Lijkele Beimers1, George A C Murrell1. 1. Orthopaedic Research Institute, St George Hospital, Level 2, 4-10 South Street, Kogarah NSW 2217, Australia. E-mail address for L. Beimers: orthopeed@gmail.com. E-mail address for G.A.C. Murrell: murrell.g@ori.org.au.
Abstract
INTRODUCTION: Our technique of arthroscopic capsular release involving two posterior portals and one anterior portal, to accomplish a complete 360° release, improves motion and reduces pain in patients with idiopathic adhesive capsulitis. STEP 1 POSITION THE PATIENT: Place the patient in a beach-chair position for shoulder joint arthroscopy. STEP 2 ESTABLISH A ROUTINE POSTERIOR GLENOHUMERAL JOINT ARTHROSCOPY PORTAL: Use a routine posterior glenohumeral arthroscopy portal to introduce the arthroscope. STEP 3 ESTABLISH AN ANTERIOR PORTAL: Establish the anterior portal under direct vision using a spinal needle. STEP 4 RELEASE THE ROTATOR CUFF INTERVAL AND SUBSCAPULARIS TENDON: Release the rotator cuff interval, dividing no more than the upper half of the intra-articular subscapularis tendon. STEP 5 RELEASE THE ANTERIOR-INFERIOR ASPECT OF THE CAPSULE: Cut the anterior-inferior aspect of the capsule completely. STEP 6 ESTABLISH A POSTERIOR-INFERIOR PORTAL: Determine the location of the posterior-inferior portal with a spinal needle. STEP 7 RELEASE THE POSTERIOR-INFERIOR ASPECT OF THE CAPSULE: Release or perforate the posterior-inferior capsule of the joint with the arthroscopic wand. STEP 8 GENTLY MANIPULATE THE ARM: Manipulate the arm in abduction, then forward and backward flexion, and then external and internal rotation. RESULTS: An arthroscopic capsular release with use of the technique described here was performed in forty-nine shoulders in forty-three patients with idiopathic adhesive capsulitis4. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: Our technique of arthroscopic capsular release involving two posterior portals and one anterior portal, to accomplish a complete 360° release, improves motion and reduces pain in patients with idiopathic adhesive capsulitis. STEP 1 POSITION THE PATIENT: Place the patient in a beach-chair position for shoulder joint arthroscopy. STEP 2 ESTABLISH A ROUTINE POSTERIOR GLENOHUMERAL JOINT ARTHROSCOPY PORTAL: Use a routine posterior glenohumeral arthroscopy portal to introduce the arthroscope. STEP 3 ESTABLISH AN ANTERIOR PORTAL: Establish the anterior portal under direct vision using a spinal needle. STEP 4 RELEASE THE ROTATOR CUFF INTERVAL AND SUBSCAPULARIS TENDON: Release the rotator cuff interval, dividing no more than the upper half of the intra-articular subscapularis tendon. STEP 5 RELEASE THE ANTERIOR-INFERIOR ASPECT OF THE CAPSULE: Cut the anterior-inferior aspect of the capsule completely. STEP 6 ESTABLISH A POSTERIOR-INFERIOR PORTAL: Determine the location of the posterior-inferior portal with a spinal needle. STEP 7 RELEASE THE POSTERIOR-INFERIOR ASPECT OF THE CAPSULE: Release or perforate the posterior-inferior capsule of the joint with the arthroscopic wand. STEP 8 GENTLY MANIPULATE THE ARM: Manipulate the arm in abduction, then forward and backward flexion, and then external and internal rotation. RESULTS: An arthroscopic capsular release with use of the technique described here was performed in forty-nine shoulders in forty-three patients with idiopathic adhesive capsulitis4. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.