Effectiveness of arthroscopic 360° capsular release for frozen shoulder_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Jiaxing , ZHU Sizheng , ZHAO Chen , HUANG Wei , SHUI Wei , HU Ning ,  CHEN Hong

Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China;

Corresponding author：

CHEN Hong, Email: chhong113@126.com

Keywords：

Frozen shoulder; arthroscopy; capsular release; joint range of motion

DOI：

10.7507/1002-1892.202103080

Video：

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Objective To investigate the effectiveness of arthroscopic 360° capsular release for frozen shoulder.Methods Between April 2018 and April 2019, 42 patients with frozen shoulders were treated with arthroscopic 360° capsular release. There were 13 males and 29 females, with an average age of 52.3 years (range, 45-56 years). There were 14 left shoulders and 28 right shoulders. The disease duration ranged from 5 to 18 months (mean, 11.1 months). The main clinical symptoms were limited active and passive movement of the shoulder joint with severe pain. All patients excluded impingement syndrome and shoulder osteoarthritis. Preoperative range of motion was as follows: forward flexion (93.2±15.4)°, external rotation at side (15.9±6.0)°, external rotation at 90° abduction (18.4±9.9)°, and internal rotation reaching the greater trochanter in 5 cases, buttocks in 20 cases, S₁ level in 17 cases. The visual analogue scale (VAS) score was 6.7±1.7 and the American Society of Shoulder and Elbow Surgery (ASES) score was 41.6±9.3. The active range of motion of shoulder joint, VAS score, and ASES score were recorded during follow-up.Results All incisions healed by first intention, and no early complications occurred. Patients were followed up 12-24 months (mean, 15.6 months). After operation, forward flexion, external rotation at side, and external rotation at 90° abduction significantly improved when compared with preoperatively (P<0.05). The range of internal rotation restored to the level of T_6-12 at 3 weeks, which was equivalent to that of the normal side at 12 months after operation (Z=–0.943, P=0.346). VAS scores decreased and ASES scores increased after operation, and the differences between pre- and post-operation were significant (P<0.05); and with time, the VAS scores and ASES scores improved further (P<0.05).Conclusion Arthroscopic 360° capsular release can significantly increase the range of motion of the shoulder joint, release pain, and improve function. It is an effective method for the treatment of frozen shoulders.

Citation： HUANG Jiaxing, ZHU Sizheng, ZHAO Chen, HUANG Wei, SHUI Wei, HU Ning, CHEN Hong. Effectiveness of arthroscopic 360° capsular release for frozen shoulder. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(9): 1141-1146. doi: 10.7507/1002-1892.202103080 Copy

1.	Yano T, Hagiwara Y, Ando A, et al. RAGE-dependent NF-kB inflammation processes in the capsule of frozen shoulders. J Shoulder Elbow Surg, 2020, 29(9): 1884-1891.
2.	Kamal N, McGee SL, Eng K, et al. Transcriptomic analysis of adhesive capsulitis of the shoulder. J Orthop Res, 2020, 38(10): 2280-2289.
3.	Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol, 1975, 4(4): 193-196.
4.	Cvetanovich GL, Leroux TS, Bernardoni ED, et al. Clinical outcomes of arthroscopic 360° capsular release for idiopathic adhesive capsulitis in the lateral decubitus position. Arthroscopy, 2018, 34(3): 764-770.
5.	Hand C, Clipsham K, Rees JL, et al. Long-term outcome of frozen shoulder. J Shoulder Elbow Surg, 2008, 17(2): 231-236.
6.	Favejee MM, Huisstede BM, Koes BW. Frozen shoulder: the effectiveness of conservative and surgical interventions—systematic review. Br J Sports Med, 2011, 45(1): 49-56.
7.	Kivimäki J, Pohjolainen T, Malmivaara A, et al. Manipulation under anesthesia with home exercises versus home exercises alone in the treatment of frozen shoulder: a randomized, controlled trial with 125 patients. J Shoulder Elbow Surg, 2007, 16(6): 722-726.
8.	Buchbinder R, Green S, Forbes A, et al. Arthrographic joint distension with saline and steroid improves function and reduces pain in patients with painful stiff shoulder: results of a randomised, double blind, placebo controlled trial. Ann Rheum Dis, 2004, 63(3): 302-309.
9.	Le Lievre HM, Murrell GA. Long-term outcomes after arthroscopic capsular release for idiopathic adhesive capsulitis. J Bone Joint Surg (Am), 2012, 94(13): 1208-1216.
10.	Arce G. Primary frozen shoulder syndrome: arthroscopic capsular release. Arthrosc Tech, 2015, 4(6): e717-e720.
11.	Jerosch J. 360 degrees arthroscopic capsular release in patients with adhesive capsulitis of the glenohumeral joint—indication, surgical technique, results. Knee Surg Sports Traumatol Arthrosc, 2001, 9(3): 178-186.
12.	刘洋, 印凡, 许兵, 等. 冻结肩的诊断与治疗研究进展. 中国矫形外科杂志, 2012, 20(19): 1771-1773.
13.	王珂杰, 徐鹏, 丁文鸽, 等. 肩关节镜下 360° 关节囊松解治疗原发性冻结肩的中期疗效. 中华关节外科杂志 (电子版), 2019, 13(1): 6-10.
14.	袁锋, 蔡俊丰, 马敏, 等. 关节镜下 360° 松解治疗原发性冻结肩. 中华肩肘外科电子杂志, 2016, 4(2): 76-81.
15.	Yoon JP, Chung SW, Lee BJ, et al. Correlations of magnetic resonance imaging findings with clinical symptom severity and prognosis of frozen shoulder. Knee Surg Sports Traumatol Arthrosc, 2017, 25(10): 3242-3250.
16.	Sun Y, Liu S, Chen S, et al. The effect of corticosteroid injection into rotator interval for early frozen shoulder: A randomized controlled trial. Am J Sports Med, 2018, 46(3): 663-670.
17.	Brenneke SL, Reid J, Ching RP, et al. Glenohumeral kinematics and capsulo-ligamentous strain resulting from laxity exams. Clin Biomech (Bristol, Avon), 2000, 15(10): 735-742.
18.	Bennett WF. Addressing glenohumeral stiffness while treating the painful and stiff shoulder arthroscopically. Arthroscopy, 2000, 16(2): 142-150.
19.	Warner JJ, Allen A, Marks PH, et al. Arthroscopic release for chronic, refractory adhesive capsulitis of the shoulder. J Bone Joint Surg (Am), 1996, 78(12): 1808-1816.
20.	郑小龙, 李焱, 穆米多, 等. 麻醉下手法松解联合关节镜下关节囊松解和肩峰下滑囊清理治疗原发性冻结肩的中期疗效. 中国修复重建外科杂志, 2020, 34(6): 737-743.
21.	Chen J, Chen S, Li Y, et al. Is the extended release of the inferior glenohumeral ligament necessary for frozen shoulder? Arthroscopy, 2010, 26(4): 529-535.
22.	Moon NH, Lee SJ, Shin WC, et al. Is pancapsular release more effective than selective capsular release for the treatment of adhesive capsulitis? Clin Shoulder Elb, 2015, 18(1): 28-35.
23.	王海明, 赵金忠, 皇甫小桥, 等. 原发性冻结肩关节镜手术干预时机选择对疗效的影响. 中华老年医学杂志, 2016, 35(7): 743-748.
24.	徐得贵, 包瑞, 郭昊, 等. 关节镜下肩关节松解术治疗冻结肩的术后疗效与患者术前病程的相关性分析. 中国骨与关节杂志, 2020, 9(6): 457-464.
25.	Jerosch J, Filler TJ, Peuker ET. Which joint position puts the axillary nerve at lowest risk when performing arthroscopic capsular release in patients with adhesive capsulitis of the shoulder? Knee Surg Sports Traumatol Arthrosc, 2002, 10(2): 126-129.

1. Yano T, Hagiwara Y, Ando A, et al. RAGE-dependent NF-kB inflammation processes in the capsule of frozen shoulders. J Shoulder Elbow Surg, 2020, 29(9): 1884-1891.
2. Kamal N, McGee SL, Eng K, et al. Transcriptomic analysis of adhesive capsulitis of the shoulder. J Orthop Res, 2020, 38(10): 2280-2289.
3. Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol, 1975, 4(4): 193-196.
4. Cvetanovich GL, Leroux TS, Bernardoni ED, et al. Clinical outcomes of arthroscopic 360° capsular release for idiopathic adhesive capsulitis in the lateral decubitus position. Arthroscopy, 2018, 34(3): 764-770.
5. Hand C, Clipsham K, Rees JL, et al. Long-term outcome of frozen shoulder. J Shoulder Elbow Surg, 2008, 17(2): 231-236.
6. Favejee MM, Huisstede BM, Koes BW. Frozen shoulder: the effectiveness of conservative and surgical interventions—systematic review. Br J Sports Med, 2011, 45(1): 49-56.
7. Kivimäki J, Pohjolainen T, Malmivaara A, et al. Manipulation under anesthesia with home exercises versus home exercises alone in the treatment of frozen shoulder: a randomized, controlled trial with 125 patients. J Shoulder Elbow Surg, 2007, 16(6): 722-726.
8. Buchbinder R, Green S, Forbes A, et al. Arthrographic joint distension with saline and steroid improves function and reduces pain in patients with painful stiff shoulder: results of a randomised, double blind, placebo controlled trial. Ann Rheum Dis, 2004, 63(3): 302-309.
9. Le Lievre HM, Murrell GA. Long-term outcomes after arthroscopic capsular release for idiopathic adhesive capsulitis. J Bone Joint Surg (Am), 2012, 94(13): 1208-1216.
10. Arce G. Primary frozen shoulder syndrome: arthroscopic capsular release. Arthrosc Tech, 2015, 4(6): e717-e720.
11. Jerosch J. 360 degrees arthroscopic capsular release in patients with adhesive capsulitis of the glenohumeral joint—indication, surgical technique, results. Knee Surg Sports Traumatol Arthrosc, 2001, 9(3): 178-186.
12. 刘洋, 印凡, 许兵, 等. 冻结肩的诊断与治疗研究进展. 中国矫形外科杂志, 2012, 20(19): 1771-1773.
13. 王珂杰, 徐鹏, 丁文鸽, 等. 肩关节镜下 360° 关节囊松解治疗原发性冻结肩的中期疗效. 中华关节外科杂志 (电子版), 2019, 13(1): 6-10.
14. 袁锋, 蔡俊丰, 马敏, 等. 关节镜下 360° 松解治疗原发性冻结肩. 中华肩肘外科电子杂志, 2016, 4(2): 76-81.
15. Yoon JP, Chung SW, Lee BJ, et al. Correlations of magnetic resonance imaging findings with clinical symptom severity and prognosis of frozen shoulder. Knee Surg Sports Traumatol Arthrosc, 2017, 25(10): 3242-3250.
16. Sun Y, Liu S, Chen S, et al. The effect of corticosteroid injection into rotator interval for early frozen shoulder: A randomized controlled trial. Am J Sports Med, 2018, 46(3): 663-670.
17. Brenneke SL, Reid J, Ching RP, et al. Glenohumeral kinematics and capsulo-ligamentous strain resulting from laxity exams. Clin Biomech (Bristol, Avon), 2000, 15(10): 735-742.
18. Bennett WF. Addressing glenohumeral stiffness while treating the painful and stiff shoulder arthroscopically. Arthroscopy, 2000, 16(2): 142-150.
19. Warner JJ, Allen A, Marks PH, et al. Arthroscopic release for chronic, refractory adhesive capsulitis of the shoulder. J Bone Joint Surg (Am), 1996, 78(12): 1808-1816.
20. 郑小龙, 李焱, 穆米多, 等. 麻醉下手法松解联合关节镜下关节囊松解和肩峰下滑囊清理治疗原发性冻结肩的中期疗效. 中国修复重建外科杂志, 2020, 34(6): 737-743.
21. Chen J, Chen S, Li Y, et al. Is the extended release of the inferior glenohumeral ligament necessary for frozen shoulder? Arthroscopy, 2010, 26(4): 529-535.
22. Moon NH, Lee SJ, Shin WC, et al. Is pancapsular release more effective than selective capsular release for the treatment of adhesive capsulitis? Clin Shoulder Elb, 2015, 18(1): 28-35.
23. 王海明, 赵金忠, 皇甫小桥, 等. 原发性冻结肩关节镜手术干预时机选择对疗效的影响. 中华老年医学杂志, 2016, 35(7): 743-748.
24. 徐得贵, 包瑞, 郭昊, 等. 关节镜下肩关节松解术治疗冻结肩的术后疗效与患者术前病程的相关性分析. 中国骨与关节杂志, 2020, 9(6): 457-464.
25. Jerosch J, Filler TJ, Peuker ET. Which joint position puts the axillary nerve at lowest risk when performing arthroscopic capsular release in patients with adhesive capsulitis of the shoulder? Knee Surg Sports Traumatol Arthrosc, 2002, 10(2): 126-129.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of arthroscopic 360° capsular release for frozen shoulder

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