Clinical evaluation of arthroscopic treatment of shoulder adhesive capsulitis☆

This was a retrospective study, conducted between 1996 and 2012, which included 56 shoulders (52 patients) that underwent surgery; 38 were female, and 28 had the dominant side affected. The mean age was 51 (29-73) years. The mean follow-up was 65 (12-168) months and the mean preoperative time was 8.9 (2-24) months. According to Zukermann's classification, 23 cases were considered primary and 33 secondary. With the patient in the lateral decubitus position, circumferential release of the joint capsule was performed: joint debridement; rotator interval opening; coracohumeral ligament release; anterior, posterior, inferior, and finally antero-inferior capsulotomy. A subscapularis tenotomy was performed when necessary. All patients underwent intense physical therapy in the immediate postoperative period. In 33 shoulders, an interscalene catheter was implanted for anesthetic infusion. Functional results were evaluated by the UCLA criteria.

RESULTS:

Improved range of motion was observed: mean increase of 45° of elevation, 41° of external rotation and eight vertebral levels of medial rotation. According to the UCLA score excellent results were obtained in 25 (45%) patients; good, in 24 (45%); fair, in two (3%); and poor, in two (7%). Patients who had undergone inferior capsulotomy achieved better results. Only 8.8% of patients who used the anesthetic infusion catheter underwent postoperative manipulation. Seven patients had complications.

CONCLUSION:

There was improvement in pain and range of motion. Inferior capsulotomy leads to better results. The use of the interscalene infusion catheter reduces the number of re-approaches.

Keywords:
Shoulder pain; Arthroscopy; Bursitis

	Sex	Age	Dominant side	Comorbidities	Associated lesions	Symptoms	Pre-op treatment	Range of motion						Post-op UCLA		Follow-up	Complications
		ΔT/years				ΔT/months	ΔT/months	Pre-op.			Post-op.			Score	Result	ΔT/months
								Elev.	LR	MR	Elev.	LR	MR
1	F	56	-	DM II, SAH	–	36	11	90°	35°	L5	140°	45°	T6	31	Good	23	Radial neurap.
2	F	43	+	SAH, DM II	–	36	18	95°	10°	L4	130°	40°	T10	27	Fair	50	–
3	F	55	+	DM I	–	26	11	90°	20°	Glut	150°	60°	T11	33	Good	26	–
4	F	44	+	–	–	7	5	70°	20°	Glut	150°	60°	T8	33	Good	14	–
5	F	56	-	SAH	–	17	11	90°	0°	L5	125°	30°	T8	30	Good	36	–
6	F	61	-	SAH, DM II	–	12	10	100°	15°	L3	150°	45°	T7	31	Good	72	–
7	F	47	+	Epilep.	–	24	18	70°	30°	S1	120°	40°	T12	15	Bad	128	Pre-op + RCI
8	F	45	+	–	–	22	13	90°	0°	S1	130°	50°	S1	25	Fair	138	RSD
			-	–	–	15	15	100°	10°	T12	150°	60°	T10	31	Good	72	–
9	F	45	-	SAH, DM II	–	18	15	90°	0°	Glut	150°	60°	T7	35	Excellent	124	–
			+	–	–	13	11	90°	10°	Glut	150°	60°	L5	31	Good	124	Pain AC
10	F	47	+	Asthma	–	18	14	30°	-10°	GT	90°	20°	GT	15	Bad	51	Pre-op + RSD
11	M	64	-	DMII, SAH	–	22	14	70°	25°	GT	130°	40°	L1	30	Good	76	–
12	F	49	+	DMI	–	42	7	90°	0°	Glut	120°	30°	T10	30	Good	75	–
13	F	52	+	–	Post-op RCI	13	13	100°	30°	L2	140°	60°	T9	32	Good	64	–
14	M	36	+	Tab.	Post-op ft GT + glenoid	34	23	125°	0°	L4	140°	40°	T10	28	Good	67	–
15	F	42	+	SAH, Tab.	Ft. humeral neck surg. cons. treat.	49	10	90°	40°	Glut	120°	60°	L3	30	Good	42	–
16	F	56	+	–	–	24	22	90°	20°	S1	100°	20°	L3	18	Bad	16	–
17	F	55	+	DM II, SAH, breast CA	–	24	24	80°	45°	Glut	130°	45°	Glut	15	Bad	27	–
18	M	55	-	–	Post-op cal. tend.	60	9	85°	10°	L5	130°	70°	T12	30	Good	22	–
19	F	67	+	–	–	8	8	70°	0°	GT	150°	45°	T10	34	Good	115	–
20	F	60	+	Hypot.	–	2.5	2.5	110°	60°	L5	140°	60°	T8	32	Good	84	–
21	M	60	+	SAH, Dep.	–	3.5	3	60°	-10°	S1	150°	60°	L4	35	Excellent	84	–
22	F	55	+	–	–	5	5	110°	10°	L4	160°	60°	T2	35	Excellent	39	–
23	F	57	+	DM, Coron.	–	24	8	80°	10°	S1	140°	60°	L5	35	Excellent	79	–
24	F	57	-	SAH	–	13	6	90°	20°	L4	150°	80°	T5	35	Excellent	27	–
25	M	57	-	DM II	–	3	3	90°	10°	S1	150°	80°	T6	35	Excellent	70	–
26	F	53	-	–	–	9.5	7	80°	0°	L5	150°	60°	T7	35	Excellent	83	–
27	M	51	+	DM I	Tend. calc.	36	12	100°	0°	L5	150°	60°	T10	35	Excellent	69	–
28	F	45	+	–	–	12	8	80°	10°	L3	150°	60°	T7	30	Good	74	–
29	M	50	-	–	–	10	10	90°	0°	L5	140°	60°	T10	34	Excellent	92	–
30	F	49	+	–	–	24	24	100°	20°	L5	140°	60°	T8	35	Excellent	118	–
31	F	44	-	–	–	6	6	100°	20°	L5	160°	70°	T5	35	Excellent	86	–
32	M	43	+	–	Sd. impact	16	4	130°	45°	L1	140°	60°	L1	35	Excellent	122	–
33	M	43	+	DM I	–	13	5	120°	0°	L3	150°	60°	T10	35	Excellent	128	–
34	M	42	-	DM I	–	11	8	130°	20°	L3	150°	60°	T8	35	Excellent	95	–
35	F	42	-	–	–	30	6	140°	45°	T10	150°	60°	T6	35	Excellent	70	–
36	M	29	-	Tab.	Ft. GT (cons. treat.)	3	3	100°	10°	L2	140°	30°	T12	28	Good	168	–
37	F	35	-	Hypot.	–	5	3	80°	0°	S1	160°	45°	T5	35	Excellent	16	–
38	F	73	-	SAH, DM II	Osteoarthritis AC	4	3	130°	60°	S1	140°	60°	L4	34	Excellent	12	–
39	F	65	-	–	–	3	3	70°	0°	S1	150°	70°	T7	34	Excellent	25	Axillary neurap.
40	M	58	+	–	–	5	5	120°	30°	L4	140°	30°	L1	32	Good	69	–
41	F	52	-	Dep.	–	4	4	40°	-20°	Glut	160°	80°	T5	34	Excellent	107	Radial neurap.
42	F	55	-	Hypot.	–	8	6	100°	-10°	L4	150°	60°	T6	33	Good	44	–
43	F	57	-	DLP	Tend. calc.	12	6	120°	45°	L5	150°	70°	T7	33	Good	14	–
44	F	56	+	DLP	–	12	8	120°	60°	T12	160°	80°	T3	35	Excellent	19	–
45	M	52	+	SAH, Hypot.	–	7	2	100°	20°	L4	150°	80°	T7	34	Excellent	85	–
	M		-	SAH, Hypot.	–	3	3	120°	30°	L5	150°	80°	T6	35	Excellent	54	–
46	F	51	-	–	Wrist ft. + imob.	8	6	90°	10°	L2	150°	70°	T5	35	Excellent	96	–
	F		+	–	–	6	2	130°	45°	L3	140°	70°	T6	34	Excellent	49	–
47	F	49	+	–	Sd. impact	6	2	150°	20°	L4	140°	70°	T5	32	Good	52	–
48	F	53	+	Sd. Panic	Cal. tend. of the sub.	5	2	100°	10°	L4	150°	70°	T5	33	Good	72	–
49	F	48	-	Tob.	–	5	7	90°	0°	L3	130°	70°	T5	28	Good	14	–
50	M	46	+	–	Post-op SLAP	8	12	140°	45°	T8	145°	70°	T5	35	Excellent	19	–
51	F	51	+	Breast CA	Post-op epiphyseal ft	12	12	90°	-10°	Glut	130°	30°	T9	29	Good	21	–
52	F	50	+	DM I	–	6	8	80°	0°	Glut	110°	60°	T10	30	Good	13	–
Means	51.2		15.3	8.9	96°	16°	L5	141°	57°	T9	31.4		64.8

Procedures	Number of shoulders	%
Opening of the rotator interval	56	100
Coracohumeral ligament release	55	98
Anterior capsulotomy	52	93
Posterior capsulotomy	44	78
Inferior capsulotomy	20	36
Subscapularis tenotomy	14	25
Acromioplasty	24	43
Mumford	11	19
Calcareous tendinitis drainage	2	3.5

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] * Corresponding author. E-mail: lucalu@terra.com.br (L.A. Silva).

Brasil

Brasil

Clinical evaluation of arthroscopic treatment of shoulder adhesive capsulitis☆ ☆ Study conducted at the Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), Departamento de Ortopedia e Traumatologia, Grupo de Cirurgia do Ombro e Cotovelo, São Paulo, SP, Brazil.

ABSTRACT

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Clinical evaluation of arthroscopic treatment of shoulder adhesive capsulitis^{^☆} ☆ Study conducted at the Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), Departamento de Ortopedia e Traumatologia, Grupo de Cirurgia do Ombro e Cotovelo, São Paulo, SP, Brazil.