Persistent symptomatic motion deficit despite intensive and prolonged conservative treatment (> 6 months) due to adhesive capsulitis after subsidence of symptoms of inflammation.
Arthroscopic perilabral capsulotomy with preservation of the glenoid labrum, rotator interval release, coracohumeral ligament resection and delineation of the subscapularis tendon.
Symptom specific history: duration of complaints, trigger (trauma, surgery, immobilization, idiopathic), previous treatment modalities, relevant comorbidities (e. g. diabetes mellitus, hyperthyroidism, autoimmune diseases, Dupuytren contracture)
Symptom specific examination: range of motion (active and passive, capsular volume and pattern), exclusion of other causes of restriction of motion (e. g. rotator cuff massive tear with pseudo-paralysis or neurological disorders)
Exclusion of lesions of the brachial plexus, axillary or suprascapular nerves.
X-rays of the shoulder in three views (true AP, y-view, axial) to exclude a secondary frozen shoulder due to mechanical disorders (e. g. dislocated implants, malunited healed fracture or osteophytes)
MRI (optionally with intraarticular contrast agent) to evaluate assess scarring/hypertrophy of the coracohumeral ligament, the joint capsule and the rotator interval; exclusion of concomitant pathologies (e. g. rotator cuff lesions, pulley lesion, SLAP lesion).
CT (CT-arthrography if indicated) only in exceptional cases with metal artefacts in the MRI and to eventual mechanical disturbances (e. g. malunited healed fracture, osteophytes, loose bodies)
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Literature to chapter 7.3
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