ABSTRACT
Arthroscopic capsular release is an effective technique in the management of shoulder stiffness that is refractory to nonoperative regimens. It is useful for many types of “frozen shoulder,”(1) including primary adhesive capsulitis, post-traumatic, or postsurgical stiffness. Neviaser originally described the pathology as vascular and fibrotic, with a chronic inflammatory appearance, while more recent pathological descriptions have included comparisons with the histology of Dupuytren’s disease (2,3). Early reports on adhesive capsulitis described it as a self-limited process, with near complete recovery of motion (1,4-6), and others have shown the importance of physical therapy as well (7). Other studies have drawn different conclusions, reporting that the condition may take much longer to resolve and motion may never fully recover (8,9). Shaffer, for example, reported that 50% of patients had mild pain and stiffness at seven year follow-up, including permanent external rotation deficit and 60% decrease in overall range of motion (9). Nonoperative treatment typically consists of physical therapy, anti-inflammatory agents, intra-articular corticosteroid injections, and manipulation under anesthesia. While recent work at our institution supports the conclusion that most patients with adhesive capsulitis will experience resolution with nonoperative measures in a relatively short time period, a minority of patients will require operative treatment for a successful outcome, and our treatment of choice in this situation is arthroscopic capsular release (10).
