Background: Arthroscopic capsular release is
used to treat idiopathic adhesive capsulitis (frozen shoulder) that
is refractory to nonoperative treatment or manipulation under anesthesia.
The role of arthroscopic capsular release in the treatment of frozen
shoulder after shoulder surgery or fracture is less clearly understood.
The purposes of this study were to define the outcome of arthroscopic
capsular release in the management of frozen shoulder after surgery
or fracture and to compare these results with those of arthroscopic
capsular release in the treatment of idiopathic frozen shoulder.
Methods: We evaluated the results of arthroscopic
capsular release in three different groups of patients with shoulder
contracture refractory to nonoperative management and manipulation under
anesthesia. The three groups consisted of patients who had an idiopathic
frozen shoulder, shoulder stiffness after surgery, or shoulder stiffness
after fracture. We evaluated pain, function, patient satisfaction,
and range of motion in all three groups before and after the study
Results: At a mean of twenty months (range, twelve
to forty-six months) after the operation, fifty patients were available
for assessment of function and range of motion of the involved shoulder.
At the time of follow-up, each group had a significant improvement
in the scores for pain, patient satisfaction, and functional activity
as well as in the overall outcome score (p < 0.01). Comparison
of the scores among the different groups revealed that all had a
similar degree of improvement in range of motion of the involved
shoulder, but patients with postoperative frozen shoulder had significantly
(p < 0.05) lower scores for pain (p < 0.03), patient
satisfaction (p < 0.004), and functional activity (p < 0.002)
than did those with idiopathic or post-fracture frozen shoulder.
Conclusions: Arthroscopic capsular release was as
effective for improving range of motion in patients with postoperative
contracture of the shoulder as it was in patients with idiopathic
and post-fracture contracture. However, there was less improvement
in the subjective scores for pain, function, and patient satisfaction
in the postoperative group.