What is arthroscopic capsular release for the treatment of frozen shoulder syndrome (FSS) (adhesive capsulitis)?

Updated: Nov 12, 2020
  • Author: Jefferson R Roberts, MD; Chief Editor: S Ashfaq Hasan, MD  more...
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Answer

Ogilvie-Harris et al and Warner et al have demonstrated the efficacy of arthroscopic capsular release for the refractory frozen shoulder. [70, 71, 72] Based on these reports and work by others, a selective arthroscopic capsular release is recommended for patients with refractory frozen shoulder. [73]

Once the patient is under anesthesia, a detailed preoperative assessment of the affected and unaffected shoulder's passive ROM is performed. Typically the affected shoulder exhibits global loss of motion, with the contracture affecting the entire capsule.

Standard arthroscopic shoulder portals are established. Based on the preoperative examination, the glenohumeral joint capsule is released with electrocautery, as seen in the image below. Typically a circumferential capsular release is performed. Ahn et al developed an ultrasound-guided interventional release of the rotator interval using a round needle designed specifically for this procedure. All 13 patients experienced significant improvement. [74] Care is taken to avoid any release of the intra-articular subscapularis tendon. Before the patient is taken from the operating room, the shoulder ROM is documented and compared with the presurgical ROM.

True anteroposterior view of the glenohumeral joint (left); axillary lateral view (middle); supraspinatus outlet view (right)

True anteroposterior view of the glenohumeral join True anteroposterior view of the glenohumeral joint (left); axillary lateral view (middle); supraspinatus outlet view (right)

With 24-48 hours of postoperative pain relief provided by a preoperative interscalene block, ROM exercises should be initiated on the day of surgery. An interscalene catheter can be placed when performing the interscalene block to allow for an extended period of pain relief. A 2-week course of oral corticosteroids also should be initiated on the day of surgery.


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