Yoo, Jae Chul
(Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
,
Koh, Kyoung Hwan
(Department of Orthopaedic Surgery, Ilsan-Paik Hospital, Inje University School of Medicine)
,
Shon, Min Soo
(Department of Orthopaedic Surgery, National Medical Center)
,
Bae, Kyu Hwan
(Department of Orthopaedic Surgery, Eulji Hospital, Eulji University School of Medicine)
,
Lim, Tae Kang
(Department of Orthopaedic Surgery, Eulji Hospital, Eulji University School of Medicine)
Background: This study was undertaken to evaluate the outcome of the arthroscopic capsular release for adhesive capsulitis of the shoulder. Methods: This study retrospectively investigated thirty shoulders in 29 patients who presented with recalcitrant adhesive capsulitis and underwent arthroscopic ...
Background: This study was undertaken to evaluate the outcome of the arthroscopic capsular release for adhesive capsulitis of the shoulder. Methods: This study retrospectively investigated thirty shoulders in 29 patients who presented with recalcitrant adhesive capsulitis and underwent arthroscopic treatments. Other than typical findings of adhesive capsulitis, combined pathologies in the glenohumeral joint and subacromial space were evaluated by arthroscopy. Clinical evaluations were performed using the Constant's score and ranges of motion (ROM) at preoperative, 6 months postoperatively and at the final follow-up. Results: Our study included 17 women and 12 men with a mean age of 53.8 years (range, 34-74). Mean follow-up duration was 24 months (range, 12-40 months). Assessment of combined pathologies revealed that partial rotator cuff tear of less than 25% thickness, was most common (overall 83.3%; with bursal 57% and articular 23%). Subacromial synovitis and adhesion were also frequent (53.3%). The Constant score and ranges of motion significantly improved at the final follow-up, compared with preoperative levels. However, clinical results at 6 months postoperatively were found to be significantly inferior to those observed at the final follow-up ($p{\leq}0.001$ for all factors). Functional impairment was the major complaint in 59.3% patients at the 6 months follow-up. Conclusions: Although arthroscopic capsular release yielded favorable outcome at the mean 24 months follow-up, pain and motion limitations at 6-month postoperatively persisted in more than 50% of our patients. While combined pathologies were commonly encountered during arthroscopy, although their effects on surgical outcome in adhesive capsulitis remains unclear in this study.
Background: This study was undertaken to evaluate the outcome of the arthroscopic capsular release for adhesive capsulitis of the shoulder. Methods: This study retrospectively investigated thirty shoulders in 29 patients who presented with recalcitrant adhesive capsulitis and underwent arthroscopic treatments. Other than typical findings of adhesive capsulitis, combined pathologies in the glenohumeral joint and subacromial space were evaluated by arthroscopy. Clinical evaluations were performed using the Constant's score and ranges of motion (ROM) at preoperative, 6 months postoperatively and at the final follow-up. Results: Our study included 17 women and 12 men with a mean age of 53.8 years (range, 34-74). Mean follow-up duration was 24 months (range, 12-40 months). Assessment of combined pathologies revealed that partial rotator cuff tear of less than 25% thickness, was most common (overall 83.3%; with bursal 57% and articular 23%). Subacromial synovitis and adhesion were also frequent (53.3%). The Constant score and ranges of motion significantly improved at the final follow-up, compared with preoperative levels. However, clinical results at 6 months postoperatively were found to be significantly inferior to those observed at the final follow-up ($p{\leq}0.001$ for all factors). Functional impairment was the major complaint in 59.3% patients at the 6 months follow-up. Conclusions: Although arthroscopic capsular release yielded favorable outcome at the mean 24 months follow-up, pain and motion limitations at 6-month postoperatively persisted in more than 50% of our patients. While combined pathologies were commonly encountered during arthroscopy, although their effects on surgical outcome in adhesive capsulitis remains unclear in this study.
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제안 방법
We included patients with idiopathic adhesive capsulitis, which is defined as an insidious onset of shoulder pain, global limitation of both active, and passive ROM (forward flexion of less than 100°, external rotation at side of 0°–20°, and internal rotation below the thoracic vertebral level)19) and no history of major trauma, infection, or surgery around the affected shoulder. All patients were evaluated by the senior author by taking a thorough history, physical examination, and standard plain radiographs. Indication of arthroscopic treatment was persistent pain and limitation of motion that had not responded to nonoperative management for at least 6 months.
All patients were retrospectively evaluated using data collected from medical histories, physical examination findings, operation records including arthroscopic images, and clinical scores obtained from electronic medical records. For clinical assessment, the Constant-Murley’s score was determined by an independent, single observer (our shoulder physiotherapist) at every follow-up at the out-patient clinic.
Arthroscopy was performed with the arm suspended at 30° of abduction, 20° of forward flexion, and longitudinal traction using 3 to 4 kg of weight (Star Sleeve Traction System; Arthrex, Naples, FL, USA).
All clinical results were compared between preoperative, 6 months postoperatively, and final follow-up by the paired t-test or Wilcoxon signed rank test. Clinical results were also compared between groups with respect to the presence of diabetes and thyroid disease by the chi-square test. Bonferroni correction was used for multiple comparisons.
Passive ROMs were assessed at every visit, including forward elevation in the scapular plane, external rotation at the side, and internal rotation to the level of the spinous process. For the purpose of statistical analysis, the level of vertebrae were converted into contiguously numbered values: 1 to 12 for T1 to T12, 13 to 17 for L1 to L5, and 18 for the sacrum. Based on the Constant-Murley’s score, postoperative results are rated as excellent (≥80 points), good (65 to 79 points), fair (50 to 64 points), and poor (<50 points).
All procedures were performed in a lateral decubitus position. Manipulation was performed by applying a proximal force on the humerus to minimize torque and to rupture the capsule, in the following order: forward elevation, abduction, external rotation with abduction, internal rotation with abduction, and crossbody adduction. A ‘pop’ was usually heard, which subsequently resulted in a full ROM.
Indication of arthroscopic treatment was persistent pain and limitation of motion that had not responded to nonoperative management for at least 6 months. The exclusion criteria for the study were: (1) stiffness after surgery, (2) stiffness after fracture, (3) stiffness associated with arthritis, (4) tumor or avascular necrosis, (5) combined rotator cuff repair, and (6) combined calcific tendinitis that was removed and repaired.
This study therefore aimed to retrospectively review patients who underwent arthroscopic capsular release, and their outcome at postoperative 6 months and at final follow-up. Our null hypothesis was that clinical results would be similar at 6 months postoperative and final follow-up.
대상 데이터
Totally, 30 shoulders of 29 patients (17 women and 12 men) who met the inclusion criteria were reviewed. Mean patient age was 53.
데이터처리
All clinical results were compared between preoperative, 6 months postoperatively, and final follow-up by the paired t-test or Wilcoxon signed rank test. Clinical results were also compared between groups with respect to the presence of diabetes and thyroid disease by the chi-square test.
성능/효과
At 6 months postoperatively, mean value of pain visual analogue scale (VAS) decreased by 4.0 and the Constant score increased by 28.3), as compared with preoperative levels (Table 2). ROM also improved by 28.
At mean 24 months postoperatively, all clinical scores and ROMs were significantly improved compared to the preoperative levels (Table 2); mean value of pain VAS decreased by 6.1, Constant score increased by 41.6), and the ROM improved by 39.4° in forward elevation, 11.9° in external rotation, and 5.0° vertebral levels in internal rotation.
Comparison of clinical parameters at postoperative 6 months and final follow-up revealed the Constant-Murley’s score and ROMs to be significantly inferior at postoperative 6 months (Table 2).
Fourteen shoulders (46.7%) with diabetes or thyroid abnormalities showed significant improvements in clinical parameters at both 6 months postoperatively and final follow-up, as compared with their preoperative levels (p≤0.001 in all), except for external rotation at 6 months.
3. Fourth, our study cohort was small, and 24 months of mean follow-up duration was short for evaluating long term prognosis of patients.
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