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Arthroscopic Capsular Release for Shoulder Stiffness

  • Arup K. Bhadra
  • Craig S. Roberts
  • Frank O. Bonnarens
Chapter

Abstract

  • Shoulder stiffness can result due to primary idiopathic adhesive capsulitis or secondary to known intrinsic, extrinsic, or systemic conditions (including posttraumatic stiffness and postoperative stiffness).

  • Primary idiopathic adhesive capsulitis
    • Considered a painful self-limiting disease that resolves after 1–3 years.

    • Incidence is estimated to be around 2–5% in the general population.

    • Women comprise approximately 70%.

    • Contralateral shoulder is likely to be involved in 20–30% of patients.

    • Pathology results from intraarticular inflammation and fibrosis which causes contracture of the capsule and a reduced intraarticular volume.

    • It is believed to result from a systemic disorder (inflammatory, endocrine, immunologic, biochemical), although a definite etiology is not known.

    • Hannafin and Chiaia described four stages of adhesive capsulitis:
      • Stage 1: “Initial painful phase” (0–3 months) – pain with active and passive ROM, some limitation of movements

      • Stage 2: “Freezing stage” (3–9 months) – chronic pain with active and passive ROM, significant limitation of movements

      • Stage 3: “Frozen stage” (9–15 months) – minimal pain except at end ROM, significant limitation of ROM with rigid “end feel”

      • Stage 4: “Thawing stage” (15–36 months) – minimal pain, progressive improvement in ROM

  • Secondary adhesive capsulitis can result in global loss of active and passive ROM or reduced ROM in specific plane depending on the etiology.
    • Asymmetric loss of motion results from scarring in the area affected

    • Contracture may be intraarticular or extraarticular.

    • Particular pattern of limitation in ROM can assist with planning rehabilitation protocol or particular operative management

    • Reduced external rotation in adduction suggests contractures of the anterosuperior capsule and the rotator interval

    • Loss of external rotation in abduction is associated with contractures of the anteroinferior capsule

    • Decreased internal rotation in abduction or adduction and reduced cross-chest adduction is indicative of posterior capsular contractures

Keywords

Rotator Cuff External Rotation Biceps Tendon Axillary Nerve Adhesive Capsulitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Further Reading

  1. Gartsman GM. Shoulder arthroscopy. 1st ed. 2003. p. 143–151; Chap. 6.Google Scholar
  2. Holloway GB, Schenk T, Williams GR, et al. Arthroscopic capsular release for the treatment of refractory postoperative or post-fracture shoulder stiffness. JBJS. 2001;83A(11):1682–7.Google Scholar
  3. Pollock RG, Duralde XA, Flatow EI, Bigliani LU. Use of arthroscopy in the treatment of resistant frozen shoulder. Clin Orthop Relat Res. 1994;304:30–6.PubMedGoogle Scholar
  4. Warner JJ, Allen A, Marks PH, Wong P. Arthroscopic release of postoperative capsular contracture of the shoulder. JBJS. 1997;79A(8):1151–8.Google Scholar
  5. Warner JJ, Allen A, Marks PH, Wong P. Arthroscopic release of chronic, refractory adhesive capsulitis of the shoulder. JBJS. 1996;78A(12):1808–16.Google Scholar
  6. Snow M, Boutros I, Funk L. Posterior arthroscopic capsular release in frozen shoulder. J Arthros Relat Surg. 2009;25:19–23.CrossRefGoogle Scholar
  7. Bunker TD. Arthroscopic capsular release for adhesive capsulitis. Advanced reconstruction of shoulder by Zuckerman. p. 473–479; Chap. 50.Google Scholar

Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  • Arup K. Bhadra
    • 1
  • Craig S. Roberts
    • 1
  • Frank O. Bonnarens
    • 1
  1. 1.Academic Department of Trauma and Orthopaedics, School of MedicineUniversity of LouisvilleLouisvilleUSA

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