360° arthroscopic capsular release in patients with adhesive capsulitis of the glenohumeral joint – indication, surgical technique, results

Abstract

Adhesive capsulitis of the glenohumeral joint is said to be a self-limiting process. However, in some patients the disease can last much longer than 1 year, which may lead patients to more invasive treatment than merely undergoing physiotherapy. Other patients do not accept this severe limitation and choose treatment options that restore the range of motion (ROM) more rapidly. Conventional open release techniques generally improve motion but involve extensive dissection. The purpose of this study was to develop a safe and reproducible technique of arthroscopic capsular release (ACR) and to present the results of this technique in the clinical situation. The technique for ACR was first defined in a cadaver study and then applied in 28 patients with primary adhesive capsulitis of the glenohumeral joint. The patients were selected for the arthroscopic release when conservative therapy had failed for at least 6 months. All of the patients had a global loss of shoulder motion and had motion restored with a combined anterior, posterior, superior, and inferior release of the of the capsule (360 degrees release). Additionally, in all patients synovectomy with electrocautery was performed. We documented the ROM in the different planes as well as the Constant score. The Constant score improved a mean of 41 points. Range of motion for all planes significantly improved (P < 0.01). Abduction improved from 75 degrees preoperatively to 165 degrees intraoperatively; 6 weeks after surgery, mean abduction was 168 degrees and at the time of follow-up it was 167 degrees. Mean external rotation in adduction improved from 3 degrees preoperatively to 75 degrees intraoperatively. After 6 weeks, the mean external rotation in adduction was 72 degrees and at the time of follow-up the external rotation reached 76 degrees. Mean external rotation in abduction improved from 4 degrees preoperatively to 81 degrees intraoperatively, 80 degrees after 6 weeks and 85 degrees at the time of the last follow-up. Internal rotation in abduction was 17 degrees preoperatively. Intraoperatively, mean internal rotation was 59 degrees. An angle of 58 degrees was documented at 6 weeks follow-up, and at the last follow-up an angle of 63 degrees was documented. No postoperative lesion of the axillary nerve was present. We concluded that arthroscopic capsular release is a reliable method for restoring motion with minimum morbidity in carefully selected patients. When performing an ACR the incision of the glenohumeral joint capsule should be undertaken at the glenoidal insertion in the abducted and external rotated shoulder.

Arthroscopic extended rotator interval release for treating refractory adhesive capsulitis

“…11,14 Numerous recent studies have supported arthroscopic release for effectively treating refractory adhesive capsulitis through the controlled release of the capsular restraints. [4][5][6]15 Glenohumeral motion loss assessed in cadaveric cutting studies has clarified that the regional capsule must be released. 16,17 Loss of external rotation mandated the release of the MGHL, rotator interval, coracohumeral ligament extra-articularly, or intra-articular portion of the subscapularis.…”

“…Given the recent advances in arthroscopy, arthroscopic release of the joint capsule is more favorable than other treatment options. [3][4][5] However, the extent of release is still controversial. Several authors have recommended 360 release, whereas others have suggested a relatively conservative release.…”

Is Pancapsular Release More Effective than Selective Capsular Release for the Treatment of Adhesive Capsulitis?

“…[4][5][6][7] Nicholson 5) showed good clinical outcomes in 68 patients with adhesive capsulitis after arthroscopic pancapsular release, and proposed that for an enhanced postoperative internal rotation, performing a posterior capsular release is recommended. Another study carried out Ide and Takagi 6) on 44 patients with adhesive capsulitis showed a successful outcome after pancapsular release.…”

“…the release of the rotator interval and the anteroinferior capsule, gives results that are comparable to the results after posterior capsular release. [5][6][7][8][9] To rule out one of the possiblility that selective capsular release alone could give clinical outcomes that are comparable to those of posterior capsular release for the treatment of adhesive capsulitis, we investigated whether selective capsular release and pancapsular release have any relative advantage over one another for the treatment of adhesive capsulitis in terms of the clinical outcome and range of motion (ROM).…”

A Randomized Comparative Study of a Standard Anterior Capsular Release versus Inferior Extended Release for the Treatment of Shoulder Stiffness

“…7,8) However, the extent of release is still the subject of debate. Besides the CHL and rotator interval, some authors have recommended release of the subscapularis tendon, 9) inferior capsule, 10) posterior capsule, 11,12) or global capsule 13) to improve elevation and internal rotation (IR), as well as external rotation (ER). Pearsall et al 14) reported that information regarding preoperative motion loss would precisely direct selective capsular release.…”