Sunday, April 17, 2016

Can a stiff shoulder be loosened up with arthroscopic surgery?

Arthroscopic Management of the Stiff Shoulder

These authors have conducted a most thorough review of the application of arthroscopy to the management of the stiff shoulder.

Their bullet points are:

➢ Shoulder stiffness affects a diverse population of patients suffering a decrease in function and shoulder pain. Arthroscopic management of this debilitating spectrum of pathology is a safe and effective course of action in cases recalcitrant to nonoperative therapy.

➢ Arthroscopic management of the stiff shoulder has been reported to be effective in the treatment of stiffness due to adhesive capsulitis, birth palsy, stiffness in the setting of rotator cuff tears, and osteoarthritis in the posttraumatic patient, in the postoperative patient, and in the throwing athlete.

➢ Arthroscopic management is most effective in treating the stiff shoulder in the setting of adhesive capsulitis recalcitrant to nonoperative therapy or posttraumatic stiffness. Results are more guarded in the treatment of postoperative stiffness.

➢ Excessive force and trauma to the shoulder, including fracture of the humerus, can be avoided with a 360° capsular release for shoulder stiffness rather than manipulation under anesthesia.

Comment: A post about evaluating a shoulder for stiffness is shown here. Critically they point out the difference between idiopathic frozen shoulder (classically defined as a functionally important limitation of passive and active range of motion in the absence of prior surgery, injury, congenital defects and x-ray abnormalities) from the myriad of other potential causes of shoulder stiffness (e.g. birth defects, glenohumeral arthritis, post-surgical stiffness, etc).  See this link. The former is usually very responsive to management because the rest of the joint is normal. The other causes of stiffness may be addressed by arthroscopic releases, but the effectiveness of releasing the capsule may be limited by joint surface, bony, and other pathologies.

Finally, the authors point to the importance of a complete capsular release and complete muscle relaxation so that minimal force is applied when the shoulder is manipulated.

It is nice that the authors credit the contributions of our late partner, Doug Harryman, to the application of arthroscopy to the management of the stiff shoulder. See this link.


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