Arthroscopic Capsular Release: Restore Shoulder Motion and Comfort

Arthroscopic capsular release is a minimally invasive surgical procedure designed to treat adhesive capsulitis, commonly known as frozen shoulder. The procedure aims to release the thickened and contracted capsule of the shoulder joint, restoring range of motion and reducing pain.

Surgical Technique:

The procedure begins with standard arthroscopic portal placement, typically utilizing anterior, posterior, and lateral portals. After diagnostic arthroscopy confirms the diagnosis, systematic release of the contracted capsule is performed. The release typically starts with the rotator interval, followed by the anterior capsule, inferior capsule, and posterior capsule. Care is taken to protect the axillary nerve during inferior capsule release. The coracohumeral ligament is also released to address any restriction of external rotation.

Indications:

Primary indications include failed conservative management of frozen shoulder, typically after 6 months of non-operative treatment. Patients should demonstrate significant restriction in both active and passive range of motion, particularly external rotation and elevation. The procedure may also be indicated in cases of secondary frozen shoulder following trauma or surgery.

Preoperative Considerations:

Thorough clinical examination and imaging studies are essential to confirm the diagnosis and rule out other pathologies. MRI may be utilized to exclude concurrent shoulder pathology. Patient education regarding post-operative rehabilitation is crucial for optimal outcomes.

Postoperative Management:

Early aggressive physical therapy is initiated immediately post-surgery to maintain the achieved range of motion. Continuous passive motion devices may be employed in the immediate postoperative period. Pain management typically includes multimodal analgesia. Most patients require 4-6 weeks of structured rehabilitation.

Expected Outcomes:

Success rates typically range from 70-90% in appropriately selected patients. Most patients experience significant improvement in range of motion within 6-12 weeks post-surgery. Pain relief is generally achieved earlier than full motion recovery. Return to normal activities usually occurs within 2-3 months.

Potential Complications:

While generally safe, potential complications include axillary nerve injury, infection, shoulder instability, and recurrent stiffness. The risk of complications is minimized through meticulous surgical technique and appropriate patient selection.

Contraindications:

Relative contraindications include active infection, severe osteoporosis, and uncontrolled diabetes. Patients with significant glenohumeral arthritis may not be ideal candidates for this procedure.

Long-term Results:

Long-term studies demonstrate sustained improvement in shoulder motion and function in most patients. However, some patients may experience mild residual stiffness. Patient satisfaction rates are generally high when appropriate expectations are set preoperatively.

Conclusion:

Arthroscopic capsular release represents an effective surgical intervention for recalcitrant frozen shoulder when conservative measures fail. Success depends on appropriate patient selection, meticulous surgical technique, and committed postoperative rehabilitation