Luo Jia-Long, Huang Ye-Bin, Deng Xing-Hao, Wang Jing-Song, Li Yu-Heng, Li Wei-Ping, Jiang Chuan, Zhang Zheng-Zheng, Chen Zhong
Department of Orthopedics, Sun Yat-Sen Memorial Hospital, sun Yat-Sen University, Guangzhou, China.
Orthop Surg. 2025 Aug;17(8):2331-2341. doi: 10.1111/os.70104. Epub 2025 Jun 27.
Idiopathic glenohumeral adhesive capsulitis, known as idiopathic frozen shoulder (IFS) and characterized by pain and limited motion of the shoulder, is often treated by arthroscopic capsule release surgery, though residual symptoms may remain postoperatively. Due to overlapping symptoms and shared anatomical involvement, it is hard to distinguish the source of shoulder pain between concurrent long head of the biceps tendon (LHBT) inflammation and IFS. The study aimed to verify that LHBT tenotomy, compared with leaving it in situ, could provide better pain reduction and shoulder mobility in early rehabilitation of post-arthroscopic IFS capsule release surgery.
From January 2020 to January 2022, 73 patients with idiopathic adhesive capsulitis were divided into two groups based on the preoperative LHBT lesions and treatment received for LHBT: tenotomy or left in situ. All patients underwent arthroscopic capsular release, coracohumeral ligament release, and subacromial decompression. Outcomes were measured before surgery and at 1, 3, 6, 12, and 24 months and final follow-up postoperatively, including shoulder functional scores, joint range of motion, visual analog scale (VAS) score for pain, and complications. T-test, Chi-square test, and Fisher's test were performed to analyze the data.
This study found that while functional scores and joint range of motion of both groups improved significantly in the final follow-up, the LHBT tenotomy group showed lower VAS scores for pain at 1 (2.2 ± 0.8) and 3 months (2.1 ± 0.6) postoperatively (p < 0.001). Additionally, there was better shoulder mobility in external rotation compared to the LHBT left in situ group at 1-12 months postoperatively (p < 0.001). There was no significant difference in postoperative complications between the two groups.
In idiopathic adhesive capsulitis patients undergoing arthroscopic release, LHBT tenotomy led to significant improvements in joint mobility and pain reduction in early rehabilitation stages compared with leaving LHBT in situ, despite two groups showing no significant difference at the final follow-up postoperatively.
特发性肩肱关节粘连性关节囊炎，即特发性冻结肩（IFS），其特征为肩部疼痛和活动受限，通常采用关节镜下关节囊松解手术进行治疗，不过术后可能仍会残留症状。由于症状重叠且解剖结构受累情况相同，很难区分肱二头肌长头肌腱（LHBT）并发炎症和IFS时肩部疼痛的来源。本研究旨在验证，与保留LHBT原位相比，LHBT切断术在关节镜下IFS关节囊松解术后的早期康复中能否更好地减轻疼痛并改善肩部活动度。
2020年1月至2022年1月，73例特发性粘连性关节囊炎患者根据术前LHBT病变情况及针对LHBT所接受的治疗分为两组：切断术组或保留原位组。所有患者均接受了关节镜下关节囊松解、喙肱韧带松解和肩峰下减压。在术前以及术后1、3、6、12和24个月及最终随访时测量结果，包括肩部功能评分、关节活动范围、疼痛视觉模拟量表（VAS）评分和并发症情况。采用t检验、卡方检验和Fisher检验进行数据分析。
本研究发现，虽然两组在最终随访时功能评分和关节活动范围均有显著改善，但LHBT切断术组在术后1个月（2.2±0.8）和3个月（2.1±0.6）时疼痛VAS评分更低（p<0.001）。此外，与LHBT保留原位组相比，术后1至12个月时切断术组外旋肩部活动度更佳（p<0.001）。两组术后并发症无显著差异。
在接受关节镜下松解术的特发性粘连性关节囊炎患者中，与保留LHBT原位相比，LHBT切断术在早期康复阶段能显著改善关节活动度并减轻疼痛，尽管两组在术后最终随访时无显著差异。
