GLENO-HUMERAL ARTHROSCOPIC RELEASE FOR SH OULD STIFFNESS - A SERIES OF 26 CASES

Shoulder stiffness is a problem which covers many different conditions . In fact there is still a semantic Ind pathogenetic confusion The wor ds : capsule retractile: frozen shoulder. adhesive capsulitis. stiff s houlder contracture have been successively used and this ambiguity ren ders the literature difficult to interpret. Moreover the cause of the stiffness which depends on the aetiology, is not airways clearly known : capsular contraction. capsular adhesion, capsular scarring followin g trauma or suggery, sutra capsular phenomenons In the subacromial bur sa, muscles or tendons. Materials and Methods 26 shoulders (25 patient s) were reviewed with a follow to of 21 months using the Constant's sc oring system. Patients had an average duration of symptoms for 13 mont hs (1 to 27). Pre op passive motion was : abduction : 74 degrees, exte rnal rotation : 6 degrees, forward flexion : 84 degrees. The average m otion core was 12.9/40. We distinguished Three groups : primary frozen shoulder (13 cases) ; bipolar stiffness (3 cases) due to rotator cuff disease : acquired << surgical >> stiffness, (10 cases). The capsular release was performed, at the anterior rim of the glenoid fossa, pure ly anterior or anterior and inferior. followed by gentle manipulation, If external rotation was not improved the coraco-humeral ligament was detached from its coracoid attachment. Additional procedures were per formed : acromioplasty (5 cases), bursectomy (3 cases), SLAP lesion de bridement (1 case). Only 2 out 13 primary shoulders required an additi onal procedure. Results 1 - There were no intra-operative complication s (vascular or neural). 2 - Range of Motion : the average gain under a nesthesia was : abduction : 72 degrees. external rotation : 34 degrees , forward flexion : 86 degrees. Final result was obtained with a mean duration of seven months. There was no difference according to the aet iology. Gain was mole important in the primary group (9.69 to 34.9 vs 15.8 to 30.6). 3 - Subjective results were better in the primary group . 4 - Objective results demonstrated an absolute Constant's score of 7 0.3, that is to say 83,4 per cent of the contralateral supposed health y shoulder. There were 3 excellent, 5 very good, 7 good, but 11 fair o r poor results. The relative Constant's score was 91 per cent in the p rimary group and only 76 per cent in the acquired group. The differenc e was due to the pain and strength which were greatly improved in the primary group. Discussion Arthroscopic release of shoulder contracture is feasible, safe and effective. For primary frozen shoulder, there i s usually spontaneous recovery. Indications for surgery are very few. There is no evidence that arthroscopic release shortens spontaneous ev olution. Therefore, we propose it in very selected cases of dramatical ly limited motion. One year of evoluation is an acceptable time. For b ipolar stiffnesses, arthroscopy allows one to recognize the exact caus e of the stiffness and to treat it, especially the subacromial patholo gy. In this occurrence, buroscopy must be performed and cuff pathology treated. For acquired surgical stiffness, gain of motion is significa nt. Subjective and objective results are less satisfactory than those oi primary frozen shoulder, due to persistance of pain and lack of str ength. The alternative is open release, but arthroscopic release has l ess morbidity. It can be proposed early as soon as capsular tissue has healed (for instance 6 months).