Arthroscopic 360-Degree Capsular Release for Idiopathic Adhesive Capsulitis in the Lateral Decubitus Position

Abstract

Objectives:Idiopathic glenohumeral adhesive capsulitis impairs patient motion and function. If conservative management fails, arthroscopic capsular release is classically performed in the beach-chair position with incapsule release and manipulation under anesthesia. We report outcomes following arthroscopic 360-degree capsular release in lateral decubitus position followed by limited manipulation to confirm restoration of range of motion.Methods:A retrospective case series of patients undergoing arthroscopic capsular release in the lateral decubitus position for idiopathic adhesive capsulitis with minimum 2-year follow-up was conducted. Patient demographics, preoperative range of motion (ROM), postoperative ROM, and postoperative outcome scores were recorded. Complications and reoperations were recorded. Paired t-tests were used to compare preoperative and postoperative ROM, with p<0.05.Results:Overall, 43 patients were identified, of which 10 were excluded due to posttraumatic etiology. Of the remaining 33 patients, 27/33 (81.8%) completed a minimum follow-up of 2-years. The mean age was 54.8+/-7.4 years and 73% female, with duration of symptoms 16.2+/-21.0 months (range 2 to 125). Hypothyroidism was present in 6% and diabetes present in 33%. Pre-operatively, patients had 1.8+/-1.1 preoperative corticosteroid injections (range 0-5). Active forward flexion improved from 115.0+/-21.9 degrees to 156.2+/-16.1 degrees at final follow-up (mean difference 41.2, 95% confidence interval [33.7,48.7], p<0.001). Active external rotation with the arm adducted improved from 28.1+/-16.3 degrees preoperatively to 56.8+/-15.7 degrees at final follow-up (mean difference 27.7, 95% confidence interval [19.1,36.3], p<0.001). Significant range of motion improvements were seen even as early as 2-weeks postoperative (Figure). Overall, final outcomes were excellent, including VAS pain of 0.2+/-0.5, SANE 96.3+/-4.9, SST 11.3+/-1.2, and ASES 97.0+/-4.7. There were no revision surgeries and no complications.Conclusion:Arthroscopic 360-degree capsular release in the lateral decubitus position for idiopathic adhesive capsulitis results in a significant early and lasting improvement in range of motion, excellent functional outcomes, and low revision and complication rates.