Summary
With advances in arthroscopic technique, arthroscopic release was believed to be an effective method for the recalcitrant cases resistant to conservative treatment. Regarding the extent of release, however, there were various debates in the literature.
Abstract
Purpose
The aims of our study were to assess effects of the extent of capsular release and to define the benefit of combination release of the subscapularis tendon and inferior glenohumeral ligament in frozen shoulder.
Methods
Forty consecutive patients with refractory frozen shoulder underwent arthroscopic capsular release. The extent of release focused on the subscapularis tendon and inferior glenohumeral ligaments (IGHL), both of the inferior and posterior. VAS, Constant functional scores and the Fudan university shoulder score (FUSS) were used to assess the outcome. The range of motion (ROM) in various directions was also recorded preoperatively and postoperatively.
Results
Follow-up was obtained in all patients, and it averaged 10.5weeks.At 12 w postoperatively, both of VAS, Constant score and FUSS performed increased significantly in all patients compared with preoperative. However, FUSS had already reached significant improvement at the 8 w postoperatively compared with 4 w (P<0.05), while for Constant score this happened only at the 12 w postoperatively. Overall, range of motion showed satisfactory results at final follow-up. Abduction, flexion, external rotation at 90° of abduction, internal rotation at 0°of abduction, and internal rotation at 90° of abduction recovered more rapidly within 4 weeks after surgery, however, there was no significant difference in ROM after 12weeks.
Conclusion
In this broad group of patients with recalcitrant adhesive capsulitis, the combination of the subscapularis tendon and inferior glenohumeral ligament release significantly improve patient function and ROM. Furthermore, FUSS was probably more sensitive for the early postoperative evaluation, especially for nighttime pain sensation and patient satisfaction.