拘縮肩に対する鏡視下授動術

Abstract

The purpose of this study is to report the arthroscopic and bursoscopic findings in shoulder stiffness and to determine the efficacy of arthroscopic capsular release and its effect on the time course for this disease. 40 patients (23 females, 17 males, 40 shoulders) with a mean age of 55.5 (38 to 69) years were evaluated at a mean follow-up of 60 (6 to 84) months. All patients failed to show improvement with conservative measures within a mean period of 7.5 (3 to 24) months. 30 of the stiff shoulders were classified as idiopathic frozen shoulder. 4 developed after significant traumatic events and 4 after prolonged immobilization. 2 patients were diabetic. We performed arthroscopic capsular release and synovial debridement for all patients and subacromial decompression for the patients suspected of subacromial impingement by bursoscopy. Intraarticular findings (n=40) were vascular synovitis (100%), adhesion between biceps tendon and rotator cuff (15%), incomplete rotator cuff tears (13%) and labral lesions (8%). There were no cartilaginous lesions. Intrabursal findings (n=20) were vascular synovitis (95%), incomplete rotator cuff tears (45%), subacromial erosion (35%) and fibrous band (10%). The mean postoperative active motion was Flex.=168.0 (+85.2), E. R.=53.4 (+45.6) and I. R.=Th10 (+7 segments). The mean JOA shoulder score improved to 93.0 (+38.8). Gains in the motion and JOA shoulder score were all statistically significant (p<0.05). The mean duration of formal rehabilitation with a CPM was 4 (3 to 11) weeks. The mean time to achieve painless final motion was 12 (3 to 16) weeks. Regardless of etiology, all patients manifested extremely similar intraarticular findings, but subacromial impingement was suspected in one third of the patients by bursoscopy. Through the management of refractory shoulder stiffness in this study, final painless motion was achieved within a mean of 12 weeks.