Restore shoulder range of motion (ROM) in a stiff or frozen shoulder secondary to capsule inflammation and fibrosis, termed adhesive capsulitis.

Minimally invasive procedure.

Relatively short recovery time.

Faster return to full activity.

Shorter operative time than an open procedure.

Can be performed under regional anesthesia.

Failure to improve with nonoperative treatment of at least 6 months. Nonoperative treatment can vary but includes the following:

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  Physical therapy to improve ROM.

  
  
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  Nonsteroidal anti-inflammatory drug (NSAID) medications.

  
  
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  Intra-articular corticosteroid injections for pain relief and to allow release of adhesions with therapy and home stretching.

Idiopathic adhesive capsulitis is most common in women between the ages of 40 and 60 years:

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  This generally presents with a gradual onset and no predisposing factor.

Risk factors for adhesive capsulitis include diabetes mellitus, thyroid conditions, cardiac disease, Parkinson’s disease, Peyronie’s disease, Dupuytren’s contracture, cardiac disease, and pulmonary disease:

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  Three to six times higher incidence in diabetic patients.

Secondary adhesive capsulitis may occur after previous shoulder trauma or surgery.

Motion loss with shoulder prosthesis.

Myositis ossificans.

Clinical evaluation:

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  Important to obtain complete injury history including onset and duration of symptoms and prior shoulder trauma, surgery, or period of immobilization:

  
  
  
  
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    Three clinical phases of adhesive capsulitis:

    
    
    
    
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      i. Freezing or painful stage:

      
      
      
      
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         Pain at night and with shoulder ROM.

         
         
      2. 
         

         Duration of 6 weeks to 9 months.

      
      
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      ii. Frozen phase:

      
      
      
      
      1. 
         

         The loss of global shoulder ROM.

      
      
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      iii. Thawing phase:

      
      
      
      
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         Return of shoulder ROM toward normal.

         
         
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         At least 10% of patients have incomplete recovery without surgical intervention.

    
    
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    Equal loss of passive and active ROM.

    
    
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    Passive ROM evaluation:

    
    
    
    
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      i. Certain physical examination findings may correlate with contractures in specific areas of the capsule:

      
      
      
      
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         Loss of external rotation (ER) in adduction → anterosuperior capsule.

         
         
      2. 
         

         Loss of ER in abduction → anteroinferior capsule.

         
         
      3. 
         

         Loss of internal rotation (IR) → posterior capsule.

         
         
      4. 
         

         Loss of flexion and abduction → inferior capsule.

  
  
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  Adhesive capsulitis is a clinical diagnosis. Imaging is obtained to rule out other diagnoses.

  
  
  
  
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    Routine shoulder radiographs include anteroposterior, scapular Y, and axillary lateral shoulder view. Typical finding may include the following:

    
    
    
    
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      i. Normal shoulder anatomy.

      
      
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      ii. Calcific tendinitis.

    
    
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    MRI:

    
    
    
    
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      i. Coracohumeral ligament and joint capsule thickening at the rotator cuff interval.

      
      
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      ii. Rule out rotator cuff pathology.

  
  
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  If not contraindicated, we prefer regional anesthesia for muscle paralysis and immediate postoperative pain control.

Arthroscopy can be performed with the patient in either beach-chair or lateral decubitus position. For this procedure, we prefer the patient in the beach-chair position ( Fig. 3.1 ).

A hydraulic arm positioner is used to maintain arm position throughout the procedure ( Fig. 3.1 ).

All bony prominences are well padded.

An examination under anesthesia is performed to evaluate shoulder ROM before incision.