевом суставе (the comprehensive arthroscopic management procedure) [24][25][26][27].…”

Correlations between clinical features and MRI findings in early adhesive capsulitis of the shoulder: a retrospective observational study

“…Capsular fibrosis becomes most severe in the late stage as the inflammation subsides. Although the symptoms of AC are known to improve naturally over time, complete recovery may take up to 2 years [2,6,20,28]. There are various treatments available, including physical therapy, corticosteroid injection, manipulation under anesthesia, and surgical capsular release [13,18,29].…”