Addressing glenohumeral stiffness while treating the painful and stiff shoulder arthroscopically

The shoulder can be primarily or secondarily stiff. Cadaveric cutting studi es have shown increases in passive range of glenohumeral motion when certai n portions of the capsule are released. This study has recorded the intraop erative gains made in passive range of motion for external rotation, flexio n, abduction, and internal rotation with sequential release of the rotator interval, inferior capsule, and posterosuperior capsule, regardless of init ial etiology, and followed-up over time. Thirty one of 60 shoulders, found clinically to have a loss of passive range of motion and having failed a no noperative approach, underwent a capsular release. Eighteen patients underw ent a partial capsular release (group 1) and 13 patients (group 2) underwen t a complete capsular release. Thirty of 31 shoulders had statistically sig nificant gains in passive range of motion with sequential release. Tn gener al, resection of the rotator interval contributed to gains in external rota tion; resection of the inferior capsule (anteroinferior and posteroinferior ) contributed gains to external rotation, forward flexion, and internal rot ation; and resection of the posterosuperior capsule contributed to gains on ly in internal rotation. At a minimum of 18 months follow-up, 30 of 31 shou lders retained their intraoperative gains. There was no difference in the r esults between primarily and secondarily stiff shoulders for motion gains ( P > .05). Arthroscopically addressing capsular tightness is beneficial in r eturning shoulders with a loss of passive glenohumeral motion to normal reg ardless of the etiology.