Arthroscopic Capsular Release Research Articles

Non-operative and Operative Treatment of Adhesive Capsulitis: Results in Ninety-Nine Consecutive Patients (SS-15)

Adhesive capsulitis usually responds favorably to therapeutic exercise, but manipulation and arthroscopic capsular release are effective for refractory cases. The results of non-operative and operative treatment for adhesive capsulitis are similar, but patients with diabetes and more limited function appear to benefit the most from capsular release. Compared with older patients, younger patients respond better to non-operative treatment, but they are also more likely to undergo surgery. Adhesive capsulitis or frozen shoulder often responds to a four-quadrant stretching program but operative intervention comprising manipulation and arthroscopic capsular release is typically employed for refractory cases. Previous studies have demonstrated good outcomes with both treatment methods, but few studies have evaluated concurrently the results of both non-operative and operative treatment. We hypothesized that both treatments produce similar outcomes and that certain patient factors predict outcome and the need for surgery. Ninety-nine consecutive patients (104 shoulders) underwent non-operative treatment for adhesive capsulitis until either symptom resolution or surgery. There were 65 females and 34 males with a mean age of 52.7 years (range 34-83 years). Non-operative treatment comprised supervised four-quadrant stretching and selective intra-articular corticosteroid injections. Twenty-nine patients, including 9 diabetics, underwent manipulation and arthroscopic pan-capsular release followed by continuous passive motion and supervised stretching. Range of motion was measured upon discharge from treatment. Shoulder function was evaluated using the Simple Shoulder Test (SST) and ASES scores at minimum 24 months follow-up (mean 39 months, range 24-68 months). Four patients (5 shoulders) were deceased and 10 patients were lost to follow-up so that outcome scores could be obtained for 85 patients (89 shoulders). Forward elevation, external rotation at the side, and internal rotation to the back improved from 118±21 to 152±15, 30±18 to 46±11, and from the gluteal region to the T12 spinous process, respectively (p<0.0001). Similar improvements in mobility were observed for both operative and non-operative groups, but the improvement in forward elevation was greater for the operative group (p<0.05). Mean SST improved from 4.0±2.7 to 9.9±2.8 (p<0.0001) and mean final ASES score was 85±15. Female patients had a lower mean initial SST than male patients (3.3±3.6 compared with 5.2±2.6, p<0.005), but mean final SSTs were similar (9.7±2.9 compared with 10.3±2.6). Improvement in SST and final ASES scores did not appear to vary by gender, diabetes, or depression. Younger patients (p<0.001) and those with lower initial SST scores (p<0.05) were more likely to undergo surgery. For the entire cohort, initial SST score predicted final SST score (p<0.05) and shorter duration of symptoms predicted a higher final ASES score (p<0.05). Non-operative and operative groups demonstrated similar final SST (10.0±2.8 and 9.7±2.9) and ASES scores (86±13 and 82±12). Following non-operative treatment, patients with diabetes had a lower mean final SST score than patients without diabetes (8.9 compared with 10.6, p<0.05), but following surgery the mean scores were identical (9.7). For patients undergoing non-operative treatment, absence of diabetes (p<0.005), shorter duration of symptoms (p=0.05), and young age (p<0.01) predicted a higher final SST. Adhesive capsulitis usually responds favorably to therapeutic exercise, but manipulation and arthroscopic capsular release are effective for refractory cases. The results of non-operative and operative treatment for adhesive capsulitis are similar, but patients with diabetes and more limited function appear to benefit the most from capsular release. Compared with older patients, younger patients respond better to non-operative treatment, but they are also more likely to undergo surgery.

Arthroscopic Management of Stiffness Following Rotator Cuff Repair: Techniques and Results (SS-03)

Arthroscopic capsular release and lysis of adhesions is safe, reliable, and our preferred method of treating stiffness following rotator cuff repair. Stiffness is the most common complication following rotator cuff repair independent of repair technique. The purpose of this study is to identify a cohort of patients who developed stiffness following rotator cuff repair and to report the results following arthroscopic capsular release, lysis of adhesions, manipulation under anesthesia, and aggressive physical therapy. Operative logs of the four senior surgeons were reviewed and thirty-one patients who underwent an arthroscopic lysis of adhesions between July 2004 and April 2007 for the treatment of arthrofibrosis following either an arthroscopic (56%), open (28%), or mini-open (16%) rotator cuff repair were identified. The average age of patients was 48.7 at the time of injury and 19 (61%) were involved in workman's compensation claims. Data was obtained retrospectively from chart review for 30 patients. Thirteen patients were available for follow-up at which time range of motion (ROM), outcome scores (American Shoulder and Elbow Surgeons Score, Constant-Murley, Visual Analog Score, and Simple Shoulder Test), and dynamometer strength testing was recorded for purposes of this study by a single examiner. Three patients were available for a phone interview only. The average follow-up was 44.9 months. Prior to arthroscopic lysis of adhesions, shoulder ROM averaged: 103.8 degrees of forward elevation (FE) and 27.2 degrees of external rotation at the side (ERS). At most recent follow-up, a significant increase in ROM was noted with FE of 157.1 degrees (p<0.001) and ERS of 58.2 degrees (p<0.001). Subjective outcome scores and strength were also improved. There were 3 (10%) failures requiring a repeat operative procedure for recurrent stiffness. There was no difference in outcomes with regard to index surgery repair technique (arthroscopic, open or mini-open repair). There were no complications such as dislocation, infection, or nerve injury. Arthroscopic capsular release and lysis of adhesions is safe, reliable, and our preferred method of treating stiffness following rotator cuff repair. Furthermore, significant improvement in shoulder ROM, strength, subjective outcome scores, and patient satisfaction can be expected with an arthroscopic technique and aggressive rehabilitation treatment protocol.

A case of rupture of a long head of the biceps tendon after arthroscopic capsular release

A case of rupture of a long head of the biceps tendon after arthroscopic capsular release

Outcomes with Combined Arthroscopic Rotator Cuff Repair and Capsular Release for Partial-thickness Rotator Cuff Tears with Shoulder Stiffness

Outcomes with Combined Arthroscopic Rotator Cuff Repair and Capsular Release for Partial-thickness Rotator Cuff Tears with Shoulder Stiffness

Short-term outcome of arthroscopic subacromial decompression and arthroscopic capsular release for subacromial impingement syndrome

Short-term outcome of arthroscopic subacromial decompression and arthroscopic capsular release for subacromial impingement syndrome

강직을 동반한 제 2형 SLAP 병변의 관절경적 관절막 유리술과 봉합술의 임상적 결과

Purpose: We assessed the clinical results after the operative treatment of type 2 SLAP lesion with stiffness. Materials and Methods: 13 patients who had SLAP lesion with stiffness were treated with arthroscopic capsular release, SLAP repair and treatment of the associated lesion. The average follow-up period was above 12 months. Results: The postoperative mean VAS was scored 1.5 and the postoperative ROWE score was 92.3, which showed a significant improvement after the operation (P<0.001). The mean range of motion was a significantly improved after the operation (P<0.001). The ROWE score was excellent for all the cases. Conclusion: Arthroscopic capsular release and SLAP repair and treatment of the associated lesion in patients with type 2 SLAP lesion with stiffness are effective treatments for the increasing the range of motion and decreasing the pain.

Dynamic Movement of the Long Head of the Biceps Tendon in Frozen Shoulders

To assess the importance of the dynamic movement of the long head of the biceps (LHB) tendon for treatment of frozen shoulder. 87 consecutive patients (with 88 frozen shoulders) aged 36 to 77 (mean, 54) years underwent arthroscopic capsular release by a single surgeon. Preoperative treatments included rehabilitation, steroid and/or hyaluronic acid injections. The inclusion criteria were severe night pain, no improvement of flexion and external rotation, and poor response to rehabilitation for at least 6 months. Shoulders were divided into 3 types; types A/B/C indicate slight/moderate/severe degree of synovitis and adhesion of the LHB tendon to the rotator interval. 23 shoulders were type A, 26 type B, and 39 type C. 18 of the 39 type-C shoulders were controls with release of the capsule alone but not the LHB tendon. Patients were followed up for a mean of 21 (range, 12-35) months. Changes in the American Shoulder and Elbow Surgeons (ASES) score, range of movement, and muscle strength (flexion and external rotation) among types A, B, C, and controls were compared. The severity of the adhesion of the LHB tendon to the rotator interval was associated with the ASES score. In all adhesion types, muscle strength and the range of movement in flexion, external rotation, and internal rotation improved postoperatively. Arthroscopic capsular release for adhesion of the LHB tendon to the rotator interval improves the sliding movement and thereby shoulder function.

Posterior Arthroscopic Capsular Release in Frozen Shoulder

The aims of our study were to assess the overall effectiveness of arthroscopic capsular release and to determine if the addition of a posterior capsular release had any benefit, particularly in relation to internal rotation. Forty-eight consecutive patients with primary or secondary frozen shoulder in whom conservative physiotherapy had failed were included in the study. Arthroscopic capsular release was performed in all cases. Group 1 had an anterior and inferior release only; group 2 included a posterior release. All data were collected prospectively. Constant-Murley functional scores were used to assess outcome. Overall satisfaction and patient reported outcomes were also measured. The mean patient age was 51 years (range, 28 to 65 years), with no difference between the 2 groups. There were 27 patients in group 1 and 21 patients in group 2. The mean follow-up was 5 months. Etiology of the frozen shoulder was primary (22), diabetic (7), post-traumatic (7), and postoperative (11). Overall across both groups, there was a highly significant improvement in Constant score (P < .001) postoperatively. A similar pattern was noted in the range of motion (P < .001). The mean satisfaction score was 7 of 10 postoperatively. The patients reported overall outcome as much better (24), better (15), the same (1), and worse (4). There was no significant difference in Constant score between the 2 groups, and no significant difference in the improvement of the range of motion, in particular internal rotation. We have shown an overall rapid significant improvement following arthroscopic capsular release for primary and secondary frozen shoulder. There was no significant difference in the overall outcome with the addition of a posterior release. Level III, therapeutic, retrospective comparative study.

Translational Manipulation After Failed Arthroscopic Capsular Release for Recalcitrant Adhesive Capsulitis: A Case Report

Objective This article reports the use of translational manipulation after failed arthroscopic capsular release for adhesive capsulitis. Clinical Features The patient was a 40-year-old woman, insulin-dependent diabetic with the insidious onset of right shoulder adhesive capsulitis. The patient underwent physical therapy 3 times a week for 6 weeks with minimal changes in her range of motion or pain. After failing physical therapy, the patient had arthroscopic capsular release and long-lever arm rotational manipulation of the right shoulder. The patient participated in physical therapy again, failing to regain her range of motion. Intervention and Outcome Subsequently, the patient underwent interscalene block and translational manipulation by the same therapist followed by physical therapy. The patient's range-of-motion measures, strength testing, pain scale measurements, and functional scoring were recorded throughout her rehabilitation. She returned 2 years postdischarge for the same tests and measurements. Conclusion Adhesive capsulitis in association with diabetes mellitus poses a serious treatment dilemma. Arthroscopic release may have limited benefits secondary to limited release and/or postoperative pain limiting rehabilitation. Translational manipulation under interscalene block may be considered in this difficult treatment group.

Arthroscopic Dorsal Capsular Release in the Wrist

Wrist stiffness is a multifactorial condition that is debilitating for those which it affects. Although good results have been achieved in the past with aggressive physiotherapy and splinting regimens, however, there are some cases that remain refractory to this treatment. In those cases that are caused primarily by arthrofibrosis, arthroscopic surgical release of the capsule is another treatment option. Arthroscopic release of the volar wrist capsule has been previously described. The authors describe this new technique for arthroscopic dorsal capsular release using an intracapsular nylon tape to afford protection to the extensor tendons. They believe that the procedure is relatively safe with a low complication rate as well as good patient outcomes. Although the cohort of patients in whom this procedure is indicated is likely to be small, we feel that it gives the upper-limb surgeon another option for managing this often difficult problem.

Moderate Preoperative Shoulder Stiffness Does Not Alter the Clinical Outcome of Rotator Cuff Repair With Arthroscopic Release and Manipulation

The purpose of this study was to determine whether moderate preoperative shoulder stiffness affects the clinical outcome of rotator cuff repair, and to evaluate the serial change in range of motion (ROM), functional scores, pain, and satisfaction after rotator cuff repair. Rotator cuff repair was performed in 125 consecutive patients (127 shoulders). Thirty patients had concomitant moderate shoulder stiffness at the time of the repair. There were no statistical differences in sex ratio, age, the size and retraction of the tear, or the associated pathologies and repair procedure between the stiffness and nonstiffness groups. Arthroscopic capsular release and manipulation were added to the stiffness group, and the same rehabilitation protocol was applied according to the size of the tear. Clinical outcomes were evaluated using ROM, American Shoulder and Elbow Surgeon (ASES) score, Constant score, Simple Shoulder Test (SST), and short form 36. Pain and postoperative patient satisfaction were measured by a visual analog scale. All clinical parameters were prospectively recorded on the day before surgery, and at 3, 6, and 9 months postoperatively, and at their last follow-up visit. Differences of ROM did not reach statistical significance after 6 months of operation. Other functional outcome instruments showed no statistical difference at any follow-up period. Postoperative cuff integrity after 1 year showed no statistical difference between 2 groups. This study suggests that moderate preoperative shoulder stiffness does not affect clinical outcomes of rotator cuff repair if arthroscopic capsular release with manipulation is added to the index procedure. Arthroscopic capsular release with manipulation and a well programmed rehabilitation program can avoid any delay of surgery and limitation of motion after cuff repair in patients with concomitant moderate shoulder stiffness. Level III, retrospective comparative study.

견관절 일차성 유착성 관절낭염 환자의 견봉하 관절경 소견

Purpose: To evaluate the bursoscopic findings of refractory primary adhesive capsulitis of the shoulder and to determine the clinical correlation. Materials and Methods: Arthroscopic capsular release was performed in 21 refractory adhesive capsulitis patients who had not responded to conservative treatment. The VAS for pain, range of motion, UCLA score was checked before and after surgery, and at the last follow up. Results: Bursitis, mild friction and impingement on coracoacromial ligament, as well as adhesion were observed. The function and pain improved earlier than after simple acromiohumeral joint capsular release. Conclusion: Subacromial bursoscopy helps rule out a hidden secondary frozen shoulder or secondary changes with primary adhesion. In addition, it has the advantage of being both a treatment and procedure for making a prognosis.

Arthrolyse antérieure de l’épaule sous arthroscopie dans les séquelles de paralysie obstétricale du plexus brachial. Résultats préliminaires

Retraction of the shoulder in internal rotation is observed in 25% of children with brachial plexus birth palsy (C5, C6 +/- C7). Early bone and joint deformities affecting the glenohumeral joint are the consequences. The stiff internal rotation requires surgical release which can involve the capsule and ligaments, muscles, or both. Internal release can be combined with muscle transfer to improve active external rotation. We report the results obtained with arthroscopic anterior capsular release combined with latissimus dorsi transfer. From 1999 through 2006, fourteen children with a stiff shoulder in internal rotation secondary to brachial plexus birth palsy were managed in our unit. All had recovered biceps function six months after surgery. The glenohumeral dysplasia was analyzed on the preoperative magnetic resonance imaging. Pre- and postoperative passive external rotation (RE) were measured with the arm along the body and at 90 degrees elbow flexion. Internal rotation was measured using the Mallet score (hand-back test). Combined active abduction antepulsion was measured when the child was playing. Mean age at surgery was three years six months. Arthroscopic internal release was performed for eight children. All had an associated latissimus dorsi transfer. Among the 14 children managed in the unit, arthrolysis was not be performed in six, either because of the lack of an adequate electrode (two patients) or because the child presented posterior glenohumeral dislocation making it impossible to introduce the optic channel (four patients). Arthroscopic anterior release was performed for the eight other patients. These eight patients were reviewed at a mean three-year follow-up. Passive external rotation was improved, with a mean gain of 60 degrees with no recovery of passive internal rotation. The abduction antepulsion movement was also improved, mean gain 90 degrees . A stiff shoulder in internal rotation can develop during the first two years of life. Several techniques have been proposed for internal release. The origin of the progressive limitation of passive external rotation remains a subject of debate. Is it due to retraction of the internal rotators, or to capsule-ligament retraction, or both? In 1992, Harryman et al. demonstrated the role of the capsule and the coracohumeral ligament in limiting external rotation. Consequently, we have opted for early release (less than two years of age) using an arthroscopic method limited to the capsule and ligaments. Our results for passive external rotation are comparable to those reported by others. However, this technique enables preserved mobility for internal rotation. Arthroscopic anterior release limited to the capsule and the ligaments is an effective, minimally invasive technique. Leaving the internal rotator muscles intact preserves internal rotation of the shoulder and reduces the risk of anterior instability.

(iv) Arthroscopy of the elbow

Summary There has been increasing interest in elbow arthroscopy over the past decade with improved techniques and available technology. The indications for elbow arthroscopy have expanded from loose body excision in the arthritic elbow to a variety of procedures including arthroscopic capsular release and excision of the radial head. Complications are rare but potentially devastating, and meticulous surgical technique is necessary to avoid this. This review describes the indications for elbow arthroscopy as well as the general setup and portal placements. The treatment and outcomes for the arthritic elbow, release of capsular contractures, thrower's elbow and other less common pathologies are discussed.

Suprascapular nerve block as a method of preemptive pain control in shoulder surgery

The purpose of the study was to evaluate the effect of suprascapular nerve block (SSNB) in shoulder surgery. The study group consisted of 260 patients, which were subjected to shoulder operations. The patients were divided into two equal groups: group I with nerve block compared to a control group II without a nerve block. The mean age of the patients in group I was 56.2 +/- 6.86 years and that in group II was 54.5 +/- 7.06 years. The female to male ratio was 71:59 in group I and was 69:61 in group II. Surgical procedures were arthroscopic rotator cuff repair, arthroscopic subacromial decompression, arthroscopic acromioclavicular resection, arthroscopic removal of calcific tendonitis, arthroscopic reconstruction of instability, arthroscopic capsular release and shoulder replacement. In all cases the pain was documented by the visual analogue scale (VAS) preoperative, at the first, the second as well as at the third day after surgery. In order to evaluate the amount of fluid, which is needed for infiltration of the area of the supraspinatus fossa, we injected different amount of local anesthetic in combination with contrast dye in five patients. In this study to document the fluid distribution, after injecting with different milliliters, 10 ml is proved to be more than enough to have sufficient local anesthetic to block the SSN. Pre-operatively the mean VAS was comparable between both groups. We documented a significant difference in favour of SSNB from day 1 to day 3 after surgery. No specific complications due to this nerve block procedure were found in any patient post-operatively.

Arthroscopic capsular release for posttraumatic shoulder stiffness

Severe pain and shoulder stiffness after soft tissue trauma or fracture is a major cause of dysfunction. Some patients may have residual, resistant, significant shoulder stiffness that causes long-term functional impairment. This study reports the results of arthroscopic capsular release in 21 patients who presented with posttraumatic stiff shoulders resistant to nonoperative therapy. They underwent arthroscopic circumferential capsular and subacromial release of adhesions under interscalene block, followed with immediate regular physiotherapy. A highly significant improvement in the range of motion (ROM) was achieved immediately postoperatively (P < .0001). At 6 months, a mean 48% of the ROM gain was lost. Thereafter, ROM steadily improved to a mean net gain of 110% compared with the immediate postoperative time (mean follow-up, 33 months). Most patients (95%) expressed satisfaction with their outcome. Arthroscopic capsular release is a useful treatment for resistant posttraumatic stiff shoulder, particularly to alleviate of pain and restore a functional ROM.

Arthroscopic posteromedial capsular release for knee flexion contractures

Extension deficits of the knee can cause functional limitations in patients after knee surgery or injury. Most frequently, they are treated with manipulations, arthroscopic anterior compartment debridements, or open posterior capsular releases once nonoperative treatment fails. However, an arthroscopic posteromedial capsular release to manage flexion deficits has yet to be studied comprehensively. Arthroscopic posteromedial capsular releases of the knee can result in improved knee motion postoperatively. An arthroscopic posteromedial capsular release involves sectioning the posteromedial capsule at its meniscofemoral portion, midway between its femoral attachment and its posterior horn medial meniscus junction. A review of 15 patients who underwent this operation was performed. Passive knee extension and flexion was measured in patients in the supine position using a goniometer at preoperative evaluations, under anesthesia prior to and immediately after the posteromedial capsular release, and at postoperative follow-up evaluations. The average time from the arthroscopic posteromedial capsular release to the final postoperative follow-up was 24.1 months. Preoperative knee extension averaged 14.7 degrees in 15 patients. The average immediate postoperative knee extension averaged -0.9 degrees. At the final postoperative follow-up, knee extension averaged 0.7 degrees. Overall knee motion improved from an average are of motion of 101.6 degrees-129.4 degrees. Arthroscopic posteromedial capsular releases and the concurrent postoperative rehabilitation program were effective in the treatment of knee extension deficits. The encouraging results of this study compare well to data presented in open posterior capsular release studies. We believe that arthroscopic posteromedial capsular releases are an effective means to address symptomatic knee extension deficits.

The Influence of Arthroscopic Subscapularis Tendon and Capsule Release on Internal Rotation Strength in Treatment of Frozen Shoulder

Background Arthroscopic release of the capsule is a popular treatment option for chronic refractory frozen shoulder. Additional release of the intra-articular part of the subscapularis is controversial regarding possible impairment of subscapularis function. Hypothesis Arthroscopic release of the intra-articular part of the subscapularis produces good clinical results and does not lead to reduced internal rotation strength. Study Design Case series; Level of evidence, 4. Methods Twenty-two patients were retrospectively evaluated 53 months (range, 12–106) after undergoing arthroscopic anterior capsular release, including release of the intra-articular portion of the subscapularis. Clinical outcome was evaluated using the American Shoulder and Elbow Surgeons score and the Constant score. Isometric and isokinetic strength for internal and external rotation were determined at the time of follow-up in both shoulders using a Cybex dynamometer. Results The Constant score was improved significantly from 17.7 points to 82.8 points (P < .0001) and the American Shoulder and Elbow Surgeons score increased significantly from 23.5 points to 76.8 points (P < .0001). The mean range of motion was significantly improved for external rotation from 16° to 58°, from 66° to 142° for abduction, and from 76° to 155° for forward flexion. Isometric and isokinetic strength in the standard abduction position of the Cybex dynamometer showed no significant side-to-side difference. Conclusion Arthroscopic capsular release combined with a release of the intra-articular portion of the subscapularis tendon revealed good clinical results in the arthroscopic treatment of adhesive capsulitis without significant loss of internal rotation strength.

Adhesive Capsulitis

Adhesive capsulitis is a common problem seen in the general population by orthopedic surgeons. It is a problem that causes patients pain and disability, and symptoms can last up to 2 years and longer. The questions of when and how to treat the frozen shoulder can present challenges. Most treatments are conservative; however, indications for surgery do exist. Arthroscopic capsular release has gained popularity over the years and offers a predictably good treatment in patients with adhesive capsulitis. The purpose of this paper is to review the orthopedic literature on adhesive capsulitis, to provide background information on this topic, and to describe our technique in arthroscopic capsular release.

Arthroscopic Debridement and Capsular Release for Glenohumeral Osteoarthritis

Osteoarthritis of the glenohumeral joint in younger, active patients presents a difficult situation to the surgeon, who would like to delay the necessity for hemiarthroplasty or total shoulder replacement until the patient is older and less active. This report outlines our technique of arthroscopic debridement and capsular release. By using electrocautery to release the rotator interval, anterior capsule, posterior capsule, and axillary recess, we have been able to improve the range of motion and to achieve pain relief. In 8 patients the mean improvement in range of motion was as follows: forward elevation, 21.4°; external rotation, 16.6°; and internal rotation, 31.1°. We believe that a reduction in joint contact pressures through a greater range of motion is the primary mechanism for pain relief resulting from capsular release.