Morsy Mohamed Gamal, Waly Ahmed Hassan, Ashraf Galal Mostafa, Ayman El Hussein Mohamed, Gawish Hisham Mohamed
Department of Orthopaedic Surgery and Traumatology, Arthroscopy and Sports Injury Unit, Alexandria University, Alexandria, Egypt.
Department of Orthopaedic Surgery and Traumatology, Kafr El Sheikh University, Kafr el-Sheikh, Egypt.
Video J Sports Med. 2021 Mar 10;1(2):26350254211000065. doi: 10.1177/26350254211000065. eCollection 2021 Mar-Apr.
The inadequate arthroscopic release of the tight posterior capsule in frozen shoulder may result in limited postoperative shoulder internal rotation.
The purpose of this article is to describe an L-shaped arthroscopic posterior capsular release to overcome the limited internal rotation that may be encountered following the standard longitudinal technique. Operative intervention is indicated in patients with refractory shoulder stiffness with limitation of internal rotation of grade 0, +2, +4 (according to the Constant-Murley Score), after failure of conservative measures for 3 to 6 months. The technique is contraindicated if less than 3 months of physical therapy, shoulder stiffness due to osseous deformity, infection, or cuff tear arthropathy.
After performing a standard anterior capsular release, the scope is shifted to the anterior portal to perform posterior capsular release by introducing the radiofrequency ablation device through the posterior portal. Posterior release begins from the glenoid level down to the 6 o'clock position until the back fibers of the infraspinatus muscle appear. Then the hook-tip part of the radiofrequency ablation device is used to perform a transverse release in the posterior capsule, starting from the beginning of the longitudinal limb. The transverse limb is performed in a stepwise manner going step-by-step laterally but ending before reaching the rotator cuff to avoid any damage of the cuff. After that, the shoulder was manipulated according to Codman technique.
A comparative study was performed on 43 patients with primary frozen shoulder to compare the standard longitudinal (22 patients) and L-shaped (21 patients) posterior capsular release. At the final follow-up, there was a statistically significant improvement in the internal rotation range of motion in the L-shaped group ( < .001). There was no loss of function over time. Moreover, there were no infections, instability, or axillary nerve injury in either group.
DISCUSSION/CONCLUSION: Restriction of internal rotation in frozen shoulder has been attributed to posterior capsular tightness. The L-shaped arthroscopic posterior capsular release in patients with primary frozen shoulder significantly improves the postoperative internal rotation range of motion.
冻结肩患者关节镜下对紧张的后关节囊松解不充分可能导致术后肩关节内旋受限。
本文旨在描述一种L形关节镜下后关节囊松解术，以克服标准纵向技术可能出现的内旋受限。对于保守治疗3至6个月失败后，内旋受限达0级、+2级、+4级（根据Constant-Murley评分）的难治性肩关节僵硬患者，建议进行手术干预。如果物理治疗时间少于3个月、存在骨畸形导致的肩关节僵硬、感染或肩袖撕裂性关节病，则该技术为禁忌。
在进行标准的前关节囊松解后，将关节镜移至前入路，通过后入路插入射频消融装置进行后关节囊松解。后关节囊松解从肩胛盂水平开始向下至6点位，直至冈下肌后纤维出现。然后使用射频消融装置的钩尖部分在后关节囊内从纵向切口起始处开始进行横向松解。横向切口以逐步方式向外侧进行，但在到达肩袖之前结束，以避免损伤肩袖。之后，根据Codman技术对肩关节进行手法操作。
对43例原发性冻结肩患者进行了一项对比研究，比较标准纵向（22例患者）和L形（21例患者）后关节囊松解术。在末次随访时，L形组的内旋活动范围有统计学意义的改善（P<0.001）。随着时间推移，功能没有丧失。此外，两组均未发生感染、不稳定或腋神经损伤。
讨论/结论：冻结肩的内旋受限归因于后关节囊紧张。原发性冻结肩患者采用L形关节镜下后关节囊松解术可显著改善术后内旋活动范围。
