Clinical outcome of arthroscopic capsular release for frozen shoulder: essential technical points in 255 patients

Katsuaki Kanbe, Katsuaki Kanbe

Abstract

Background: The purpose of this study was to investigate the long-term clinical outcome and its related factors regarding the severity of adhesion of CH ligament over long head of biceps (LHB) after shoulder arthroscopic capsular release for frozen shoulder with technical points in 255 patients.

Methods: We performed arthroscopic capsular release for frozen shoulder in 267 shoulders of 255 patients, 112 males and 143 females, with mean age of 56.39 years, mean disease duration periods of 0.934 years for conservative treatment, and mean follow-up periods of 5.6 years. The frozen shoulders were divided based on the severity of adhesion between CH ligament over LHB: those with slight degree of synovitis, no adhesion by obtuse rod, and slight thickness of the released capsule (type A), those with moderate degree of synovitis, moderate adhesion of the LHB by obtuse rod, and moderate thickness of the released capsule (type B), and those with severe degree of synovitis, severe adhesion of the LHB by obtuse rod, and severe thickness of the released capsule adhesion and a flatly shaped LHB (type C). We assessed the clinical factors related to the scoring of the shoulders by the criteria of the American Shoulder and Elbow Surgeons (ASES) and the relationship with severity of LHB adhesion.

Results: The ASES scores improved at 5 years postoperatively in all three groups significantly. The range of motion also significantly improved in all three groups significantly. The severity of the LHB adhesion over the CH ligament was confirmed to influence the ASES scores before and after the arthroscopic capsular release. There was a significant difference between type A and type B (p < 0.0001) or type C (p < 0.0001) before and after surgery. Logistic regression analysis showed disease duration, diabetes mellitus (DM), and ASES score were significantly associated to the severity type of LHB, especially DM has high odds ratio and was a risk factor for LHB adhesion. There is no adverse event including dislocation or axillary nerve injury and recurrence after arthroscopic capsular release at 5 years after surgery.

Conclusions: The long-term results of arthroscopic capsular release in frozen shoulder were confirmed in 255 patients. The severity of LHB adhesion over the CH ligament, a pathological condition related to DM as a risk factor, seems to play an important role in the functional outcome. Therefore, the sufficient release of LHB was essential technical point for arthroscopic capsular release in frozen shoulder.

Keywords: Arthroscopic capsular release; CH ligament; Frozen shoulder; LHB.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the ethics committee of Tokyo Women’s Medical University. All patients provided informed consent to participate in this study. This study was conducted in accordance with the latest version of the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The author declares that he has no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Arthroscopic classification based on the severity of adhesion of LHB and CH ligament. a Slight adhesion to easily get into the back of LHB by obtuse rod. b Moderate adhesion to hardly get into the back of LHB by obtuse rod. c Severe adhesion with no space to get into the back of LHB by obtuse rod. Asterisk is LHB
Fig. 2
Fig. 2
Procedure of arthroscopic capsular release for frozen shoulder. a Arthroscopic finding around LHB with synovium over CH ligament. Asterisk is LHB. b Rasp is used just outside of labrum along with the glenoid neck bone. c Subacromial decompression was performed concomitantly by using abrader arthroscopically. d After arthroscopic capsular release, CH ligament adhered over LHB was removed and joint space was widen clearly
Fig. 3
Fig. 3
ASES scores at baseline in each group. Asterisk indicates significant difference compared with type A (p < 0.001). Two asterisks indicate significant difference compared with type B (p < 0.001)
Fig. 4
Fig. 4
ASES scores at 5 years after arthroscopic capsular release in each group. Asterisk indicates significantly different compared with type A (p < 0.001). Two asterisks indicate significantly different compared with type B (p < 0.001)
Fig. 5
Fig. 5
The ratio of the patients with DM in each group. DM ratio of type C was significantly higher than that of type A (p = 0.0012) and type B (p = 0.0302)

References

    1. Walther M, Blanke F, Von Wehren L, Majewski M. Frozen shoulder-comparison of different surgical treatment options. Acta Orthop Belg. 2014;80(2):172–177.
    1. Evans JP, Guyver PM, Smith CD. Frozen shoulder after simple arthroscopic shoulder procedures: what is the risk? Bone Joint J. 2015;97(7):963–966. doi: 10.1302/0301-620X.97B7.35387.
    1. Mubark IM, Ragab AH, Nagi AA, Motawea BA. Evaluation of the results of management of frozen shoulder using the arthroscopic capsular release. Orthop Traumatol Rehabil. 2015;17(1):21–28. doi: 10.5604/15093492.1143530.
    1. Neviaser J. Arthrography of the shoulder joint: study of the findings in adhesive capsulitis of the shoulder. Study of the findings in adhesive capsulitis of the shoulder. J Bone Joint Surg Am. 1962;44(A):1321–1359. doi: 10.2106/00004623-196244070-00004.
    1. Mengiardi B, Pfirrmann CW, Gerber C, Hodler J, Zanetti M. Frozen shoulder: MR arthrographic findings. Radiology. 2004;233(2):486–492. doi: 10.1148/radiol.2332031219.
    1. Arai R, Nimura A, Yamaguchi K, Yoshimura H, Sugaya H, Saji T, et al. The anatomy of the coracohumeral ligament and its relation to the subscapularis muscle. J Shoulder Elb Surg. 2014;23(10):1575–1581. doi: 10.1016/j.jse.2014.02.009.
    1. Kanbe K, Inoue K, Inoue Y. The dynamic movement of the long head of the biceps tendon is associated with treatment of frozen shoulder. J Orthop Surg. 2008;16(3):295–299. doi: 10.1177/230949900801600305.
    1. Michener L, McClure P, Snennett B. American shoulder and elbow surgeons standardized shoulder assessment form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elb Surg. 2002;11(6):587–594. doi: 10.1067/mse.2002.127096.
    1. Buchbinder R, Hoving JL, Green S, et al. Short course prednisolone for adhesive capsulitis (frozen shoulder or stiff painful shoulder): a randomised, double blind, placebo controlled trial. Ann Rheum Dis. 2004;63(11):1460–1469. doi: 10.1136/ard.2003.018218.
    1. Le Lievre HM, Murrell GA. Long-term outcomes after arthroscopic capsular release for idiopathic adhesive capsulitis. J Bone Joint Surg Am. 2012;94(13):1208–1216. doi: 10.2106/JBJS.J.00952.
    1. Grey RG. The natural history of “idiopathic” frozen shoulder. J Bone Joint Surg Am. 1978;60(4):564.
    1. Saito T, Sasanuma H, Iijima Y, Kanaya Y, Saito T, Watanabe H, et al. Short-term clinical results of frozen shoulder treated with shoulder manipulation under ultrasound-guided cervical nerve root block at outpatient setting: a case series. J Orthop Sci. 2017;22(2):275–280. doi: 10.1016/j.jos.2016.11.007.
    1. Green S, Buchbinder R, Hetrick S. Physiotherapy interventions for shoulder pain. Cochrane Database Syst Rev. 2003;2:CD004258.
    1. Buchbinder R, Youd JM, Green S, Stein A, Forbes A, Harris A, et al. Efficacy and cost-effectiveness of physiotherapy following glenohumeral joint distension for adhesive capsulitis: a randomized trial. Arthritis Rheum. 2007;57(6):1027–1037. doi: 10.1002/art.22892.
    1. Grant JA, Schroeder N, Miller BS, Carpenter JE. Comparison of manipulation and arthroscopic capsular release for adhesive capsulitis: a systematic review. J Shoulder Elb Surg. 2013;22(8):1135–1145. doi: 10.1016/j.jse.2013.01.010.
    1. Ogilvie-Harris D, Biggs D, Fitsialos D, Mackay M. The resistant frozen shoulder. Clin Orthop Relat Res. 1995;319(10):238–248.
    1. Robinson CM, Seah KT, Chee YH, Hindle P, Murray IR. Frozen shoulder. J Bone Joint Surg Br. 2012;94(1):1–9. doi: 10.1302/0301-620X.94B1.27093.
    1. Thomas SJ, McDougall C, Brown ID, Jaberoo MC, Stearns A, Ashraf R, et al. Prevalence of symptoms and signs of shoulder problems in people with diabetes mellitus. J Shoulder Elb Surg. 2007;16(6):748–751. doi: 10.1016/j.jse.2007.02.133.
    1. Manske RC, Prohaska D. Diagnosis and management of adhesive capsulitis. Curr Rev Musculoskelet Med. 2008;1(3-4):180–189. doi: 10.1007/s12178-008-9031-6.
    1. Kanbe K, Inoue K, Inoue Y, Chen Q. Inducement of mitogen-activated protein (MAP) kinases in frozen shoulder. J Orthop Sci. 2009;14(1):56–61. doi: 10.1007/s00776-008-1295-6.
    1. Hsu JE, Anakwenze OA, Warrender WJ, Abboud JA. Current review of adhesive capsulitis. J Shoulder Elb Surg. 2011;20(3):502–514. doi: 10.1016/j.jse.2010.08.023.
    1. Pearsall AW, 4th, Osbahr DC, Speer KP. An arthroscopic technique for treating patients with frozen shoulder. Arthroscopy. 1999;15(1):2–11. doi: 10.1053/ar.1999.v15.0150002.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe