Arthroscopic Capsular Release for Shoulder Stiffness

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


  • 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


Rotator Cuff External Rotation Biceps Tendon Axillary Nerve Adhesive Capsulitis 
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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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