Background: To compare the clinical outcomes of arthroscopic capsular release in patients with and without inferior capsular release for shoulder stiffness. Methods: Between January 2010 and December 2015, 39 patients who underwent arthroscopic capsular release for shoulder stiffness were enrolled a...
Background: To compare the clinical outcomes of arthroscopic capsular release in patients with and without inferior capsular release for shoulder stiffness. Methods: Between January 2010 and December 2015, 39 patients who underwent arthroscopic capsular release for shoulder stiffness were enrolled and randomized into two groups. In group I, 19 patients underwent arthroscopic capsular release of the rotator interval and anterior capsule. In group II, 20 patients underwent arthroscopic capsular release of the anterior to inferior capsule, including the rotator interval. The American Shoulder and Elbow Surgeons score, Constant scoring system, Simple Shoulder Test, visual analogue scale for pain, and range of motion (ROM) were used for evaluation before surgery, at 3, 6, and 12 months after surgery and on the last follow-up. Results: Preoperative demographic data revealed no significant differences (p>0.05). The average follow-up was 16.07 months. Both groups showed significantly increased ROM at the last follow-up compared with preoperative (p0.05) between groups I and II in functional scores and ROM (forward flexion, p=0.91; side external rotation, p=0.17; abduction external rotation, p=0.72; internal rotation, p=0.61). But we found that group II gained more flexion compared to group I at 3 months and 6 months (p<0.05) after the surgery. Conclusions: Both techniques of capsular release are effective for stiffness shoulder. However, the extended inferior capsular release shows superiority in forward flexion over anterior capsular release alone during 6 months of follows-up (level of evidence: Level I, therapeutic randomized controlled trial).
Background: To compare the clinical outcomes of arthroscopic capsular release in patients with and without inferior capsular release for shoulder stiffness. Methods: Between January 2010 and December 2015, 39 patients who underwent arthroscopic capsular release for shoulder stiffness were enrolled and randomized into two groups. In group I, 19 patients underwent arthroscopic capsular release of the rotator interval and anterior capsule. In group II, 20 patients underwent arthroscopic capsular release of the anterior to inferior capsule, including the rotator interval. The American Shoulder and Elbow Surgeons score, Constant scoring system, Simple Shoulder Test, visual analogue scale for pain, and range of motion (ROM) were used for evaluation before surgery, at 3, 6, and 12 months after surgery and on the last follow-up. Results: Preoperative demographic data revealed no significant differences (p>0.05). The average follow-up was 16.07 months. Both groups showed significantly increased ROM at the last follow-up compared with preoperative (p0.05) between groups I and II in functional scores and ROM (forward flexion, p=0.91; side external rotation, p=0.17; abduction external rotation, p=0.72; internal rotation, p=0.61). But we found that group II gained more flexion compared to group I at 3 months and 6 months (p<0.05) after the surgery. Conclusions: Both techniques of capsular release are effective for stiffness shoulder. However, the extended inferior capsular release shows superiority in forward flexion over anterior capsular release alone during 6 months of follows-up (level of evidence: Level I, therapeutic randomized controlled trial).
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문제 정의
The goal of this study was to determine the extent of capsular release needed in arthroscopic surgery for shoulder stiffness. To accomplish this, we compared the clinical outcomes of capsular release between those with and without inferior capsular release for shoulder stiffness.
가설 설정
To accomplish this, we compared the clinical outcomes of capsular release between those with and without inferior capsular release for shoulder stiffness. The hypothesis of our study was that the addition of inferior capsular release would contribute to improved outcomes.
제안 방법
org). After arthroscopic confirmation of inclusion and exclusion criteria, the surgical procedure was determined by a random number taken from a sealed envelope at the time of surgery. All patients were blinded to this treatment and informed about the advantages and disadvantages of both treatments.
*Patients who underwent arthroscopic capsular release for shoulder stiffness were enrolled and randomized into two groups: group I, patients who underwent arthroscopic capsular release of the rotator interval, anterior (a standard anterior release); group II, patients who underwent arthroscopic capsular release of the anterior to inferior capsule, including the rotator interval (a standard anteroinferior release).
ROM including forward flexion, ER at side, ER at 90° of abduction, and IR of the treated shoulder was measured with a goniometer, and a visual analogue scale (VAS) for pain (0, no pain; 10, the most severe pain) was used to evaluate all patients at each visit.
A senior shoulder specialist conducted all surgical procedures with the patient under general anesthesia. The patients underwent standard glenohumeral arthroscopy in the lateral decubitus position. In group I, capsular release began with the rotator interval via 3.
For analysis, the vertebral level was numbered serially: 0 for any level below the sacral region and 1 point added for each level above the sacrum. The postoperative cuff tendon integrity was assessed at 8 weeks and 12 month after the operation using magnetic resonance imaging (MRI). All assessment data were prospectively collected by a clinical researcher who was blinded to the current study.
For small-sized (<1 cm) rotator cuff tears, a single-row repair was conducted, and a trans osseous equivalent repair (suture bridge technique) was performed for medium-sized (1–3 cm) tears. The selection of the surgical method was based on the location and shape of the torn tendon. Acromioplasty was performed for all type II and III acromions, along with the removal of sub-acromial spurs.
When passive shoulder ROM was restored to 90%, isometric exercises in all planes were recommended. Thera-Band exercises, strengthening exercises for the muscles stabilizing the scapula, and advanced muscle strengthening exercises with dumbbells were taught 12 weeks after the operation. All listed procedures were recommended until the last visit after 12 months.
대상 데이터
Between January 2010 and December 2015, 152 consecutive patients with rotator cuff tear with concomitant stiffness were enrolled. Inclusion criteria were as follows: patients whose main symptom was shoulder stiffness, patients with small- to medium-sized full-thickness rotator cuff tear, and pain and functional limitation of the shoulder for at least 3 months.
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