ARTHROSCOPIC RELEASE OF POSTOPERATIVE CAPSULAR CONTRACTURE OF THE SHOULDER

A loss of motion after an operation on the shoulder often cannot be tr eated successfully with physical therapy or closed manipulation, Altho ugh open release techniques generally improve motion, they involve ext ensive dissection, We developed a technique of arthroscopic capsular r elease and applied it in eighteen patients who had postoperative stiff ness of the shoulder, The patients were selected for the arthroscopic release technique if a conservative program of physical therapy and an attempted closed manipulation had failed to restore motion and if the y had no known extra-articular contractures. Five of the thirteen pati ents who had had a global loss of shoulder motion had motion restored with the anterior capsular release, and six needed an additional relea se of the posterior aspect of the capsule - that is, a combined (anter ior and posterior) capsular release, The arthroscopic procedure could not be completed in the remaining two patients because of an extra-art icular scar involving the subscapularis, but those patients were manag ed successfully with an open release, As five patients had lost only i nternal rotation and flexion, they had only a posterior capsular relea se. For the eleven patients who had had either an anterior or a combin ed (anterior and posterior) capsular release, the mean improvement in the score of Constant and Murley was 43 points (range, 31 to 62 points ) and all improvements in motion were significant (p < 0.01), Flexion improved a mean of 51 degrees (range, 10 to 65 degrees); external rota tion in adduction and abduction, 31 degrees (range, 10 to SO degrees) and 40 degrees (range, 5 to 80 degrees), respectively; and internal ro tation in adduction and abduction, six spinous-process levels (range, three to eleven levels) and 41 degrees (range, 20 to 70 degrees), resp ectively, For the five patients who had an isolated posterior capsular release, the score of Constant and Murley improved a mean of 20 point s (range, 5 to 35 points) and the improvements in motion also were sig nificant (p < 0.05 and 0.005), Internal rotation in adduction and abdu ction improved a mean of four spinous-process levels (range, one to te n levels) and 42 degrees (range, 30 to 60 degrees), respectively, Eigh t patients had an arthroscopic acromioplasty for concomitant impingeme nt disease, One patient who had had a combined (anterior and posterior ) release and one who had had a posterior capsular release continued t o have pain because of injury of the articular cartilage from a previo us operation. We concluded that arthroscopic capsular release is a rel iable method for restoring motion with minimum morbidity in carefully selected patients who have postoperative stiffness of the shoulder. Wh en necessary, it can be converted to an open release.