Clinical outcomes of arthroscopic pan-capsular release with or without entire coracohumeral ligament release for patients with frozen shoulder

The Effect of Arthroscopic Extra-Articular Entire Coracohumeral Ligament Release for Patients with Recalcitrant Frozen Shoulder

OBJECTIVE

The thickened coracohumeral ligament (CHL) is an important part of the typical manifestations and magnetic resonance imaging of frozen shoulder. However, only a few clinical studies with limited cases on arthroscopic extra-articular entire CHL release exist in the literature. This study was to evaluate the effect of arthroscopic extra-articular entire CHL release for patients with recalcitrant frozen shoulder.

METHODS

From February 2014 to February 2020, 81 cases of recalcitrant frozen shoulder patients treated with surgery in a single-center shoulder department and followed for more than 2 years were analyzed. Arthroscopic 360° capsular release was performed with intra-articular partial release (IPR group) or additional extra-articular entire release (IPR + EER group) of CHL. The same rehabilitation program was performed after surgery in both groups. Visual analogue scale (VAS) for pain, range of motion (ROM), and the Constant-Murley scoring system was evaluated before operation, at 3 months after operation, 6 months after operation, and the final follow-up. T-test, Mann-Whitney U-test and chi-squared test were used to compared data.

RESULTS

There were 39 patients in the IPR group, with an average follow-up of 29.2 months. A total of Forty-two patients in the IPR + EER group completed a mean follow-up of 25.7 months. All incisions healed in stages. There were significant differences in Constant-Murley shoulder score, VAS score, and ROM before operation and at the final follow-up in both groups (both P < 0.001). The VAS score of the IPR + EER group was lower than that of the IPR group at 3 months after surgery (P < 0.05), and 6 months after operation (P < 0.05). External rotation, internal rotation, and abduction of ROMs and Constant-Murley shoulder score were significantly greater in the IPR + EER group at 3 months (P < 0.001, P < 0.05, P < 0.001, P < 0.05, respectively) and 6 months after operation (P < 0.001, P < 0.05, P < 0.001, P < 0.05, respectively). At the last follow-up, there was no significant difference in forward flexion, internal rotation, and abduction of ROMs, VAS, and the Constant-Murley shoulder score between the IPR and IPR + EER groups. The external rotation of the IPR + EER group was still greater than that of the IPR group at the last follow-up (P < 0.001).

CONCLUSION

Arthroscopic extra-articular entire coracohumeral ligament release could solve early pain of shoulder joint, recover shoulder joint functions effectively, and achieve a satisfactory efficacy in the treatment of recalcitrant frozen shoulder.

Preemptive middle glenohumeral ligament release in arthroscopic rotator cuff repair does not reduce the postoperative stiffness: a retrospective comparative study

BACKGROUND

This study aimed to evaluate the efficacy of preemptive middle glenohumeral ligament (MGHL) release in arthroscopic rotator cuff repair (ARCR) to reduce postoperative stiffness.

METHODS

Patients who underwent ARCR were enrolled and allocated into two groups retrospectively: the preemptive MGHL release group (n = 44) and the preemptive MGHL non-release group (n = 42). Clinical outcomes were assessed and compared between the two groups, including the range of motion, Japanese Orthopedic Association Shoulder Score, Constant Shoulder Score, and the University of California, Los Angeles Score preoperatively and 3 months, 6 months, and 12 months postoperatively and complications. The integrity of the repaired tendon was assessed at the 12-month follow-up using magnetic resonance imaging.

RESULTS

There were no significant differences between the groups in all range of motion and all functional scores at any of the assessed time points. There was also no significant difference in the healing failure rate 2.3% in the preemptive MGHL group and 2.4% in the preemptive MGHL non-release group (p = .97), and postoperative stiffness was 2.3% in the preemptive MGHL group and 7.1% in the preemptive MGHL non-release group (p = .28). There was no postoperative instability in both group.

CONCLUSION

ARCR effectively facilitates the recovery of range of motion and function in patients with a rotator cuff tear. However, preemptive MGHL release could not be an effective method to reduce postoperative stiffness.

Evaluation of muscle stiffness in adhesive capsulitis with Myoton PRO

Background

Adhesive capsulitis (AC) is characterized by pain and limited range of motion, caused by stiffness of the joint capsule and coracohumeral ligament. On the other hand, there have been few reports on muscle stiffness in AC. The purpose of this study was to assess muscle stiffness in patients of AC with a portable and noninvasive device, Myoton PRO. We hypothesized that muscle stiffness around shoulder joint increases in AC.

Methods

At first, we surveyed correlation between Myoton PRO and shear wave elastography with phantoms. Second, reproducibility and repeatability of healthy volunteers with Myoton PRO were evaluated. Finally, muscle stiffness was measured in 40 patients who were diagnosed with AC. Muscle stiffness was quantitatively measured with Myoton PRO. We compared the stiffness of the anterior deltoid (AD), pectoralis major, and latissimus dorsi (LD) in AC patients on both the affected and nonaffected sides.

Results

Correlation coefficient in shear wave elastography and Myoton PRO was 0.99(P = .001). Reliability of intraoperator and interoperator with Myoton PRO was 0.9 or higher. Muscle stiffness values (N/m) of the AD, pectoralis major, and LD were 355 ± 61, 252 ± 54, 207 ± 51 in the affected sides and 328 ± 50, 252 ± 41, 186 ± 37 in the nonaffected sides, and the differences were significant in the AD and LD (P = .005, P = .002, respectively).

Conclusions

We used Myoton PRO to evaluate muscle stiffness in AC. The AD and LD muscles of AC patients were significantly stiffer on the affected side compared to the nonaffected side.

Contracted joint capsule affects labral and chondral lesions in patients with frozen shoulder

PURPOSE

Intra-articular pathologies, such as labral and chondral lesions, are common in patients with frozen shoulder. This study evaluated the correlations between the range of motion and labral and chondral lesions in patients with frozen shoulder and investigated their pathophysiologies.

METHODS

In total, 125 individuals (53 men and 72 women) who underwent arthroscopic pan-capsular release between 2014 and 2020 were included in the study. The range of motion was measured using scapular fixation and true glenohumeral motion under general anaesthesia. The American Shoulder and Elbow Surgeons Shoulder score and the Shoulder Rating Scale score of the University of California, Los Angeles were used to compare intra-articular pathologies.

RESULTS

More than 80% of patients with frozen shoulder had labral pathologies, and nearly half of them had chondral pathologies. Labral lesions extending to the anterior rim of the glenoid had a greater range of motion and the greatest total American Shoulder and Elbow Surgeons Shoulder score. More severe chondral lesions had a lesser range of motion, but presented the greatest function scores and the lowest strength scores according to the Shoulder Rating Scale of the University of California, Los Angeles. The pain scores of the American Shoulder and Elbow Surgeons Shoulder score and the Shoulder Rating Scale of the University of California, Los Angeles were not correlated with the degree of these pathologies. The traction force affected the labrum during true range of motion, and the compression force occurred on the articular cartilage during internal rotation at 90° of forward flexion during diagnostic arthroscopy.

CONCLUSION

Labral and chondral lesions are common in patients with frozen shoulder. Adherence to the capsulolabral complex induced a limited range of motion and labral and chondral pathologies. Diagnostic arthroscopy with motion is an important method of reproducing the pathogenesis of intra-articular structures for patients with frozen shoulder.

LEVEL OF EVIDENCE

Level III.