Posterior Arthroscopic Capsular Release in Frozen Shoulder, a Prospective Cohort Study

Authors: I Boutros, M Snow, L Funk

References: BESS 2007, Telford

Abstract
Introduction: Arthroscopic capsular release has become an increasingly popular treatment for resistant frozen shoulder. Significant internal rotation limitation is thought to be due to posterior capsular thickening and therefore adding a posterior release to the anterior and inferior releases seems sensible. However, this is technically more difficult.

The role of this study is to assess the overall outcome of arthroscopic capsular release and to establish whether inclusion of a posterior capsular release has an additional beneficial.

Patients and Methods: Fourty eight patients with primary or secondary frozen shoulder in whom conservative physiotherapy had failed were included in the study. Arthroscopic capsular release was performed in all cases. One group had an anterior and inferior release only, whilst the second group included a posterior release. All data was collected prospectively. Constant and Murley functional score was used to assess outcome. Overall satisfaction and patient reported outcomes were also measured.

Results: The mean patient age was 51 (range 28-65), with no difference between the two groups. There were 27 patients in the first cohort (without posterior release) and 21 patients in the second (with posterior release). The mean follow up was 5 months.

Aetiology of the frozen shoulder was primary (22), diabetic (7), post-traumatic (7) and post-operative (11).

Overall across both groups; there a highly significant improvement in Constant score (P <0.001) post-operatively. A similar pattern was noted in the range of motion (P<0.001). Satisfaction post-operatively was measured by a satisfaction questionnaire (minimum 1 and maximum 10). The mean satisfaction score was 7 post-operatively. The patients reported overall outcome as much better (24), better (15), same (1) and worse (4). There was no significant difference in Constant Score between the two groups (P = 0.56) and no significant difference in the improvement of the range of motion, in particular internal rotation (P=0.35).

Conclusion: We have demonstrated an overall rapid significant improvement following arthroscopic capsular release for primary and secondary frozen shoulder. There was no significant difference in the overall outcome with the addition of a posterior release.

Clinical Relevance: Adding a posterior release to an arthroscopic capsulectomy does not seem to add any significant benefit to the outcome.