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Arthroscopic Capsular Release for Idiopathic Adhesive Capsulitis
Lijkele Beimers, MD, PhD1; George A.C. Murrell, MD, DPhil1
1 Orthopaedic Research Institute, St George Hospital, Level 2, 4-10 South Street, Kogarah NSW 2217, Australia. E-mail address for L. Beimers: orthopeed@gmail.com. E-mail address for G.A.C. Murrell: murrell.g@ori.org.au
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Based on an original article: J Bone Joint Surg Am. 2012 Jul 3;94(13):1208-16.



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2013 Jan 23;3(1):e2 1-5. doi: 10.2106/JBJS.ST.L.00024
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Extract

Overview
Introduction

Our technique of arthroscopic capsular release involving two posterior portals and one anterior portal, to accomplish a complete 360° release, improves motion and reduces pain in patients with idiopathic adhesive capsulitis.

Step 1: Position the Patient

Place the patient in a beach-chair position for shoulder joint arthroscopy.

Step 2: Establish a Routine Posterior Glenohumeral Joint Arthroscopy Portal

Use a routine posterior glenohumeral arthroscopy portal to introduce the arthroscope.

Step 3: Establish an Anterior Portal

Establish the anterior portal under direct vision using a spinal needle.

Step 4: Release the Rotator Cuff Interval and Subscapularis Tendon

Release the rotator cuff interval, dividing no more than the upper half of the intra-articular subscapularis tendon.

Step 5: Release the Anterior-Inferior Aspect of the Capsule

Cut the anterior-inferior aspect of the capsule completely.

Step 6: Establish a Posterior-Inferior Portal

Determine the location of the posterior-inferior portal with a spinal needle.

Step 7: Release the Posterior-Inferior Aspect of the Capsule

Release or perforate the posterior-inferior capsule of the joint with the arthroscopic wand.

Step 8: Gently Manipulate the Arm

Manipulate the arm in abduction, then forward and backward flexion, and then external and internal rotation.

Results

An arthroscopic capsular release with use of the technique described here was performed in forty-nine shoulders in forty-three patients with idiopathic adhesive capsulitis4.

What to Watch For

Indications

Contraindications

Pitfalls & Challenges

Figures in this Article

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    Video 1: Short video clip showing the capsular release procedure in a right frozen shoulder.

    Running Time: 0:42

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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