• 360° release
• Adhesive capsulitis
• Arthroscopic
• Frozen shoulder
• Range of motion
• Shoulder release

• Adhesive capsulitis
• Pharmacopuncture
• Physiotherapy
• Pragmatic trial
• Randomized controlled trial
• Shoulder pain

• 360°
• adhesive capsulitis
• anterior release
• arthroscopy
• frozen shoulder

• Humans
• Range of Motion, Articular
• Bursitis/therapy
• Bursitis/complications
• Shoulder Joint/pathology
• Joint Capsule/pathology
• Shoulder Pain/etiology
• Shoulder Pain/therapy
• Shoulder Pain/pathology
• Treatment Outcome

• Adhesive capsulitis
• Arthroscopic
• Capsular release
• Complications
• Extended
• Frozen shoulder

• Inflammation
• Joint capsule
• Pain
• Shoulder joint

• 27398C0007 NIEHS NIH HHS
• HK20C0007 Ministry of Health and Welfare

Arthroscopic capsular release (ACR) for the treatment of adhesive capsulitis of the shoulder can be performed in either the beach-chair (BC) or lateral decubitus (LD) position.

To determine the clinical outcomes and recurrence rates after ACR in the BC versus LD position.

Systematic review; Level of evidence, 4.

A systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed by searching PubMed, Embase, and the Cochrane Library databases for studies reporting clinical outcomes of patients undergoing ACR in either the BC or LD position. All English-language literature from 1990 through 2017 reporting on clinical outcomes after ACR with a minimum 3-month follow-up were reviewed by 2 independent reviewers. Recurrence rates, range of motion (ROM) results, and patient-reported outcome (PRO) scores were collected. Study methodological quality was evaluated using the modified Coleman Methodology Score (MCMS).

A total of 30 studies (3 level 1 evidence, 2 level 2 evidence, 4 level 3 evidence, 21 level 4 evidence) including 665 shoulders undergoing ACR in the BC position (38.1% male; mean age, 52.0 ± 3.9 years; mean follow-up, 35.4 ± 18.4 months) and 603 shoulders in the LD position (41.8% male; mean age, 53.0 ± 2.3 years; mean follow-up, 37.2 ± 16.8 months) were included. There were no significant differences in overall mean recurrence rates between groups (BC, 2.5%; LD, 2.4%; P = .81) or in any PRO scores between groups (P > .05). There were no significant differences in improvement in ROM between groups, including external rotation at the side (BC, 36.4°; LD, 42.8°; P = .91), forward flexion (BC, 64.4°; LD, 79.3°; P = .73), abduction (BC, 77.8°; LD, 81.5°; P = .82), or internal rotation in 90° of abduction (BC, 40.8°; LD, 45.5°; P = .70). Significantly more patients in the BC group (91.6%) underwent concomitant manipulation than in the LD group (63%) (P < .0001). There were significantly more patients with diabetes in the LD group (22.4%) versus the BC group (9.6%) (P < .0001).

Low rates of recurrent shoulder stiffness and excellent improvements in ROM can be achieved after ACR in either the LD or BC position. Concomitant manipulation under anesthesia is performed more frequently in the BC position compared with the LD position.

• adhesive capsulitis
• arthroscopic
• arthroscopic surgery
• beach-chair position
• capsular release
• lateral decubitus position
• shoulder

To evaluate the effect of timing of arthroscopic release and manipulation under anesthesia for frozen shoulder in patients with diabetes and non-diabetes.

One hundred and twenty-seven patients with frozen shoulder were included in the study. Each patient was assigned to: 1) one of four groups according to the duration from symptom onset to surgery (group A: ≤3 months; group B: 3–6 months; group C: 6–12 months; group D: >12 months), 2) diabetic or nondiabetic group. The outcomes were measured by shoulder range of motion (ROM), Disabilities of the Arm, Shoulder, and Hand (DASH) score, American Shoulder and Elbow Surgeons (ASES) Shoulder score, the period of pain relief, overall duration of disease, and satisfaction.

All the patients got great improvement in shoulder ROM (P < .0001) after arthroscopic surgery, but there was no statistical difference in the pre-operative and post-operative shoulder ROM between the four groups and between diabetic and nondiabetic groups. The overall duration of disease was mean 55.4~68.7 weeks, which demonstrated much shorter disease course compared with nature course.

Improvement were also seen in shoulder ROM at one week to one month, and the period of total pain relief was at a mean time of 3.7 to 3.8 weeks. There were higher ASES Shoulder score in group B than in group C (P = 0.02) and higher DASH score in diabetic group in short term follow-up.

Arthroscopic release provides effective and rapid improvements to shoulder motion and function, unrelated to the timing of surgery, in patients with frozen shoulder. The diabetic patients do not have functional outcomes as good as the nondiabetic patient at short-term follow-up.

• Adult
• Aged
• Arthroscopy
• Bursitis/physiopathology
• Bursitis/surgery
• Diabetes Mellitus/pathology
• Female
• Humans
• Male
• Middle Aged
• Patient Satisfaction
• Postoperative Complications/etiology
• Range of Motion, Articular
• Time Factors
• Treatment Outcome

• Adhesive capsulitis
• Coracohumeral ligament
• Frozen shoulder
• Glenohumeral joint capsule
• Magnetic resonance imaging
• Subcoracoid fat triangle

To compare the clinical outcomes of one-stage and two-stage procedures for the management of patients with rotator cuff tear and concomitant shoulder stiffness.

From December 2013 to June 2016, we recruited 42 consecutive patients with rotator cuff tear and concomitant shoulder stiffness. Twenty-two patients underwent a one-stage procedure, including arthroscopic capsule release and concomitant rotator cuff repair, within 2 weeks of the diagnosis. For the remaining twenty patients, conservative treatment for the recovery of range of motion (ROM) was initially performed before arthroscopic rotator cuff repair. The ROM, visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, and satisfaction rate were assessed preoperatively; 3, 6, 12, and 24 months after surgery; and at final follow-up.

The mean follow-up period was 26.3 months (range, 24–33 months). No significant difference was noted in preoperative demographic data (age, sex, dominant/non-dominant, diabetes mellitus, thyroid disease, and duration of symptoms) between the two groups (P = 0.165, P = 0.580, P = 0.662, P = 0.716, P = 0.231, and P = 0.152, respectively). After treatment, all patients exhibited significant improvement in ROM and functional scores (P = 0.001 and P = 0.001, respectively). At 3 months postoperatively, the two-stage group exhibited significantly improved forward flexion and internal rotation compared with the one-stage group (P = 0.001 and P = 0.038, respectively). No significant difference in ROM was noted between the two groups at 6, 12, 24 months postoperatively and the final follow-up. In addition, no significant differences in VAS, ASES, Constant-Murley score and satisfaction rate were noted between the two groups at final follow-up (P = 0.319, P = 0.529, P = 0.711, and P = 0.085, respectively).

In the treatment of rotator cuff tear with concomitant stiffness, although the recovery of ROM took longer in patients who underwent the one-stage procedure, satisfactory results at final follow-up can be achieved using either the one-stage procedure or two-stage procedure.

Case-control study.

• Arthroscopic surgery
• Capsular release
• Conservative treatment
• Repair
• Rotator cuff
• Stiffness

• Capsulitis
• exercise
• shoulder
• therapeutics
• ultrasonic therapy

• Antibody
• arthrofibrosis
• collagen synthesis
• knee
• large joint
• scar
• shoulder

This study was undertaken to evaluate the outcome of the arthroscopic capsular release for adhesive capsulitis of the shoulder.

This study retrospectively investigated thirty shoulders in 29 patients who presented with recalcitrant adhesive capsulitis and underwent arthroscopic treatments. Other than typical findings of adhesive capsulitis, combined pathologies in the glenohumeral joint and subacromial space were evaluated by arthroscopy. Clinical evaluations were performed using the Constant’s score and ranges of motion (ROM) at preoperative, 6 months postoperatively and at the final follow-up.

Our study included 17 women and 12 men with a mean age of 53.8 years (range, 34–74). Mean follow-up duration was 24 months (range, 12–40 months). Assessment of combined pathologies revealed that partial rotator cuff tear of less than 25% thickness, was most common (overall 83.3%; with bursal 57% and articular 23%). Subacromial synovitis and adhesion were also frequent (53.3%). The Constant score and ranges of motion significantly improved at the final follow-up, compared with preoperative levels. However, clinical results at 6 months postoperatively were found to be significantly inferior to those observed at the final follow-up (p≤0.001 for all factors). Functional impairment was the major complaint in 59.3% patients at the 6 months follow-up.

Although arthroscopic capsular release yielded favorable outcome at the mean 24 months follow-up, pain and motion limitations at 6-month postoperatively persisted in more than 50% of our patients. While combined pathologies were commonly encountered during arthroscopy, although their effects on surgical outcome in adhesive capsulitis remains unclear in this study.

• Adhesive capsulitis
• Arthroscopy
• Capsular release
• Shoulder

• Rotator cuff tear
• arthroscopy
• manipulation release
• rotator cuff repair
• shoulder stiffness

• Frozen shoulder
• Neuroticism
• SHC
• SPADI
• Shoulder capsulitis
• Shoulder pain and disability index
• Subjective health complaints

• Adhesive capsulitis
• Avaliação de desfecho
• Bloqueio de nervo
• Capsulite adesiva
• Nerve block
• Ombro
• Outcome assessment
• Qualidade de vida
• Quality of life
• Shoulder

To compare the results of arthroscopic capsular release with intra-articular steroid injections in patients of frozen shoulder.

Fifty-six patients with frozen shoulder were randomised to one of two treatment groups: Group 1, complete 360 degree arthroscopic capsular release and group 2, intra-articular corticosteroid injection (40 mg methyl prednisolone acetate). Both groups were put on active and passive range of motion exercises following the intervention. The outcome parameters were visual analogue scale (VAS) score for pain, range of motion and Constant score which were measured at baseline, 4, 8, 12, 16 and 20 wk after intervention.

All the parameters improved in both the groups. The mean VAS score improved significantly more in the group 1 as compared to group 2 at 8 wk. This greater improvement was maintained at 20 wk with P value of 0.007 at 8 wk, 0.006 at 12 wk, 0.006 at 16 wk and 0.019 at 20 wk. The Constant score showed a more significant improvement in group 1 compared to group 2 at 4 wk, which was again maintained at 20 wk with P value of 0.01 at 4, 8, 12 and 16 wk. The gain in abduction movement was statistically significantly more in arthroscopy group with P value of 0.001 at 4, 8, 12, 16 wk and 0.005 at 20 wk. The gain in external rotation was statistically significantly more in arthroscopy group with P value of 0.007 at 4 wk, 0.001 at 8, 12, and 16 wk and 0.003 at 20 wk. There was no statistically significant difference in extension and internal rotation between the two groups at any time.

Arthroscopic capsular release provides subjective and objective improvement earlier than intra-articular steroid injection.

• Adhesive capsulitis
• Frozen shoulder
• Capsular release
• Corticosteroid
• Idiopathic stiff shoulder
• Intra articular injection
• Steroid injection
• Arthroscopic arthrolysis
• Constant score

• adhesive capsulitis
• arthrofibrosis
• frozen shoulder
• shoulder capsulitis
• shoulder pain
• shoulder stiffness

Adhesive capsulitis of the shoulder (ACS) is a common self-limiting condition characterized by disabling pain and restricted movements. Its pathophysiology is poorly understood, clinically it is characterized by stages of pain and stiffness, and finally often patients never recover fully. However, there is no consensus about available methods of treatment for ACS. The aims of this paper are to discuss and develop issues regarding approaches to management in ACS in the stages of it.

A review of the literature was performed and guidelines for the treatment of that clinical entity for doctors and health care professionals are provided.

Anti-inflammatory medications, steroid and/or hyaluronate injections and physiotherapy is the mainstay of conservative management either alone in the first stages or in combination with other treatment modalities in the later stages. Next line of treatment, involving minor to moderate intervention, includes suprascapular nerve block, distension arthrography and manipulation under anaesthesia. In order to avoid complications of “blind intervention”, arthroscopic capsular release is gradually more commonly applied, and in recalcitrant severe cases open release is a useful option.

Various modalities of conservative management and gradually more surgical release are applied. However, often clinicians choose on personal experience and training rather than on published evidence.

• Adhesive capsulitis
• Shoulder
• Treatment

• Arthroscopy
• Bursitis
• Shoulder pain

Of all the most frequent soft tissue disorders of the shoulder, idiopathic frozen shoulder (IFS) offers the greatest potential for studying proprioception. Studies concerning the presence of proprioception dysfunctions have failed to determine the potential for spontaneous healing of passive shoulder stabilizers (anterior and posterior capsule, middle and inferior gleno-humeral ligaments), its relationship with passive (PJPS) and active (AJPS) shoulder proprioception for internal and external rotation (IR, ER), as well as the isokinetic muscle performance of the internal and external rotators. This study investigates these dependencies in the case of arthroscopic release of IFS.

The study group comprised 23 patients (average aged 54.2) who underwent arthroscopic release due to IFS and 20 healthy volunteers. The average follow-up time was 29.2 months. The Biodex system was used for proprioception measurement in a modified neutral arm position and isokinetic evaluation. The results were analysed using the T-test, Wilcoxon and interclass correlation coefficient. P-values lower than 0.05 were considered significant.

Statistically significant differences were found between involved (I) and uninvolved (U) shoulders only in the cases of PJPS and AJPS, peak torque, time to peak torque and acceleration time for ER (p < 0.05). No statistically significant difference was noted between PJPS IR and PJPS ER or between AJPS IR and AJPS ER (p > 0.05) for the U shoulders.

The anatomical structure of anterior (capsule, middle and anterior band of inferior gleno-humeral ligament) and posterior (capsule and posterior band of inferior gleno-humeral ligament) passive shoulder restraints has no impact on the difference in PJPS values between ER and IR in a modified neutral shoulder position. The potential for spontaneous healing of the anterior and posterior passive shoulder restraints influences PJPS recovery after arthroscopic release of IFS. ER peak torque deficits negatively affect AJPS values. PJPS and AJPS of ER and IR can be measured with a high level of reproducibility using an isokinetic dynamometer with the arm in a modified neutral shoulder position. Differences greater than 15 % for PJPS and >24 % for AJPS for ER and IR can be helpful for future studies as baseline data for identification of particular passive and active shoulder stabilizers at risk.

• Frozen shoulder
• Isokinetics
• Passive stabilizers
• Proprioception

• adhesive capsulitis
• corticosteroids
• frozen shoulder
• intra-articular injections

Frozen shoulder is a common disease which causes significant morbidity. Despite over a hundred years of treating this condition the definition, diagnosis, pathology and most efficacious treatments are still largely unclear. This systematic review of current treatments for frozen shoulder reviews the evidence base behind physiotherapy, both oral and intra articular steroid, hydrodilatation, manipulation under anaesthesia and arthroscopic capsular release. Key areas in which future research could be directed are identified, in particular with regard to the increasing role of arthroscopic capsular release as a treatment.

• Frozen shoulder
• Adhesive capsulitis
• Bursitis
• Shoulder
• Arthroscopic capsular release
• Arthrographic distension
• Physiotherapy
• Steroid
• Hydrodilatation

• Arthroscopy
• Bursitis
• Joint capsule release
• Range of motion, articular
• Shoulder pain

• Adult
• Aged
• Arthroscopy
• Bursitis/diagnostic imaging
• Bursitis/physiopathology
• Bursitis/surgery
• Female
• Humans
• Joint Capsule/diagnostic imaging
• Joint Capsule/physiopathology
• Joint Capsule/surgery
• Joint Capsule Release
• Male
• Middle Aged
• Muscle Strength
• Muscle Strength Dynamometer
• Radiography
• Range of Motion, Articular
• Shoulder/diagnostic imaging
• Shoulder/physiopathology
• Shoulder/surgery
• Young Adult

• arthroscopic capsular release
• shoulder
• stiffness

• frozen shoulder
• adhesive capsulitis
• oxford shoulder score
• range of movement

• Adult
• Aged
• Anesthetics, Local/administration & dosage
• Arthroscopy/methods
• Bupivacaine/administration & dosage
• Bursitis/physiopathology
• Bursitis/therapy
• Electrocoagulation/methods
• Exercise Therapy/methods
• Female
• Humans
• Injections, Intra-Articular
• Joint Capsule Release/methods
• Male
• Manipulation, Orthopedic/methods
• Methylprednisolone/administration & dosage
• Middle Aged
• Pain, Postoperative/physiopathology
• Pain, Postoperative/prevention & control
• Paresthesia/etiology
• Prospective Studies
• Range of Motion, Articular/physiology
• Recovery of Function
• Shoulder Pain/physiopathology
• Shoulder Pain/prevention & control
• Treatment Outcome

• Frozen shoulder syndrome
• Isometric endurance
• Isometric working capacity
• Rehabilitation

• Shoulder
• Systematic Review
• adhesive capsulitis
• arthroscopy
• capsular release
• frozen shoulder
• manipulation under anesthesia
• systematic review

• Adult
• Aged
• Arthroscopy/methods
• Bursitis/pathology
• Bursitis/therapy
• Female
• Glucocorticoids/therapeutic use
• Humans
• Injections, Intra-Articular
• Joint Capsule/drug effects
• Joint Capsule/pathology
• Joint Capsule/surgery
• Male
• Manipulation, Orthopedic/methods
• Methylprednisolone/analogs & derivatives
• Methylprednisolone/therapeutic use
• Methylprednisolone Acetate
• Middle Aged
• Patient Satisfaction
• Prospective Studies
• Range of Motion, Articular
• Shoulder Joint/drug effects
• Shoulder Joint/pathology
• Shoulder Joint/surgery
• Shoulder Pain