Clinical evaluation of arthroscopic treatment of shoulder adhesive capsulitis

Abstract

ObjectiveTo evaluate the results of arthroscopic releases performed in patients with adhesive capsulitis refractory to conservative treatment.MethodsThis was a retrospective study, conducted between 1996 and 2012, which included 56 shoulders (52 patients) that underwent surgery; 38 were female, and 28 had the dominant side affected. The mean age was 51 (29–73) years. The mean follow-up was 65 (12–168) months and the mean preoperative time was 8.9 (2–24) months. According to Zukermann's classification, 23 cases were considered primary and 33 secondary. With the patient in the lateral decubitus position, circumferential release of the joint capsule was performed: joint debridement; rotator interval opening; coracohumeral ligament release; anterior, posterior, inferior, and finally antero-inferior capsulotomy. A subscapularis tenotomy was performed when necessary. All patients underwent intense physical therapy in the immediate postoperative period. In 33 shoulders, an interscalene catheter was implanted for anesthetic infusion. Functional results were evaluated by the UCLA criteria.ResultsImproved range of motion was observed: mean increase of 45° of elevation, 41° of external rotation and eight vertebral levels of medial rotation. According to the UCLA score excellent results were obtained in 25 (45%) patients; good, in 24 (45%); fair, in two (3%); and poor, in two (7%). Patients who had undergone inferior capsulotomy achieved better results. Only 8.8% of patients who used the anesthetic infusion catheter underwent postoperative manipulation. Seven patients had complications.ConclusionThere was improvement in pain and range of motion. Inferior capsulotomy leads to better results. The use of the interscalene infusion catheter reduces the number of re-approaches.

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.…”

“…However, there were no postoperative complications related to the procedure, including axillary nerve dysfunction, instability, or infection, reported in the 13 BC studies. †† Of the 15 LD studies, 3 studies 3,32,34 described complications. An LD study 3 reported 1 case of delayed healing of the posterior portal and 1 case of postoperative hematoma, both of which did not require subsequent surgical treatment (n = 2; 6.6%).…”

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

“…We cautiously state that there was an apparent benefit in terms of flexion with additional inferior capsular release. Miyazaki et al 27) found that there were better improvements in pain, IR and ER in patients who underwent anteroinferior capsulotomy.…”

Concordancia diagnóstica de capsulitis adhesiva por resonancia magnética entre centros de imagenología y una clínica de reconstrucción articular con correlación quirúrgica

“…1,3 La liberación artroscópica reporta buenos resultados cuando se realiza la liberación de la porción larga del bíceps y del ligamento coracohumeral, 18 cuando se libera sólo la región posteroinferior de la cápsula 19 o con la apertura del intervalo rotador con resección del ligamento coracohumeral. 20 En nuestro estudio, los casos que se llevaron a tratamiento quirúrgico fueron los pacientes que no mostraron mejoría con el tratamiento conservador, sólo dos casos presentaron lesiones del supraespinoso y seis casos de tendinopatía del bíceps que requirió tenodesis, uno de los cuales tenía un lipoma. Se comprobó la presencia de sinovitis (Figuras 6 a 9 www.medigraphic.org.mx sinovectomía, en dos aperturas del intervalo rotador (Figura 11).…”