Primary Frozen Shoulder Syndrome: Arthroscopic Capsular Release

Abstract

Idiopathic adhesive capsulitis, or primary frozen shoulder syndrome, is a fairly common orthopaedic problem characterized by shoulder pain and loss of motion. In most cases, conservative treatment (6-month physical therapy program and intra-articular steroid injections) improves symptoms and restores shoulder motion. In refractory cases, arthroscopic capsular release is indicated. This surgical procedure carries several advantages over other treatment modalities. First, it provides precise and controlled release of the capsule and ligaments, reducing the risk of traumatic complications observed after forceful shoulder manipulation. Second, release of the capsule and the involved structures with a radiofrequency device delays healing, which prevents adhesion formation. Third, the technique is straightforward, and an oral postoperative steroid program decreases pain and allows for a pleasant early rehabilitation program. Fourth, the procedure is performed with the patient fully awake under an interscalene block, which boosts the patient's confidence and adherence to the physical therapy protocol. In patients with refractory primary frozen shoulder syndrome, arthroscopic capsular release emerges as a suitable option that leads to a faster and long-lasting recovery.

Anatomical structure of the coracohumeral ligament and its effect on shoulder joint stability

“…In 1970, Neer [16] first proposed the term "rotator interval" (RI) to describe the histological structure between supraspinatus tendon and subscapularis tendon, consisting of the coracohumeral ligament (CHL), the superior glenohumeral ligament (SGHL) and a part of the anterior articular capsule, and verified that the RI played a role in maintaining shoulder joint stability in subsequent studies with Foster [17]. Since Neer's study, Neer et al [18] reported in 1992 that the CHL played an important limiting role on the external rotation of the shoulder joint; CHL release or amputation for patients with frozen shoulder joint obstruction during external rotation began clinically, having significant influences on the long-term anterior shoulder stability [2,11,14]. In this study, the length, width and thickness of the CHL at a specific position of the shoulder joint are measured anatomically, and changes in tension are described by observing the contraction state, with a view to illuminate the specific action mechanisms of CHL on maintaining shoulder joint stability.…”

Do diabetic patients have different outcomes after arthroscopic capsular release for frozen shoulder?

“…This method is standardized and adopted for all patients undergoing arthroscopic capsular release in this institution and is a widely used approach. 20,21 First, an inspection of the glenohumeral joint is done via the posterior viewing portal ( Fig. 2A).…”

Outcomes of Arthroscopic Capsular Release in the Beach-Chair Versus Lateral Decubitus Position: A Systematic Review

“…ACR can be performed in the beach-chair (BC) position 1 as well as in the lateral decubitus (LD) position. 11,27 Typically, surgeon preference for patient positioning is based on training, experience and the intended procedure.…”