An Arthroscopic Technique for Treating Patients With Frozen Shoulder

https://doi.org/10.1053/ar.1999.v15.0150002Get rights and content

Abstract

Summary: Forty-three patients with a diagnosis of primary or secondary frozen shoulder who had symptoms for an average of 12 months and failed conservative treatment of at least 12 weeks of physical therapy, were treated with an arthrosopic capsular release. Oon completion of standard shoulder arthroscopy, intra-articular cautery was used to completely divide the anterior-inferior capsule, the intra-articular portion of the subscapularis tendon, and the middle glenohumeral, the superior glenohumeral, and the coracohumeral ligaments. The subacromial space was inspected in all patients. Eighteen patients had extensive subacromial fibrosis that required debridement. Subacromial decompression was reserved for patients with evidence of an acromial spur seen at the time of arthroscopy. Postoperatively, all patients showed substantial gains in shoulder range of motion, as well as diminished shoulder pain. Thirty-five patients completed a telephone survey at an average of 22 months after surgery. The average modified shoulder score was 19 (scale, 13 to 65), with 83% of patients indicating that their shoulder was normal or caused only mild symptoms. In conclusion, the authors believe that arthroscopic capsular release is an effective and safe alternative to manipulation in patients with a recalcitrant frozen shoulder.

0749-8063/99/1501-1667$3.00/0

Section snippets

MATERIALS AND METHODS

Forty-six patients with a diagnosis of primary or secondary frozen shoulder who had symptoms for an average of 12 months and failed conservative management of at least 12 weeks of physical therapy and nonsteroidal and/or systemic steroid medications, were treated arthroscopically with the procedure described below. No patient had undergone a previous surgical procedure for frozen shoulder. All procedures were performed over a 3-year period and no patient underwent manipulation under anesthesia.

STATISTICS

Descriptive statistics including mean and standard deviations were calculated for patients' range of motion measurements. A Pearson correlation at the P <.01 level of significance was used to analyze the modified shoulder questionnaire variables.

SURGICAL TECHNIQUE

Interscalene anesthesia with ropivacaine 0.5% and epinephrine 1:200,000 was used in all patients and the surgery was performed as an outpatient procedure. All patients received intravenous sedation. The interscalene anesthetic provided approximately 12 to 18 hours of pain relief postoperatively.

After a side-to-side examination of allowable passive glenohumeral motion was performed, the patient underwent standard glenohumeral arthroscopy in the beach chair position. The anterior portal was

RESULTS

There were 22 men and 24 women with an average age of 49 years (range, 21 to 76 years). Because of incomplete records, only 43 charts were used for statistical analysis. The average follow-up periods for the functional and clinical assessments were 22 and 5 months, respectively. Twelve percent of patients had a history of diabetes mellitus and 49% underwent at least one subacromial injection before surgery. Twenty-four charts of patients who underwent an isolated anterior release were reviewed,

DISCUSSION

The etiology of the frozen shoulder remains enigmatic. Investigators have proposed a variety of causes from autoimmune theories to systemic disease. 5, 6, 7, 8, 9 Lundberg subdivided the frozen shoulder syndrome into (1) primary or idiopathic and (2) secondary. 10 Others have simply defined frozen shoulder syndrome as a clinical loss of glenohumeral motion preceded in many patients by a period of relative immobilization.2, 11 A variety of factors have been reported to be associated with frozen

References (33)

  • BJ. Lundberg

    The frozen shoulder

    Acta Orthop Scand (Suppl)

    (1969)
  • RJ. Neviaser

    Painful conditions affecting the shoulder

    Clin Orthop

    (1983)
  • M Waldburger et al.

    The frozen shoulder: Diagnosis and treatment. Prospective study of 50 cases of adhesive capsulitis

    Clin Rheum

    (1992)
  • AF. DePalma

    Loss of scapulohumeral motion

    Ann Surg

    (1952)
  • FE Bruckner et al.

    A prospective study of adhesive capsulitis of the shoulder (“frozen shoulder”) in a high risk population

    Q J Med

    (1981)
  • WN. Coombes

    Distention-manipulation for the treatment of adhesive capsulitis (frozen shoulder syndrome) (letter)

    Clin Orthop

    (1984)
  • Cited by (92)

    • Arthroscopic Lateral Border Resection in Medialized Scapula Neck Fractures

      2017, Arthroscopy Techniques
      Citation Excerpt :

      This likely results in fewer accidental iatrogenic injuries. For preparation close to the inferior glenoid rim, we prefer radiofrequency ablation, as electricity can cause a feedback from the nerve resulting in a twitching of the arm in close proximity to the nerve.18,19 However, possible damage can occur from the resulting heat, and the radiofrequency should be used with breaks to allow cooling of the fluid.20

    • The Stiff Shoulder

      2016, Rockwood and Matsen’s The Shoulder
    • Arthroscopic capsular release for refractory shoulder stiffness

      2013, Revista da Associacao Medica Brasileira
      Citation Excerpt :

      None of our 12 of 18 patients presented axillary nerve palsy, as in the study by Jerosch27; however, Harryman et al. had one case, with spontaneous resolution31. Pearsall et al.28 and Ogilvie-Harris et al.30 reported the release of the intra-articular portion of the subscapularis tendon, lateral to the musculotendinous junction, although most studies showed excellent results without this procedure27,29,32. This portion represents only 25% of the cephalocaudal length of the subscapularis muscle28.

    View all citing articles on Scopus

    Address correspondence and reprint requests to Kevin P. Speer, M.D., Section of Sports Medicine and Rehabilitation, Division of Orthopaedic Surgery, Duke University Medical Center, Box 3435, Durham, NC 27710, U.S.A.

    View full text