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The Journal of Bone and Joint Surgery (American) 83:1682-1687 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Arthroscopic Capsular Release for the Treatment of Refractory Postoperative or Post-Fracture Shoulder Stiffness

G. Brian Holloway, MD, Thomas Schenk, MD, Gerald R. Williams, MD, Matthew L. Ramsey, MD and Joseph P. Iannotti, MD, PhD

Investigation performed at the Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

G. Brian Holloway, MD
Thomas Schenk, MD
Gerald R. Williams, MD
Matthew L. Ramsey, MD
Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104

Joseph P. Iannotti, MD, PhD
Department of Orthopaedic Surgery, The Cleveland Clinic Foun- dation, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail address: iannotj{at}ccf.org

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: Arthroscopic capsular release is used to treat idiopathic adhesive capsulitis (frozen shoulder) that is refractory to nonoperative treatment or manipulation under anesthesia. The role of arthroscopic capsular release in the treatment of frozen shoulder after shoulder surgery or fracture is less clearly understood. The purposes of this study were to define the outcome of arthroscopic capsular release in the management of frozen shoulder after surgery or fracture and to compare these results with those of arthroscopic capsular release in the treatment of idiopathic frozen shoulder.

Methods: We evaluated the results of arthroscopic capsular release in three different groups of patients with shoulder contracture refractory to nonoperative management and manipulation under anesthesia. The three groups consisted of patients who had an idiopathic frozen shoulder, shoulder stiffness after surgery, or shoulder stiffness after fracture. We evaluated pain, function, patient satisfaction, and range of motion in all three groups before and after the study treatment.

Results: At a mean of twenty months (range, twelve to forty-six months) after the operation, fifty patients were available for assessment of function and range of motion of the involved shoulder. At the time of follow-up, each group had a significant improvement in the scores for pain, patient satisfaction, and functional activity as well as in the overall outcome score (p < 0.01). Comparison of the scores among the different groups revealed that all had a similar degree of improvement in range of motion of the involved shoulder, but patients with postoperative frozen shoulder had significantly (p < 0.05) lower scores for pain (p < 0.03), patient satisfaction (p < 0.004), and functional activity (p < 0.002) than did those with idiopathic or post-fracture frozen shoulder.

Conclusions: Arthroscopic capsular release was as effective for improving range of motion in patients with postoperative contracture of the shoulder as it was in patients with idiopathic and post-fracture contracture. However, there was less improvement in the subjective scores for pain, function, and patient satisfaction in the postoperative group.


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