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.
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
Pitfalls & Challenges