ARTHROSCOPIC MANAGEMENT OF REFRACTORY SHOULDER STIFFNESS

Glenohumeral stiffness is a major cause of shoulder disability and pai n. Conventional management strategies often fail to yield consistent o r prompt return of comfort and function. Over the past 5 years, we hav e employed a prospective approach to the evaluation and management of glenohumeral stiffness using arthroscopic release of capsular contract ures for the most refractory. This report concerns the first 30 patien ts who failed at least 6 months (28 month mean) of nonoperative manage ment for unilateral refractory shoulder stiffness and who were managed by arthroscopic capsular release. Fourteen patients were diabetic. Fo llowup averaged 33 months (range 12 to 56 months). Each patients' moti on and strength was documented according to the American Shoulder and Elbow Surgeons standard examination. Functional outcome measures were patient-assessed using the Simple Shoulder test before and after surge ry. Before surgery, active range-of-motion of the affected shoulder av eraged 41% of the opposite asymptomatic side. The day after surgery, m otion had improved dramatically to a mean of 78%. An additional 15% of motion was gained after discharge from the hospital. The final motion averaged 93% of the opposite side. All Simple Shoulder Test (SST) par ameters and six of nine SF-36 health status scores were improved signi ficantly. Only 6% of patients were able to sleep comfortably on their side and 35% could place 1 Ib. on a shelf at shoulder height before su rgery. After surgery, 73% were able to sleep comfortably on the affect ed side and 83% were able to place 1 lb. on a shelf at shoulder height . There were no differences among all outcome measures between diabeti c or nondiabetic patients. Three patients developed recurrent refracto ry stiffness. The only complication was a single axillary neuropraxia which resolved spontaneously. No patient developed instability. Arthro scopic capsular release can be a safe and effective tool in the manage ment of refractory shoulder stiffness.