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The Journal of Bone and Joint Surgery, Vol 71, Issue 10 1511-1515, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
Recalcitrant chronic adhesive capsulitis of the shoulder. Role of contracture of the coracohumeral ligament and rotator interval in pathogenesis and treatment
J Ozaki, Y Nakagawa, G Sakurai and S Tamai
Department of Orthopaedic Surgery, Nara Medical University Hospital, Japan.
Seventeen patients who had recalcitrant chronic adhesive capsulitis were
operated on between 1979 and 1986 and were followed for an average of 6.8
years. At operation, the major cause of the restricted glenohumeral
movement was found to be contracture of the coracohumeral ligament and
rotator interval. Release of the contracted structures relieved pain and
restored motion of the shoulder in all patients. Histological study showed
fibrosis, hyalinization, and fibrinoid degeneration in the contracted
connective tissues, as well as fibrosis of the subsynovial tissue and an
absence of the synovial cell layer on the joint side of the rotator
interval. The contracture of the coracohumeral ligament and rotator
interval appears to be the main lesion in chronic adhesive capsulitis.
Resection of these structures, combined with appropriate exercise, will
relieve pain and restore motion to the shoulder.
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