Villarreal-Espinosa Juan Bernardo, Saad Berreta Rodrigo, Danilkowicz Richard, Dave Udit, Carpenter Melissa, Chahla Jorge, Verma Nikhil N
Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, USA.
Video J Sports Med. 2025 Feb 5;5(1):26350254241291589. doi: 10.1177/26350254241291589. eCollection 2025 Jan-Feb.
Recalcitrant adhesive capsulitis, manifesting as persistent pain and continued range of motion deficits after a trial of conservative care, can be managed via lysis of adhesions with associated capsular release. While traditionally performed in the beach-chair position, capsular release performed via a lateral decubitus approach may provide enhanced visualization and the ability to perform a 360° release without iatrogenic injury to the cartilage surfaces.
Arthroscopic capsular release in the setting of adhesive capsulitis is utilized when conservative strategies, such as physical therapy and/or corticosteroid injections, do not provide pain and range of motion improvement.
Upon induction of general anesthesia, the patient is placed on the operating table in a lateral decubitus position utilizing the arm positioner of choice. The shoulder's bony landmarks are identified for proper placement of the arthroscopic portals. A standard posterior portal is first established followed by an anterior portal in the rotator interval. Two-portal diagnostic arthroscopy then ensues. The rotator interval is then released, as is the superior capsule, to the 12-o'clock position using electrocautery. Next, a basket scissor is utilized to release the anterior capsule to the 6-o'clock position followed by posterior-superior and posterior-inferior capsular release while viewing anteriorly. Scope instrumentation is withdrawn and the shoulder manipulated, achieving full range of motion.
It is the senior author's belief that by performing a capsular release via the lateral decubitus approach, better visualization, and access to the anterior, inferior, and posterior glenoid can be achieved for a complete 360° release. Additionally, risk of cerebral hypoperfusion and iatrogenic injury to the cartilage surfaces while instrumenting the joint is diminished. Upon procedure completion, the patient was observed to have gained full forward flexion, external rotation, and internal rotation.
DISCUSSION/CONCLUSION: Although traditionally approached via a beach-chair approach, capsular release of end-stage adhesive capsulitis via a lateral decubitus approach has shown to facilitate a circumferential view while providing ease of access to the inferior, anterior, and posterior glenoid, thereby substantially and immediately increasing patient range of motion.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
顽固性粘连性关节囊炎表现为在保守治疗试验后持续疼痛和持续的活动范围受限，可通过粘连松解联合关节囊松解来治疗。虽然传统上是在沙滩椅位进行，但通过侧卧位入路进行关节囊松解可能会提供更好的视野，并能够进行360°松解而不会对软骨表面造成医源性损伤。
当保守治疗策略，如物理治疗和/或皮质类固醇注射，不能改善疼痛和活动范围时，可采用关节镜下粘连性关节囊炎关节囊松解术。
全身麻醉诱导后，使用选定的手臂定位器将患者置于手术台上的侧卧位。确定肩部的骨性标志以正确放置关节镜入路。首先建立标准的后入路，然后在旋转间隙建立前入路。接着进行双入路诊断性关节镜检查。然后使用电灼术松解旋转间隙以及上方关节囊至12点位置。接下来，使用篮式剪刀将前方关节囊松解至6点位置，然后在向前观察的同时进行后上方和后下方关节囊松解。撤出关节镜器械并对肩部进行手法操作，实现全范围活动。
资深作者认为，通过侧卧位入路进行关节囊松解，可以获得更好的视野，能够完全进入前方、下方和后方的关节盂进行360°松解。此外，在对关节进行器械操作时，脑灌注不足和软骨表面医源性损伤的风险降低。手术完成后，观察到患者获得了完全的前屈、外旋和内旋。
讨论/结论：虽然传统上通过沙滩椅入路进行，但终末期粘连性关节囊炎通过侧卧位入路进行关节囊松解已显示出有助于获得周向视野，同时便于进入下方、前方和后方的关节盂，从而显著并立即增加患者的活动范围。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本提交发表的文章附上患者的豁免声明或其他书面形式的批准。
