Arthroscopic Release of Adhesive Capsulitis: Results Five Years LaterGradual, unexplained pain and stiffness of the shoulder that limits motion and function is referred to as idiopathic adhesive capsulitis. Idiopathic means "unknown cause." The joint capsule (connective tissue surrounding the joint) is thick and tight. The collagen fibers that make up the capsule are packed together more densely than normal.
Treatment ranges from conservative (nonoperative) care with doing nothing, physical therapy, or steroid injections to surgery to release the adhesions. Surgery can be done with a simple manipulation (shoulder is moved through full motion while patient is anesthetized), arthroscopic capsular release, or open incision release.
In this study, one surgeon from the Orthopaedic Research Institute in Australia followed his patients for five or more years to see what kind of long-term results are possible. All patients had idiopathic adhesive capsulitis and were treated with arthroscopic release of the capsule.
The surgeon performed a complete 360-degree release of the capsule (all the way around the shoulder joint). Then a gentle manipulation was performed by moving the arm through its full range-of-motion. The surgeon injected the joint with a numbing agent combined with a steroid (antiinflammatory) medication.
The goal of the injection therapy was post-operative pain relief. Everyone treated with this approach went home on the day of surgery without a sling and with instructions from the physical therapist for the proper exercises to perform.
Results were measured by comparing before and after surgery range-of-motion, pain intensity, activities and function. The ability to reach behind the head and back was measured. Ability to lie on the painful side and sleep at night were also reported and recorded. Current level of sports participation was rated from "none" to hobby, club, or professional play.
All the patients reported immediate pain relief during activity and at night while sleeping. There was at least a 50 per cent improvement in range of motion early on. Functional skills like reaching overhead or behind the back improved steadily from postoperative week 6 through the end of the first year. By the end of the first year, the affected shoulder had motion equal to that of the unaffected shoulder. And there were no complications (e.g., infection, worse symptoms, nerve damage, joint instability).
The author concluded that arthroscopic capsular release for idiopathic adhesive capsulitis is an acceptable, safe, and effective treatment technique. The good-to-excellent results in the short-term were maintained into equally good long-term results. This is the first study to report such results more than two years after the first arthroscopic procedure.
Hugh M. J. Le Lievre, and George A. C. Murrell, MD, DPhil. Long-Term Outcomes After Arthroscopic Capsular Release for Idiopathic Adhesive Capsulitis. In The Journal of Bone & Joint Surgery. July 3, 2012. Vol. 94A. No. 13. Pp. 1208-1216.
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