[Arthroscopic release for shoulder stiffness].

OBJECTIVE: Arthroscopic capsular release for refractory shoulder stiffness to recreate active and passive shoulder joint mobility.

INDICATIONS: Adhesive capsulitis of the shoulder (primary and secondary frozen shoulder) after receiving at least 3 months of conservative treatment.

CONTRAINDICATIONS: Boney-related stiffening of the shoulder joint, joint infection, freezing phase of the primary frozen shoulder and shoulder stiffness after reconstructive surgery.

SURGICAL TECHNIQUE: Opening of the lower shoulder joint capsule over a gentle unidirectional manipulation under general anesthesia. A diagnostic arthroscopy in lateral position with extension of the arm is then performed. The release is completed with incision of the ventral and the dorsal part of the capsule under arthroscopic control.

POSTOPERATIVE MANAGEMENT: While still in the operation room, the anesthetist places an interscalene brachial plexus catheter, thus, delivering the best possible analgesia. This enables full range of active and passive movement of the shoulder joint for at least 3 days. Outpatient continuation of physiotherapy with anti-inflammatory and analgesic medication.

RESULTS: The literature shows good functional results with age- and gender-related Constant scores greater than 75 %. Our retrospective inquiry of 37 cases with a mean follow-up of 40 months confirms this outcome. The disease duration was shortened by arthroscopic release. Ability to work was achieved after a mean of 1.9 months; treatment ended 3.6 months after operation. In 10 cases with secondary shoulder stiffness, residual symptoms remained.