title: Arthroscopic capsular release for stiff shoulders: effect of etiology on outcomes.
abstract: OBJECTIVE
  The etiology, pathogenesis, time course, and response to treatment of stiff shoulder pathology is still under investigation and debate. This prospective study evaluated arthroscopic capsular release to treat stiff shoulder pathology that was resistant to conservative management. The etiology of the shoulder stiffness was categorized and analyzed for effect on outcomes.
  
  
  METHODS
  Operative technique and prospective evaluation.
  
  
  METHODS
  In 68 stiff shoulders (41 in women, 27 in men) that underwent arthroscopic capsular release, 5 distinct etiologies were identified: postsurgical in 20, idiopathic in 17, post-traumatic in 15, diabetic in 8, and impingement syndrome (prior primary impingement developing stiffness) in 8. Average age was 50 years (range, 29 to 72), and follow-up averaged 3 years (range, 2 to 8). Prior to this procedure, duration of symptoms averaged 7.3 months (range, 3 to 48), and formal physical therapy averaged 3.7 months (range, 1 to 12). Preoperative average American Shoulder and Elbow Surgeons Score (ASES) was 35.5 (range, 10 to 77), median Simple Shoulder Test (SST) was 3 (0 to 10), and median Visual Analog Score (VAS) for pain was 6 (0 to 10). Average active forward elevation (FE) was 92 degrees, external rotation (ER) at side was 12 degrees, and median internal rotation (IR) was to the buttock. All patients underwent arthroscopic capsular release with a standard aftercare protocol.
  
  
  RESULTS
  The study population showed significant improvement (P <.0001) for all outcome scores and active motion parameters. Average and median outcome parameters for the population, with improvement in parenthesis were: ASES 93 (+57.5), SST 10 (+7), VAS 0 (-6), FE 165 degrees (+73 degrees ), ER at side 56 degrees (+44 degrees ), and IR to T -12 (+7 spinal segments). The time in formal physical therapy averaged 2.3 months (2 to 20 weeks) and time to attain final, pain-free range of motion averaged 2.8 months (1 to 6). Outcomes for, and between, each etiology were analyzed. There was no difference in time to final motion between the etiologic groups.
  
  
  CONCLUSIONS
  Stiff shoulder pathology can result from a variety of differing etiologic factors. Arthroscopic capsular release was equally effective across the 5 identified etiologic groups, and provided significant pain relief, restoration of motion, and function within an average of 3 months.
authors.affiliation: Department of Orthopedic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA. orthonick@aol.com
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Nicholson
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017746:Joint Capsule / Q000503:physiopathology* / Q000601:surgery*; D007592:Joint Diseases / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D012785:Shoulder Joint / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome