Frozen Shoulder

Arthroscopic Arthrolysis for Recalcitrant Frozen Shoulder: Double Posterior Approach

Arthroscopic capsular release is required in some patients with frozen shoulder (FS). In some cases of recalcitrant FS, arthroscopic capsular release is difficult because of the abnormal narrowing of the joint space. The aim of this article is to introduce an arthroscopic double posterior approach combined with lateral and anterior approaches that is used to complete release of the glenohumeral joint capsule at 360°, subacromial debridement, and long head of biceps tenotomy. This article shows that this double posterior technique is a safe and highly effective totally intra-arthroscopic release technique for recalcitrant FS.

Transarterial Embolization for Adhesive Capsulitis of the Shoulder: Midterm Outcomes on Function and Pain Relief

PURPOSE

To determine the safety and potential effectiveness of transarterial embolization for adhesive capsulitis of the shoulder.

MATERIALS AND METHODS

This prospective study analyzed consecutive adult patients with adhesive capsulitis referred for embolization between January 2018 and May 2023 after a poor response to treatment (symptoms and limitation of motion in ≥2 axes; ≤120° flexion, ≤50° external rotation and/or internal rotation with the shoulder abducted 90°) persisting for >3 months after having completed ≥6 weeks of analgesics and physical therapy. Different types of pain and mobility were measured before embolization and 1, 3, and 6 months after embolization. Overall upper limb function (Quick Disabilities of Arm, Shoulder, and Hand) and patient satisfaction were measured before and 6 months after embolization. Long-term follow-up comprised telephone interviews and clinical history reviews.

RESULTS

A total of 20 patients (12 [60%] women; median age, 50.7; interquartile ranges [IQR], 45‒55 years) were included; 6 (30%) had diabetes and 15 (75%) were off work. Median duration of symptoms before embolization was 39.4 weeks (IQR, 28‒49 weeks), and median duration of rehabilitation therapy was 12.8 weeks (IQR, 8‒16 weeks). Six months after embolization, significant improvements were observed in nocturnal pain (P = .003), pain on moving (P = .001), external rotation (P < .001), internal rotation (P < .001), active flexion (P < .001), passive flexion (P = .03), active abduction (P < .001), passive abduction (P < .001), and overall function (P < .001). Despite objective improvements, patient satisfaction was nearly unchanged. Only 1 patient experienced a mild adverse event.

CONCLUSION

Transarterial embolization is safe and potentially effective in treating adhesive capsulitis of the shoulder refractory to conventional treatment. Clinical improvements were maintained in the mid to long term.