Miniopen coracohumeral ligament release and manipulation for idiopathic frozen shoulder

Abstract

In the management of idiopathic frozen shoulder, manipulation under anaesthesia is known to have serious potential complications including fractures and intra-articular injuries. Arthroscopy is a safer treatment modality but requires special instruments, experience, and involves added cost. The aim of this work was to study the use of miniopen Coracohumeral ligament release and manipulation of the shoulder as a safe and simple method of treating idiopathic frozen shoulder that could be performed as a quick procedure under short duration anaesthesia obtaining a significant improvement of shoulder function while avoiding complications that are feared to occur with the use of manipulation under anaesthesia. Miniopen Coracohumeral ligament release is performed through a 3-cm incision. The Coracohumeral ligament is divided, and then the shoulder is manipulated without undue force. A case series including fifteen patients (19 shoulders) with idiopathic frozen shoulder operated by this technique is described. Miniopen Coracohumeral ligament release and manipulation is a quick procedure that may be performed under short duration anaesthesia obtaining a significant improvement of shoulder function meanwhile avoiding complications that are feared to occur with the use of manipulation under anaesthesia.

High‐Pressure Balloon‐Assisted Stretching of the Coracohumeral Ligament to Determine the Optimal Stretching Positions: A Cadaveric Study

“…However, a guide wire and balloon were introduced, and the subsequent experiment was successfully performed. Considering that the CHL and underlying capsule are totally sectioned in current surgical practices [5,6,10], capsular tear while introducing a balloon would not incur significant risks in future clinical application.…”

“…The importance of the coracohumeral ligament (CHL) as a key pathological structure for adhesive capsulitis is evidenced by studies on imaging [1‐4], histology [5‐8], biomechanics [9], and surgical outcomes [5,6,10]. Stretching the thickened and fibrosed capsule comprises the main treatment option for adhesive capsulitis [11].…”

“…Stretching the thickened and fibrosed capsule comprises the main treatment option for adhesive capsulitis [11]. Being a thickened capsular band and affected frequently and severely by adhesive capsulitis, the pathologically tightened CHL was reported to restrict glenohumeral range of motion [5,10] especially in external rotation direction [6,7,9]. It appears obvious that the CHL should be the main target of stretching treatment [5,7]; however, surprisingly, there is a lack of research [12,13] on how to stretch the tightened CHL specifically.…”

“…It appears obvious that the CHL should be the main target of stretching treatment [5,7]; however, surprisingly, there is a lack of research [12,13] on how to stretch the tightened CHL specifically. Consequently, clinical attempts to loosen the CHL have resorted to complete surgical resection [5,6,10], which, however, raises concerns of endangering stability [5,14]. In contrast to invasive treatments, therapeutic stretching would be more appropriate and beneficial, because the structure is viscoelastic, and the continuity of the structure can be preserved while minimizing the risk of instability.…”

Manipulation Under Anesthesia for Frozen Shoulders

“…Eid reported a use of mini-open coracohumeral ligament release combined with MUA [ 8 ]. The background of this procedure is that MUA has serious potential complications, whereas arthroscopic capsular release is much safer but requires special instrument, experience, and high cost.…”