Clinical Outcome after Arthroscopic Capsular Release for Adhesive Capsulitis of the Shoulder

Abstract

BACKGROUND: This study was undertaken to evaluate the outcome of the arthroscopic capsular release for adhesive capsulitis of the shoulder.METHODS: This study retrospectively investigated thirty shoulders in 29 patients who presented with recalcitrant adhesive capsulitis and underwent arthroscopic treatments. Other than typical findings of adhesive capsulitis, combined pathologies in the glenohumeral joint and subacromial space were evaluated by arthroscopy. Clinical evaluations were performed using the Constant's score and ranges of motion (ROM) at preoperative, 6 months postoperatively and at the final follow-up.RESULTS: Our study included 17 women and 12 men with a mean age of 53.8 years (range, 34?74). Mean follow-up duration was 24 months (range, 12?40 months). Assessment of combined pathologies revealed that partial rotator cuff tear of less than 25% thickness, was most common (overall 83.3%; with bursal 57% and articular 23%). Subacromial synovitis and adhesion were also frequent (53.3%). The Constant score and ranges of motion significantly improved at the final follow-up, compared with preoperative levels. However, clinical results at 6 months postoperatively were found to be significantly inferior to those observed at the final follow-up (p≤0.001 for all factors). Functional impairment was the major complaint in 59.3% patients at the 6 months follow-up.CONCLUSIONS: Although arthroscopic capsular release yielded favorable outcome at the mean 24 months follow-up, pain and motion limitations at 6-month postoperatively persisted in more than 50% of our patients. While combined pathologies were commonly encountered during arthroscopy, although their effects on surgical outcome in adhesive capsulitis remains unclear in this study.

Functional Outcome After Arthroscopic Capsular Release in Management of the Shoulder Adhesive Capsulitis

“…31.88 ± 7.52 at last follow up is coincident with other study that reported that after arthroscopic capsular release in managing shoulder adhesive capsulitis, there was an increase of 28.8 degrees of ROM in forward elevation, 5.3 degrees in external rotation, and 4.0 degrees vertebral levels in internal rotation. There was statistically significant increase in the Constant-score, Murley's forward elevation, and internal rotation but not in external rotation (20) . In other study, it was found that the mean Constant-score at 6 months postoperatively was 83.4 % of the values at the final follow-up.…”

“…As a result of arthroscopic capsular release, other studies have found that the overall results are favourable and comparable to those previously reported. After surgery, pain, functional scores of the shoulders and ranges of motion were significantly improved (20,(22)(23)(24)(25)(26)(27)(28)(29)(30) . There were a number of clinical parameters at 6 months post-operatively that were lower when compared to those at the final follow-up (31,32) .…”

Arthroscopic capsular release versus manipulation under anesthesia for primary frozen shoulder

“…Arthroscopic capsular release (ACR) and manipulation under anesthesia (MUA) are treatment options for primary frozen shoulder (FS). Both of these are useful for primary FS [ 1 - 3 ]. In addition, MUA is possible without the surgical equipment needed for an arthroscopic procedure.…”

“…Although MUA is an useful option for primary FS, several complications such as proximal humerus fracture, shoulder dislocation, brachial plexus stretching injury, rotator cuff injury, and glenoid fracture may result [ 1 - 3 , 5 ]. Therefore, MUA should be performed with great caution.…”

“…MUA is more simple and easy than ACR because arthroscopic equipment is not necessary. However, MUA can lead to several serious complications [ 1 - 3 , 5 ]. If experienced surgeons perform ACR, it can be more safe than MUA.…”