360 degrees arthroscopic capsular release in patients with adhesive capsulitis of the glenohumeral joint - indication, surgical technique, results

Adhesive capsulitis of the glenohumeral joint is said to be a self-limiting process. However, in some patients the disease can last much longer than 1 year, which may lead patients to more invasive treatment than merely under going physiotherapy. Other patients do not accept this severe limitation an d choose treatment options that restore the range of motion (ROM) more rapi dly. Conventional open release techniques generally improve motion but invo lve extensive dissection. The purpose of this study was to develop a safe a nd reproducible technique of arthroscopic capsular release (ACR) and to pre sent the results of this technique in the clinical situation. The technique for ACR was first defined in a cadaver study and then applied in 28 patien ts with primary adhesive capsulitis of the glenohumeral joint. The patients were selected for the arthroscopic release when conservative therapy had f ailed for at least 6 months. All of the patients had a global loss of shoul der motion and had motion restored with a combined anterior, posterior, sup erior, and inferior release of the of the capsule (360 degrees release). Ad ditionally, in all patients synovectomy with electrocautery was performed. We documented the ROM in the different planes as well as the Constant score . The Constant score improved a mean of 41 points. Range of motion for all planes significantly improved (P <0.01). Abduction improved from 75 degrees preoperatively to 165 degrees intraoperatively; 6 weeks after surgery, mea n abduction was 168 and at the time of follow-up it was 167 degrees. Mean e xternal rotation in adduction improved from 3 degrees preoperatively to 75 degrees intraoperatively After 6 weeks, the mean external rotation in adduc tion was 72 degrees and at the time of follow-up the external rotation reac hed 76 degrees. Mean external rotation in abduction improved from 4 degrees preoperatively to 81 degrees intraoperatively, 80 degrees after 6 weeks an d 85 degrees at the time of the last follow-up. internal rotation in abduct ion was 17 degrees preoperatively. Intraoperatively, mean internal rotation was 59 degrees. An angle of 58 degrees was documented at B weeks follow-up , and at the last follow-up an angle of 63 degrees was documented. No posto perative lesion of the axillary nerve was present. We concluded that arthro scopic capsular release is a reliable method for restoring motion with mini mum morbidity in carefully selected patients. When performing an ACR the in cision of the glenohumeral joint capsule should be undertaken at the glenoi dal insertion in the abducted and external rotated shoulder.