Arthroscopic Release of Frozen Shoulder: Don't Shrug It Off
Stiff or "frozen" shoulders usually get better with physical therapy. Those that don't may undergo "manipulation under anesthesia." Doctors stretch the shoulder joint until it releases while the patient is asleep. What if this doesn't work? In the past, patients who didn't improve with manipulation either lived with their symptoms or had open surgery to release the tight tissues around the shoulder joint.
Now there's a new option. Doctors can release the stiff shoulder using an arthroscope, a tool that works like a TV camera under the skin. This procedure is less invasive than open surgery. It's been shown to improve movement and reduce pain in some shoulders.
Shoulder stiffness can come after surgery, such as rotator cuff repair. It can also follow fractures. Sometimes it has no known cause at all. Does the cause of stiffness affect whether the arthroscopic treatment works? Is it harder to "loosen" a shoulder after surgery or fracture?
To find out, these authors treated three groups of patients. Thirty-three patients had shoulder stiffness from surgery. Six patients had stiffness from fractures. Eleven had stiff shoulders without any known cause. Manipulation failed to restore at least 80 percent of shoulder movement in these patients, so the arthroscopic treatment was tried. Patients started a home exercise program (one hour a day) right after surgery. They were also encouraged to use the treated arm in everyday activities.
Patients were examined about two years after treatment. There were no complications from surgery. Four of the patients who'd had prior surgery still had stiffness. These patients went on to have open surgery on their shoulders. Overall, patients had good results from the arthroscopic procedure. They had more movement in their shoulders at follow-up. They also had less pain and more function. And they felt more satisfied with their treatment.
Patients who'd had surgery before didn't get quite the same benefit as the other groups. At follow-up, they had more pain, less function, and less satisfaction than the other groups. They also tended to have slightly less movement in their shoulders. These differences weren't related to the formation of scar tissue after previous surgery.
The authors feel that arthroscopic release is a reliable way to restore shoulder movement when physical therapy and manipulation have failed. Patients whose shoulder stiffness comes from surgery benefit from this treatment. However, their gains may be less than those of other patients. This is probably due to the lasting effects of the initial injury and surgery.
G. Brian Holloway, MD, et al. Arthroscopic Capsular Release for the Treatment of Refractory Postoperative or Post-Fracture Shoulder Stiffness. In The Journal of Bone & Joint Surgery. November 2001. Vol. 83-A. No. 11. Pp. 1682-1687.