ShoulderArthroscopic capsular release for refractory shoulder stiffness: A critical analysis of effectiveness in specific etiologies
Section snippets
Materials and methods
This study was approved by the IRB of the Massachusetts General Hospital (Protocol # 2009-P-000912).
From 2000 and 2005, 115 consecutive patients (115 stiff shoulders) underwent arthroscopic release for painful shoulder stiffness unresponsive to conservative management. The etiology of stiffness was either post-traumatic, postsurgical, or idiopathic. Patients who were determined to have stiffness due to bony structural abnormalities were excluded from the study. The study was approved by the
Patient data according to specific etiology
Patients with idiopathic frozen shoulders had marked restriction of passive glenohumeral joint motion. No history of trauma was recorded. Of the patients, 41 (25 women and 16 men) met these criteria. Their mean age at the time of capsular release was 52 years (range, 36 to 81 years). The dominant arm was affected in 21 patients and the nondominant arm in 20. Of the 41 patients, 16 (39%) had diabetes mellitus and 2 (4.8%) had hypothyroidism. Operative intervention was performed after at least 9
Surgical technique
The operation was performed as previously described by the senior surgeon in 1997 with a few technical modifications added after the original description.12 All patients were operated on in the beach-chair position. After positioning of the patient in the operating room, while under anesthesia, passive range of motion was documented. The entire upper extremity was then prepared in a sterile fashion, and a mechanical arm holder was used to maintain the position of the arm. An 18-gauge spinal
Aftercare
All patients had interscalene anesthesia with an indwelling interscalene catheter. They received a bolus of 30 to 40 mL of a combination of 1.5% mepivacaine and 0.5% bupivacaine, usually in a combination of 20 mL each. Then, the infusion was run with 0.1% bupivacaine at a variable rate ranging from 10 to 20 mL/h, depending on the individual patient's degree of pain.
Patients were admitted to the hospital for 48 hours to undergo immediate physical therapy, which consisted of passive range of
Statistical analysis
To determine the statistical significance between the different groups, a 1-way analysis of variance test was used. When significant, a Tukey test was performed to identify differences between groups. The level of statistical significance was set at P = .05.
Results
At a mean follow-up of 46 months (range, 24 to 89 months), the mean pain score decreased from 7.5 (range, 4 to 10) to 1 (range, 0 to 8) (P < .0001) in all patients (Table III). Of the 115 patients, 72 (63%) reported no pain, 24 (21%) reported mild pain, 14 (12%) reported moderate pain, and 5 (4%) reported severe pain. All patients with severe pain after surgery had a similar level of pain before surgery. None of the patients had worsening pain after surgery. The mean SSV increased from 29%
Results according to etiology
When the demographic data of the groups were compared, the mean age of the patients in the postsurgical stiffness group was younger than that in the patients in both the idiopathic frozen shoulder group and the post-traumatic stiffness group (P = .0007 and P = .0001, respectively). There was no difference in the 3 groups in terms of gender and dominant side (P > .05).
In the idiopathic group, all outcome measures significantly improved after arthroscopic capsular release (Table III). One patient
Comparison of outcome between groups
The outcomes after treatment of idiopathic stiffness were better than the outcomes after treatment of postsurgical stiffness in terms of pain relief (P = .01), forward flexion (P = .02), and SSV (P = .0001). There was no significant difference between the outcomes of the idiopathic stiffness and post-traumatic stiffness groups, but shoulders with post-traumatic stiffness had better postoperative SSV scores than shoulders with postsurgical stiffness (P = .006).
Discussion
Management of shoulder stiffness continues to be challenging.17, 18, 20, 21 Although physical therapy is generally effective in the management of the stiff shoulder due to adhesive capsulitis, it may not be as effective in patients in whom stiffness develops after surgery or trauma.1, 3, 10, 26 Patients in whom there is a failure to progress after a compliant commitment to conservative treatment and who continue to have not only shoulder stiffness but also pain may benefit from operative
Conclusions
Arthroscopic capsular release is a reliable treatment option for patients with idiopathic, post-traumatic, and postsurgical shoulder stiffness. It was found to reliable not only in restoring motion but also in eliminating pain. Patients with idiopathic or post-traumatic shoulder stiffness have better outcomes than those with postsurgical stiffness. Diabetic involvement did not affect the outcome of surgical treatment.
Disclaimer
The other authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article and have no potential conflicts of interest related to this manuscript.
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Arthroscopic Lysis of Adhesions for Stiffness After Surgical Management of Proximal Humerus Fractures Leads to Satisfactory Outcomes in Most Patients
2023, Arthroscopy, Sports Medicine, and RehabilitationDoes the timing of surgical intervention impact the clinical outcomes and overall duration of symptoms in frozen shoulder?
2021, Journal of Shoulder and Elbow SurgeryWhat is the optimal surgical intervention for patients with frozen shoulder and a concomitant partial-thickness rotator cuff tear?
2021, JSES InternationalCitation Excerpt :Despite partial-thickness tears being common in frozen shoulders, reported to be up to 15%,34 limited data is available on the outcomes of capsular release in this group of patients. Elhassan found no difference after arthroscopic capsular release between idiopathic and post-traumatic stiffness, but patients in his post-traumatic group included patients with shoulder fractures and dislocations.10 Our results suggest that outcomes after arthroscopic capsular release are superior in patients who have no rotator cuff tear compared with those who have a partial-thickness tear.