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

Jerosch, Joerg
May 2001
Knee Surgery, Sports Traumatology, Arthroscopy;May2001, Vol. 9 Issue 3, p178
Academic Journal
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 undergoing physiotherapy. Other patients do not accept this severe limitation and choose treatment options that restore the range of motion (ROM) more rapidly. Conventional open release techniques generally improve motion but involve extensive dissection. The purpose of this study was to develop a safe and reproducible technique of arthroscopic capsular release (ACR) and to present 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 patients with primary adhesive capsulitis of the glenohumeral joint. The patients were selected for the arthroscopic release when conservative therapy had failed for at least 6 months. All of the patients had a global loss of shoulder motion and had motion restored with a combined anterior, posterior, superior, and inferior release of the of the capsule (360° release). Additionally, 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° preoperatively to 165° intraoperatively; 6 weeks after surgery, mean abduction was 168° and at the time of follow-up it was 167°. Mean external rotation in adduction improved from 3° preoperatively to 75° intraoperatively. After 6 weeks, the mean external rotation in adduction was 72° and at the time of follow-up the external rotation reached 76°. Mean external rotation in abduction improved from 4° preoperatively to 81° intraoperatively, 80° after 6 weeks and 85° at the time of the last follow-up. Internal rotation in abduction was 17° preoperatively. Intraoperatively, mean internal rotation was 59°. An angle of 58° was documented at 6 weeks follow-up, and at the last follow-up an angle of 63° was documented. No postoperative lesion of the axillary nerve was present. We concluded that arthroscopic capsular release is a reliable method for restoring motion with minimum morbidity in carefully selected patients. When performing an ACR the incision of the glenohumeral joint capsule should be undertaken at the glenoidal insertion in the abducted and external rotated shoulder.



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