An evaluation of the effects of the extent of capsular release and of postoperative therapy on the temporal outcomes of adhesive capsulitis.
OBJECTIVE
To evaluate effects of the extent of surgical release and of postoperative physiotherapy on the outcomes of this procedure.


METHODS
Case-controlled cohort study.


METHODS
Pain and range of motion scores were compared preoperatively, operatively, and at 1, 6, 12, 24, 52, and 104 weeks postoperatively, in 2 temporal cohorts of patients with adhesive capsulitis. The first cohort (n = 18) underwent a 155 degrees +/- 40 degrees (mean +/- SEM) standard anteroinferior arthroscopic capsule release of the shoulder (ACR-S) and rehabilitation. The second cohort (n = 22) underwent capsular release that was extended an additional 65 degrees +/- 65 degrees posteriorly, a portion of the intra-articular part of the subscapularis tendon was divided, and the patients had a modified earlier, supervised postoperative physical therapy program (ACR-M).


RESULTS
In both cohorts, there was a significant reduction in pain 1 week after surgery, which was maintained at all time-points (P < .05). More gains in intraoperative range of forward flexion (121 degrees v 150 degrees), abduction (114 degrees v 146 degrees) and external rotation (55 degrees v 68 degrees) were obtained in the ACR-M cohort (P < .001). Six weeks after surgery, external and internal rotation regressed to preoperative levels in the ACR-S cohort; 2 of them required a re-release. This regression was not observed in the ACR-M cohort. There was no instability or weakness in lift-off power in either cohort.


CONCLUSIONS
This is a level IV study of 2 nonrandomized cohorts where simultaneous changes in surgical technique and rehabilitation were introduced to the ACR-M cohort. Arthroscopic capsular release for adhesive capsulitis resulted in significant reductions in pain by 1 week in both cohorts. A more extensive capsular release with division of the intra-articular portion of subscapularis improved intraoperative motion. Gains in internal and external rotation were lost postoperatively in the ACR-S cohort, but were preserved when an extended surgical release and an early, supervised postoperative physical therapy program was initiated in the ACR-M cohort.


METHODS
Level IV.
Diwan
Divya Bhargav
DB
Sports Medicine and Shoulder Service, Orthopedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, Australia.
Murrell
George A C
GA
D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D002062:Bursitis / Q000534:rehabilitation / Q000601:surgery*; D016022:Case-Control Studies; D015331:Cohort Studies; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D017746:Joint Capsule / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012399:Rotation; D012785:Shoulder Joint / Q000601:surgery*; D011795:Surveys and Questionnaires; D013710:Tendons / Q000601:surgery; D016896:Treatment Outcome