Addressing glenohumeral stiffness while treating the painful and stiff shoulder arthroscopically

Abstract

The shoulder can be primarily or secondarily stiff. Cadaveric cutting studies have shown increases in passive range of glenohumeral motion when certain portions of the capsule are released. This study has recorded the intraoperative gains made in passive range of motion for external rotation, flexion, abduction, and internal rotation with sequential release of the rotator interval, inferior capsule, and posterosuperior capsule, regardless of initial etiology, and followed-up over time. Thirty one of 60 shoulders, found clinically to have a loss of passive range of motion and having failed a nonoperative approach, underwent a capsular release. Eighteen patients underwent a partial capsular release (group 1) and 13 patients (group 2) underwent a complete capsular release. Thirty of 31 shoulders had statistically significant gains in passive range of motion with sequential release. In general, resection of the rotator interval contributed to gains in external rotation; resection of the inferior capsule (anteroinferior and posteroinferior) contributed gains to external rotation, forward flexion, and internal rotation; and resection of the posterosuperior capsule contributed to gains only in internal rotation. At a minimum of 18 months follow-up, 30 of 31 shoulders retained their intraoperative gains. There was no difference in the results between primarily and secondarily stiff shoulders for motion gains (P > .05). Arthroscopically addressing capsular tightness is beneficial in returning shoulders with a loss of passive glenohumeral motion to normal regardless of the etiology.