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Arthroscopic Capsular Release for Idiopathic Adhesive Capsulitis
Lijkele Beimers, MD, PhD; George A.C. Murrell, MD, DPhil

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

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.

Surgical management strategies for idiopathic adhesive capsulitis (a painful, stiff shoulder of unknown etiology) include an open release, manipulation under anesthesia, arthroscopic capsular release, and combinations of open or arthroscopic capsular release with manipulation under anesthesia1-3. Arthroscopic capsular release …


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