Kim Yang-Soo, Lee Hyo-Jin
Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea. E-mail address for Y-S. Kim:
JBJS Essent Surg Tech. 2015 Jul 22;5(3):e14. doi: 10.2106/JBJS.ST.N.00102. eCollection 2015 Sep 23.
Among many treatments for shoulder stiffness, which is a common debilitating condition, arthroscopic capsular release is an effective surgical method for patients who have not responded to conservative treatment, as it provides visual control of the capsular release with a lower risk of potential traumatic damage than manipulation under anesthesia.
STEP 1 POSITION THE PATIENT: Place the patient either in the lateral decubitus position or in the beach-chair position, depending on one's preference.
STEP 2 PORTAL PLACEMENT: Create a standard posterior viewing portal, an anterior portal, and a lateral portal for approaching the glenohumeral joint and the subacromial space.
STEP 3 REMOVE ROTATOR INTERVAL TISSUE: Begin the capsular release with the rotator interval and middle glenohumeral ligament using a 3.0-mm 90° electrocautery device through the anterior portal.
STEP 4 RELEASE THE ANTERIOR CAPSULE: Begin the anterior capsular release below the long head of the biceps tendon origin and preserve the glenoid labrum.
STEP 5 RELEASE THE INFERIOR CAPSULE: As the electrocautery device may not reach the inferior portion of the inferior glenohumeral ligament, switch the working portal to the posterior portal for an easier approach to the inferior portion.
STEP 6 RELEASE THE CORACOHUMERAL LIGAMENT AND THE SUBSCAPULARIS: Begin this procedure with the camera in the lateral portal viewing the anterior portion of the subdeltoid space.
STEP 7 POSTOPERATIVE REHABILITATION: The goal for the patient is to achieve an immediate range of motion by performing active-assisted and passive range-of-motion exercises including pendulum circumduction or the pulley exercise.
In our recently reported series of seventy-five patients who had a rotator cuff tear with simultaneous shoulder stiffness, treatment with an anterior and inferior capsular release showed favorable results.
IndicationsContraindicationsPitfalls & Challenges.
肩关节僵硬是一种常见的使人衰弱的病症，在其多种治疗方法中，关节镜下关节囊松解术对于那些保守治疗无效的患者而言是一种有效的手术方法，因为它能在直视下进行关节囊松解，相较于麻醉下手法松解，潜在创伤性损伤风险更低。
步骤1 患者体位摆放：根据个人偏好，将患者置于侧卧位或沙滩椅位。
步骤2 建立入口：创建一个标准的后方观察入口、一个前方入口和一个外侧入口，用于进入盂肱关节和肩峰下间隙。
步骤3 切除旋转间隙组织：通过前方入口，使用3.0毫米90°电灼设备从旋转间隙和肱盂中韧带开始进行关节囊松解。
步骤4 松解前方关节囊：在肱二头肌长头肌腱起点下方开始前方关节囊松解，并保留盂唇。
步骤5 松解下方关节囊：由于电灼设备可能无法到达肱盂下韧带的下部，将工作入口切换至后方入口以便更易于接近下部。
步骤6 松解喙肱韧带和肩胛下肌：将摄像头置于外侧入口观察三角肌下间隙前部，开始此操作。
步骤7 术后康复：患者的目标是通过进行主动辅助和被动活动度练习，包括钟摆式环转或滑轮练习，立即实现活动度。
在我们最近报道的一组75例患有肩袖撕裂并同时伴有肩关节僵硬的患者中，采用前方和下方关节囊松解治疗取得了良好效果。
适应证、禁忌证、陷阱与挑战。
