Clinical Outcomes Do Not Support Arthroscopic Posterior Capsular Release in Addition to Anterior Release for Shoulder Stiffness

Abstract

Background: Arthroscopic capsular release is an effective treatment for shoulder stiffness, yet its extent is controversial. Purpose: To compare the clinical outcomes of arthroscopic capsular release in patients with and without posterior extended capsular release for shoulder stiffness. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Between January 2008 and March 2011, 75 patients who underwent arthroscopic capsular release for shoulder stiffness were enrolled and randomized into 2 groups. In group I (n = 37), capsular release was performed, including release of the rotator interval and anterior and inferior capsule. In group II (n = 38), capsular release was extended to the posterior capsule. The American Shoulder and Elbow Surgeons score, Simple Shoulder Test, visual analog scale for pain, and range of motion (ROM) were used for the evaluation before surgery and at 3, 6, and 12 months after surgery and at the last follow-up. Results: Preoperative demographic data of age, sex, symptom duration, and clinical outcomes showed no significant differences (P > .05). The average follow-up was 18.4 months. Both groups showed significantly increased ROM at the last follow-up compared with preoperative ROM (P < .05). At the last follow-up, no statistical differences were found (P > .05) between groups I and II in American Shoulder and Elbow Surgeons score (91.3 vs 79.5), Simple Shoulder Test (83.3 vs 83.3), and visual analog scale (1.5 vs 2.2). There were also no statistical differences between the 2 groups at the last follow-up (P > .05) in ROM: forward flexion, 145.2° vs 143.3°; external rotation with 90° of abduction, 88.1° vs 86.2°; external rotation at side, 88.9° vs 82.9°; and internal rotation, 9.1° vs 8.3°. Conclusion: Posterior extended capsular release might not be necessary in arthroscopic surgery for shoulder stiffness.