title: An evaluation of the effects of the extent of capsular release and of postoperative therapy on the temporal outcomes of adhesive capsulitis.
abstract: 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.
authors.affiliation: Sports Medicine and Shoulder Service, Orthopedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, Australia.
authors.forename: Divya Bhargav
authors.initials: DB
authors.lastname: Diwan
authors.forename: George A C
authors.initials: GA
authors.lastname: Murrell
mesh_terms: 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