Arthroscopic management of refractory shoulder stiffness

Abstract

Glenohumeral stiffness is a major cause of shoulder disability and pain. Conventional management strategies often fail to yield consistent or prompt return of comfort and function. Over the past 5 years, we have employed a prospective approach to the evaluation and management of glenohumeral stiffness using arthroscopic release of capsular contractures for the most refractory. This report concerns the first 30 patients who failed at least 6 months (28 month mean) of nonoperative management for unilateral refractory shoulder stiffness and who were managed by arthroscopic capsular release. Fourteen patients were diabetic. Follow-up averaged 33 months (range 12 to 56 months). Each patients' motion and strength was documented according to the American Shoulder and Elbow Surgeons standard examination. Functional outcome measures were patient-assessed using the Simple Shoulder test before and after surgery. Before surgery, active range-of-motion of the affected shoulder average 41% of the opposite asymptomatic side. The day after surgery, motion had improved dramatically to a mean of 78%. An additional 15% of motion was gained after discharge from the hospital. The final motion averaged 93% of the opposite side. All Simple Shoulder Test (SST) parameters and six of nine SF-36 health status scores were improved significantly. Only 6% of patients were able to sleep comfortably on their side and 35% could place 1 lb. on a shelf at shoulder height before surgery. After surgery, 73% were able to sleep comfortably on the affected side and 83% were able to place 1 lb. on a shelf at shoulder height. There were no differences among all outcome measures between diabetic or nondiabetic patients. Three patients developed recurrent refractory stiffness. The only complication was a single axillary neuropraxia which resolved spontaneously. No patient developed instability. Arthroscopic capsular release can be a safe and effective tool in the management of refractory shoulder stiffness.