Arthroscopic capsular release for the treatment of refractory postoperative or post-fracture shoulder stiffness

Background: Arthroscopic capsular release is used to treat idiopathic adhes ive capsulitis (frozen shoulder) that is refractory to nonoperative treatme nt or manipulation under anesthesia. The role of arthroscopic capsular rele ase in the treatment of frozen shoulder after shoulder surgery or fracture is less clearly understood. The purposes of this study were to define the o utcome of arthroscopic capsular release in the management of frozen shoulde r after surgery or fracture and to compare these results with those of arth roscopic capsular release in the treatment of idiopathic frozen shoulder. Methods: We evaluated the results of arthroscopic capsular release in three different groups of patients with shoulder contracture refractory to nonop erative management and manipulation under anesthesia. The three groups cons isted of patients who had an idiopathic frozen shoulder, shoulder stiffness after surgery, or shoulder stiffness after fracture. We evaluated pain, fu nction, patient satisfaction, and range of motion in all three groups befor e and after the study treatment. Results: At a mean of twenty months (range, twelve to forty-six months) aft er the operation, fifty patients were available for assessment of function and range of motion of the involved shoulder. At the time of follow-up, eac h group had a significant improvement in the scores for pain, patient satis faction, and functional activity as well as in the overall outcome score (p < 0.01). Comparison of the scores among the different groups revealed that all had a similar degree of improvement in range of motion of the involved shoulder, but patients with postoperative frozen shoulder had significantl y (p < 0.05) lower scores for pain (p < 0.03), patient satisfaction (p < 0. 004), and functional activity (p < 0.002) than did those with idiopathic or post-fracture frozen shoulder. Conclusions: Arthroscopic capsular release was as effective for improving r ange of motion in patients with postoperative contracture of the shoulder a s it was in patients with idiopathic and post-fracture contracture. However , there was less improvement in the subjective scores for pain, function, a nd patient satisfaction in the postoperative group.