Introduction
Bony or soft tissue trauma to the shoulder can lead to a degree of posttraumatic stiffness or pain. The stiffness is due to a combination of capsular contracture and extracapsular adhesions. The initial management is usually conservative. When it fails, treatment that is more aggressive should be done.
Objectives
To evaluate the effectiveness of arthroscopic capsular release and subacromial decompression for treatment of refractory posttraumatic frozen shoulder.
Patients and methods
The study included 22 patients, with mean age of 43.5±12.2 years. A total of 12 patients had fracture proximal humeral end, three patients had mid-shaft fracture, and seven patients had shoulder soft tissue injury. Patients underwent arthroscopic circumferential capsular and subacromial release under general anesthesia, without violation of the subscapularis tendon or the labrum
Results
Collective visual analog pain scores (at rest, with normal activities, with strenuous activities) showed progressive highly statistically significant decrease throughout the follow-up period from 18.8±2.6 preoperatively to 4±1.6 6 months postoperatively (=0.0001). The mean modified American shoulder and elbow surgeon scores improved from 45.5 preoperatively to 59.3 postoperatively. Forward flexion improved from 93° preoperatively to 140° postoperatively. Adduction-external rotation improved from 26.9 preoperatively to 42.2° postoperatively. Abduction external rotation improved from 24.8° preoperatively to 47° postoperatively.
Conclusion
Arthroscopic capsular release and subacromial decompression is an effective method in the treatment of refractory posttraumatic frozen shoulder, alleviating pain and restoring a functional range of motion to the shoulder.