Percutaneous Capsule Release in Adhesive Capsulitis with Nanoscope under Local Anesthesia - Case Report

Introduction

Adhesive capsulitis or frozen shoulder is a painful condition. With advent of newer and newer technology, minimally invasive surgeries are being tried in all kinds of surgeries. Nanoscope is one such invention that lead to the idea of percutaneous arthroscopy. The aim of this case report is to emphasize the role of nanoscope under local anesthesia in treatment of adhesive capsulitis.

Case Report

A 45-year-old male presented with a history of restricted movements in the right shoulder for 1 year. On clinical examination, rotator cuff strength was under normal limits, his forward elevation was 100°, lateral elavation was 90°, external rotation - 45°, abduction external rotation 30°, and abduction internal rotation 40°. X-ray shoulder was normal. MRI shoulder was showing features of adhesive capsulitis.

Conclusion

Percutaneous arthroscopic capsular release with nanoscope under local anesthesia is a safe and cost-effective procedure. With minimal infrastructure, it can be developed into an outpatient procedure. The advantages of this percutaneous technique over conventional arthroscopic release needs further studies.

Arthroscopic Anterior Capsule Reconstruction Using Fascia Lata Autograft and Knotless Fibretak: A Case Report

Introduction

Shoulder has multidirectional mobility with capsule and rotator cuff as stabilizers. Irreparable subscapularis tears are relatively uncommon. Anterior capsule reconstruction (ACR) is one of the different modalities of treatment for irreparable subscapularis tears. Anterior capsular reconstruction can be performed using hamstring autograft, tibialis anterior allograft, and human dermal allograft. Procedures using hamstring autograft and tibialis anterior allograft reported severe capsular deficiency, recurrent dislocation, and subluxations. Dermal allograft is routinely used for ACR anterior capsule reconstruction. But However, there are no reports of Fascia lata autograft being used for ACR anterior capsule reconstruction. As fascia lata is an autograft, it may have a better chance of healing than dermal allograft.

Case Report

A 60-year year-old male patient came with history of slip and fall at home 3 months ago and injured his left shoulder. Magnetic resonance imaging MRI is showing subscapularis tear retracted medial to glenoid and anterior supraspinatus tear with minimal retraction. The aim of this case report is to describe in detail the arthroscopic technique of ACR anterior capsule reconstruction using fascia lata autograft using the new knotless all suture anchors (fibereTak) on glenoid.

Conclusion

Fascia lata being an autograft may have better healing potential, but its superiority over dermal allografts in the setting of ACR anterior capsule reconstruction needs further studies.

Three Dimensional Anthropometric Analysis of Glenoid Anatomy in Normal Indian Population

BACKGROUND

Shoulder unlike any other joint has a wide range of mobility and is important in day to day activities. Different ethnic groups vary in skeletal anatomy and anthropometry. Most of our knowledge on the shoulder-anatomy, surgical technique and prosthesis designs is based on western literature. There are few studies on the Indian population. Our aim is to study the anthropometry of glenoid based on 3D CT scan of the shoulder. Our objectives are to calculate glenoid height, width, version, inclination, analyse the data for differences between male and female, compare data with similar studies in India and other countries and study the impact on shoulder arthroplasty implant size.

MATERIALS AND METHODS

100 CT scans (male/female-50/50) of the Indian population are studied from our database. Glenoid measurements are calculated and analyzed.

RESULTS

The mean value of glenoid height is 32.9 ± 3.2 mm (27.6-41.7 mm), width 23.4 ± 2.62 mm (19.1-30.9 mm), version 0.07 ± 5.38° (- 11° to + 10.85°) and inclination 6.68 ± 5.49° (- 9.91° to + 20.75°). In our study glenoid is retroverted, superiorly inclined and height is more than width. The height and width are less than French and Americans but slightly more than the Japanese population.

CONCLUSION

There are significant differences in Indian glenoid measurements compared to other countries. Even the smallest size of shoulder arthroplasty glenoid component currently available in India is larger than the mean glenoid size of our study. As shoulder replacement surgeries are rising in India, we may have to bring changes in the implant design and surgical technique to suit our population.