An Arthroscopic Technique for Treating Patients With Frozen Shoulder

An Arthroscopic Technique for Treating PatientsWith Frozen Shoulder

Albert W. Pearsall IV, M.D., Daryl C. Osbahr, B.S., and Kevin P. Speer, M.D.

Summary: Forty-three patients with a diagnosis of primary or secondary frozenshoulder who had symptoms for an average of 12 months and failed conservativetreatment of at least 12 weeks of physical therapy, were treated with an arthrosopiccapsular release. Oon completion of standard shoulder arthroscopy, intra-articularcautery was used to completely divide the anterior-inferior capsule, the intra-articular portion of the subscapularis tendon, and the middle glenohumeral, thesuperior glenohumeral, and the coracohumeral ligaments. The subacromial spacewas inspected in all patients. Eighteen patients had extensive subacromial fibrosisthat required debridement. Subacromial decompression was reserved for patientswith evidence of an acromial spur seen at the time of arthroscopy. Postoperatively,all patients showed substantial gains in shoulder range of motion, as well asdiminished shoulder pain. Thirty-five patients completed a telephone survey at anaverage of 22 months after surgery. The average modified shoulder score was 19(scale, 13 to 65), with 83% of patients indicating that their shoulder was normal orcaused only mild symptoms. In conclusion, the authors believe that arthroscopiccapsular release is an effective and safe alternative to manipulation in patients witha recalcitrant frozen shoulder.Key Words: Frozen shoulder—Arthroscopiccapsular release.

The painful stiff shoulder has been the subject ofnumerous investigations to elucidate the cause

and an effective treatment for this disabling condition.Codman1 originally coined the term frozen shoulder todescribe the features of slow onset shoulder pain,localized discomfort near the deltoid insertion, aninability to sleep on the affected side, restrictedglenohumeral elevation and external rotation, and anormal radiological appearance.

One of the initial objectives in the treatment offrozen shoulder is to restore motion and therebyimprove shoulder function. A number of therapeutic

interventions have been reported with mixed results.These treatments include analgesics, systemic steroids,physical therapy, stretching and strengthening exer-cises, mobilization techniques, injections, manipula-tion, distention arthrography, and arthroscopy.2,3Amongthe numerous published treatments for frozen shoul-der, many techniques do not enable immediate rangeof motion until the treatment had been completed(stretching, systemic steroids, analgesics) or have thepotential to precipitate significant pain after the inter-vention (manipulation, mobilization techniques, disten-tion arthrography) due to soft tissue trauma.2

Before the onset of the current study, the seniorauthor (K.P.S.) treated patients with recalcitrant frozenshoulder by glenohumeral manipulation under anesthe-sia. After manipulation, many patients underwentdiagonistic shoulder arthroscopy to document theresults of this procedure. Based on these early arthro-scopic findings, it was noted that certain patterns ofcapsular tears correlated with specific preoperativeshoulder arc of motion loss. Using this clinical informa-

From the Department of Orthopaedic Surgery, University ofSouth Alabama, Mobile, Alabama (A.W.P.); and the Section ofSports Medicine, Division of Orthopaedic Surgery, Duke UniversityMedical Center, Durham, North Carolina (D.C.D., K.P.S.), U.S.A.

Address correspondence and reprint requests to Kevin P. Speer,M.D., Section of Sports Medicine and Rehabilitation, Division ofOrthopaedic Surgery, Duke University Medical Center, Box 3435,Durham, NC 27710, U.S.A.

r 1999 by the Arthroscopy Association of North America0749-8063/99/1501-1667$3.00/0

2 Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 15, No 1 (January-February), 1999: pp 2–11

tion, the authors developed an experimental model toexamine the specific contributions of the regionalcapsule to glenohumeral motion.4 Incorporating thisinformation with the patient’s preoperative motionloss, the authors found that they could precisely directtheir capsular release to maximize glenohumeral mo-tion improvement.

MATERIALS AND METHODS

Forty-six patients with a diagnosis of primary orsecondary frozen shoulder who had symptoms for anaverage of 12 months and failed conservative manage-ment of at least 12 weeks of physical therapy andnonsteroidal and/or systemic steroid medications, weretreated arthroscopically with the procedure describedbelow. No patient had undergone a previous surgicalprocedure for frozen shoulder. All procedures wereperformed over a 3-year period and no patient under-went manipulation under anesthesia.

Preoperatively all patients had a side-to-side shoul-der examination under anesthesia performed withattention directed towards allowable passive glenohu-meral range of motion. Specifically, internal and ex-ternal passive glenohumeral motion was evaluated at0° and 90° of abduction (Figs 1-3). In addition, iso-lated glenohumeral elevation (IGHE) was recorded inthe scapular plane (Fig 4). IGHE was measured byhaving the examiner stabilize the scapula with one handwhile the other hand was used to elevate the ipsilateralarm. The arc of motion of the glenohumeral joint wasnoted until movement of the scapula on the thorax wasdetected. The initiation of scapulothoraic motion delin-eated the extreme of isolated glenohumeral motion.Based on the authors’ previous work defining the spe-cific capsular contributions to glenohumeral motion,precise preoperative assessment of glenohumeral mo-tion loss determined the regional capsule that would bereleased.4 Loss of external rotation at 0° of abductionmandated a release of the anterosuperior capsule. Lossof glenohumeral external rotation at 90° of abductionmerited a release of the antero-inferior capsule. Dimin-ished IGHE merited release of the anterior-inferiorcapsule. Finally, loss of glenohumeral internal rotationwarranted a release of the posterior capsule.

Postoperatively, all patients were followed-up bythe senior author (K.P.S.) who clinically examined allpatients and documented their range of motion at themost recent follow-up (5 months). If a patient’s chartcontained at least 1 of the motion parameters recorded(IGHE, ER0 [external rotation], ER90, IR90 [internalrotation]), the data were used for statistical analysis.

Three patient records were incomplete and were notincluded, leaving 43 records for statistical analysis. Inaddition, 35 patients were contacted by telephone at anaverage of 22 months after their surgical procedure.Each patient answered a modified shoulder question-naire that addressed pain, range of motion, instability,ability to work, and overall function (Fig 5).

STATISTICS

Descriptive statistics including mean and standarddeviations were calculated for patients’ range of mo-tion measurements. A Pearson correlation at theP ,.01 level of significance was used to analyze themodified shoulder questionnaire variables.

SURGICAL TECHNIQUE

Interscalene anesthesia with ropivacaine 0.5% andepinephrine 1:200,000 was used in all patients and the

FIGURE 1. Examination of passive glenohumeral external rotationat zero degrees of shoulder abduction.

3ARTHROSCOPIC RELEASE FOR FROZEN SHOULDER

surgery was performed as an outpatient procedure. Allpatients received intravenous sedation. The intersca-lene anesthetic provided approximately 12 to 18 hoursof pain relief postoperatively.

After a side-to-side examination of allowable pas-sive glenohumeral motion was performed, the patientunderwent standard glenohumeral arthroscopy in thebeach chair position. The anterior portal was placed ascephalad as possible, so that the outflow cannulaentered the joint immediately anterior to the bicepstendon. A standard glenohumeral arthroscopy wasperformed during which the biceps tendon, anteriorand posterior glenoid labrum, humeral head, inferiorcapsular recess, and rotator cuff were inspected. Fre-quently, the intra-articular portion of the subscapularistendon was difficult to visualize secondary to prolifera-tive synovitis. Any degenerative labral tears weredebrided to a stable rim with a motorized shaver. Oncompletion of the preliminary joint arthroscopy, anintra-articular cautery was placed through the anteriorcannula. The arthroscopic cautery was placed approxi-

mately 1 cm lateral to the glenoid and used tocompletely divide the anterior capsule and the intra-articular portion of the subscapularis tendon until thesubscapularis muscle was visualized (Fig 6). Theanterior-superior capsular release involved the middleglenohumeral, superior glenohumeral, and coracohu-meral ligaments. No attempt was made to release anyof these ligaments individually. The endpoint of theanterosuperior release was defined when the posterioraspect of the coracoid was visualized and all tissueanterior to the biceps was divided. The extent of theinferior capsular release was noted when the deltoidmuscle began to twitch with the use of the intra-articular cautery, indicating regional proximity to theaxillary nerve. If a patient had preoperative evidenceof diminished glenohumeral internal rotation, thearthroscope was placed in the anterior portal while theintra-articular cautery was brought into the posteriorportal and a posterior release or partial capsulardebridement was performed. Next, subacromial arthros-copy was performed in all patients. If the subacromial

FIGURE 2. Examination of passive glenohumeral external rotationat ninety degrees of shoulder abduction.

FIGURE 3. Examination of passive glenohumeral internal rotationat ninety degrees of shoulder abduction.

4 A. W. PEARSALL ET AL.

space was seen to be free of fibrosis and subacromialspurring, the arthroscope was removed. However, ifindicated, a subacromial soft tissue debridement withrelease of the coracoacromial ligament was performed.In addition, if a prominent subacromial spur waspresent, it was removed at this time.

On completion of the intra-articular capsular releaseand subacromial debridement, the operated arm wasplaced through a range of motion, including glenohu-meral external rotation at 0° of abduction, as well asexternal and internal glenohumeral rotation at 90° ofabduction. The patient’s postsurgical shoulder motionwas compared with preoperative glenohumeral motionmeasurements of the ipsilateral and contralateral shoul-ders.

Postoperatively, all patients received narcotics forpain, cryotherapy, and a 21-day tapered course ofprednisone (Table 1). All patients had their slingsremoved the day after surgery to begin passive rangeof motion exercises with the therapist. Progressivepassive and active-assisted range of motion exercises

including aquatics were instituted the first week aftersurgery.

RESULTS

There were 22 men and 24 women with an averageage of 49 years (range, 21 to 76 years). Because ofincomplete records, only 43 charts were used forstatistical analysis. The average follow-up periods forthe functional and clinical assessments were 22 and 5months, respectively. Twelve percent of patients had ahistory of diabetes mellitus and 49% underwent atleast one subacromial injection before surgery. Twenty-four charts of patients who underwent an isolatedanterior release were reviewed, in addition to 19 chartsof patients who underwent an anterior and posteriorcapsular release. There were no postoperative compli-cations with regard to compartment syndrome oraxillary nerve injury.

Eighty-three percent of patients had improvement inIGHE postoperatively. At the latest follow-up, theaverage gain in IGHE for all patients was 24°. Amongpatients who underwent an anterior capsular release,90% showed improvement in both external rotation at0° of abduction (ER0) and external rotation at 90° ofabduction (ER90) (Table 2). The average gain in ER0

and ER90 was 37° and 36°, respectively. No patientwho underwent an anterior capsular release lost mo-tion as of the latest follow-up.

Among patients who underwent a posterior capsularrelease, 100% showed improvement in internal rota-tion at 90° of abduction (IR90) (Table 3). The averagegain in IR90 was 30°. No patient who underwent aposterior capsular release lost motion at the latestfollow-up.

Among the 35 patients who were interviewed bytelephone, the average shoulder functional score was19, with 13 indicating normal function and 65 com-pletely disabled (Table 4). The average score for painwas 1.6 and the average score for range of motion was1.9. Patients’ pain scores did not correlate with age orlength of follow-up. The patients’ perceived motionloss score averaged 1.9. The average score for instabil-ity was 1.1, with 1 patient having a score greater than 2(mild symptoms). The average score for work capabil-ity was 1.9. A statistical correlation was observedbetween patients’ functional score and motion lossscore, pain score, sports score, and work score (P,.010).

All patients had arthroscopic evidence of prolifera-tive synovitis, in addition to capsular and intra-articular subscapularis tendon thickening. The major-

FIGURE 4. Examination of IGHE.


Introductory QuestionnaireShoulder Study

Subject name: Date:

(For each of the following segments, please check the answer which best describes your feeling or conditiontoday. Check only one answer in each segment, except #7. For #7, check 1 answer for each function.)

1. Pain: (pain effect on function)

h none or mild, non-limitingh only with vigorous or prolonged

activity, mild limitationh intermittent or episodic, transient

limitationh with mild or routine activity,

significant limitationh severe limitation

2. Night Pain:Do you have pain at night? h Yes h NoIf yes, how bad is it?

h mild, do not awakenh moderate, awaken occasionallyh severe, awaken frequently

3. Limitation of Motion (effect of injury onlimb motion)

h noneh mild, no handicaph moderate, some difficultyh severe, definite handicap

4. Instability: (is your joint unstable)

h noneh mild, some disabilityh moderate, definite limitationh severe, marked limitation

5. Work: (effect of injury on work)

h unlimitedh mild limitationh moderate limitationh unable

6. Sports: (effect of injury on sports)

h unlimitedh reduced intensity since injuryh only limited participationh severely restrictedh unable

7. Functional Activities:

a. use back pocket ............... h h h h h

b. wash opposite armpit ..... h h h h h

c. eat with utensile .............. h h h h h

d. comb hair ......................... h h h h h

e. use arm with hand atshoulder level .................. h h h h h

f. carry 10-15 lb with handat side ............................... h h h h h

g. dress ................................ h h h h h

h. sleep on affected side ..... h h h h h

i. pulling .............................. h h h h h

j. pushing ............................ h h h h h

k. use hand overhead ......... h h h h h

l. throw ................................ h h h h h

m. lifting ............................... h h h h h

no

rmal

mild

dif

ficu

lty

dif

ficu

lt

wit

hai

d

un

able

FIGURE 5. Modified shoulder questionnaire.


ity of significant synovitis was noted anteriorly. Forty-one percent of patients had evidence of significantsubacromial fibrosis; however, this was not statisti-cally associated with decreased internal or externalrotation motion loss postoperatively. Although allpatients had evidence of diminished joint volume asdemonstrated by difficulty entering and maintainingthe arthroscope within the shoulder joint, no patienthad significant glenohumeral arthritis. Thirty-five per-cent of patients’ shoulders were seen to have degenera-tive labral tears, none of which were unstable. Thesignificance of these findings was unclear.

DISCUSSION

The etiology of the frozen shoulder remains enig-matic. Investigators have proposed a variety of causesfrom autoimmune theories to systemic disease.5-9

Lundberg subdivided the frozen shoulder syndromeinto (1) primary or idiopathic and (2) secondary.10

Others have simply defined frozen shoulder syndromeas a clinical loss of glenohumeral motion preceded inmany patients by a period of relative immobiliza-tion.2,11 A variety of factors have been reported to beassociated with frozen shoulder, including fractures,soft tissue trauma, and neurological injury.12 In addi-tion, an autoimmune theory has been postulated, withelevated levels of C-reactive protein and an increasedincidence of HLA-B27 histocompatibility antigen re-ported in patients with frozen shoulder versus con-trols.5,6 DePalma13 proposed that muscular inactivitywas a major etiological factor, whereas Bridgman8

identified an increased incidence of frozen shouldersin patients with diabetes mellitus. Frozen shoulder has

FIGURE 6. View of the anterior structures of the glenohumeral joint as visualized from the arthroscopic posterior portal. The arrow indicatesthe outflow cannula placed immediately caudad to the intra-articular biceps tendon. The dotted line indicates the area of capsular release.

TABLE 1. Postoperative Corticosteroid Dosingin Frozen-Shoulder Patients

PostOp Day Medication Dose

(Days 1-7) Prednisone 40 mg/day(Days 8-14) Prednisone 30 mg/day(Days 15-18) Prednisone 20 mg/day(Days 19-21) Prednisone 10 mg/day


also been associated with cervical disease, hyperthy-roidism, and ischemic heart disease.7,9,10

The term adhesive capsulitis has also been used todescribe the clinical entity of frozen shoulder.14-16

Despite the use of this term by numerous authors,adhesive capsulitis may not accurately reflect thesyndrome of frozen shoulder.14,15Several investigatorshave shown minimal inflammatory response in histo-logical specimens taken from patients with frozenshoulder.10,17-20

Despite a lack of evidence linking frozen shouldersyndrome to a specific etiology, there appear to existvarious triggers that may predispose an individual tothis problem. A few of these reported etiologic agentsinclude trauma, surgery including but not limited tothe shoulder, inflammatory disease, diabetes, regionalconditions, and various shoulder maladies that havebeen reported to have similar pathological find-ings.4,18,19 In the current study, when the pathologicalfindings observed within the subacromial space werecompared among patients, there were many similari-ties. Subacromial fibrosis with hypertrophic synovium

was noted in approximately 40% of all patients,regardless of the preoperative cause. Therefore, de-spite the small numbers in the current study, theauthors believe that the pathological and arthroscopicsimilarities found within the subacromial space amongthis study population may represent a secondaryphenomenon of frozen shoulder syndrome. The au-thors recommend a subacromial arthroscopy in allpatients with recalcitrant frozen shoulder undergoingarthroscopic capsular release. However, we only per-form a subacromial debridement and decompression inpatients with extensive subacromial scarring and arthro-scopic evidence of impingement.

Although various frozen shoulder series have re-

TABLE 2. Net Change in Glenohumeral Motion AfterAnterior Arthroscopic Capsular Release

Patient No. IGHE* ER0† ER90‡ IR90§

1 25 45 70 302 15 45 30 03 15 25 20 254 20 30 20 105 0 55 10 156 25 45 60 07 0 13 20 158 10 50 10 09 30 30 75 0

10 10 15 20 511 30 55 30 3012 70 45 60 6013 50 50 55 1014 10 55 20 3015 0 60 60 3016 30 15 70 4017 10 20 45 1518 50 25 50 019 10 0 10 020 25 25 30 521 35 45 70 3022 10 35 70 3023 25 60 45 2024 15 35 30 0

N 5 24 mean, 22 mean, 37 mean, 40 mean, 17

NOTE. Values in degrees. A negative value indicates lost motion.*Isolated glenohumeral elevation.†External rotation at 0° of abduction.‡External rotation at 90° of abduction.§Internal rotation at 90° of abduction.

TABLE 3. Net Change in Glenohumeral Motion AfterAnterior and Posterior Arthroscopic Capsular Release

Patient No. IGHE* ER0† ER90‡ IR90§

1 — 35 0 502 40 35 30 303 — 55 70 254 30 55 75 105 65 50 40 506 45 65 45 457 35 35 10 508 20 35 50 309 25 50 25 55

10 0 0 0 2011 40 65 15 1012 0 0 0 2013 15 65 40 1014 30 40 — 3015 0 20 — —16 25 30 20 1517 60 50 40 018 15 40 20 1019 0 0 0 20

N 5 19 mean, 26 mean, 38 mean, 34 mean, 27

NOTE. Values in degrees. A negative value indicates lost motion.*Isolated glenohumeral elevation.†External rotation at 0° of abduction.‡External rotation at 90° of abduction.§Internal rotation at 90° of abduction.

TABLE 4. Modified Shoulder QuestionnairePostoperative Scores

Variable Score* Range

Functional activities 19 (69) 13-65Instability 1.1 (60.4) 1-4Limitation of motion 1.9 (60.9) 1-4Night Pain 1.4 (60.8) 1-4Pain 1.6 (60.8) 1-5Sports 1.7 (60.8) 1-5Work 1.9 (61.0) 1-4

*Standard deviations shown in parenthesis.


ported fewer than 50% of patients with long-termdisability, for many patients a more aggressive manage-ment approach has been described.21 Sharma et al.22

and Mulcahy et al.23 have reported the results ofglenohumeral capsular distention with or withoutconcomitant manipulation. Although good results havebeen described with this technique, a large capsulartear can be created during the procedure, causingsignificant bleeding that may impair immediate postop-erative mobilization. In addition, the risk of humeralfracture and rotator cuff injury is present.2 Recently,arthroscopy of the shoulder has been shown to have arole in the diagnosis, staging, and treatment of frozenshoulder. Pollock et al.3 described the use of arthros-copy to debride the subacromial space and selectivelysection the coracohumeral ligament to improve gleno-humeral motion. Warner et al.24 reported on the use ofarthroscopic capsular release in patients with adhesivecapsulitis. Ogilive-Harris et al.18 reported on theirseries of 40 patients with frozen shoulder treated witharthroscopy and manipulation or arthroscopic section-ing of contracted capsular structures. In their study, allisolated arthroscopy patients underwent complete divi-sion of all anterior capsular structures, including theintra-articular portion of the subscapularis tendon. Theinferior margin of the release included the anteriorinferior glenohumeral ligament and the anterior 50%of the inferior capsule. The authors reported nopostoperative complications related to nerve injury orshoulder instabililty. Moreover, they found that arthro-scopic division of the anterior structures was signifi-cantly better than manipulation with regard to func-tion, pain, and overall outcome.18

In the current study, the authors limited the inferiorextent of the anterior-inferior capsular release becauseof the proximity of the axillary nerve. In all cases, theextent of the anterior capsular release involved aminimum of 50% of the anterior capsular structures.Despite the lack of a complete release of the anterior-inferior capsule, symmetric glenohumeral externalrotation at 0° of abduction and IGHE were noted in90% and 83% of patients, respectively. The currentstudy findings concur with those reported by Ogilive-Harris et al. that a release of the anterior capsularstructures is required to restore full glenohumeralexternal rotation and/or IGHE.18

In addition to the glenohumeral joint capsule, theintra-articular subscapularis tendon has also beenreported to contribute to limited abduction and/orexternal rotation.25 The subscapularis is a broad flatmuscle with intramuscular bands or septa that con-verge laterally and insert into the lesser tuberosity of

the humerus.25,26 Klapper et al.26 sectioned subscapu-laris specimens in four zones and described a constanthistological pattern in the distribution of the tendinousbands within the muscle. The authors noted superiormigration of the bands as they traversed laterally,eventually coming to lie within the superior one thirdof the subscapularis at its insertion. Clark and Harry-man27 reported the subscapularis capsule complex toconsist of 5 to 6 bundles of collagen fibers that enteredfrom the subscapularis muscle belly to the lessertuberosity. Totterman et al.,28 in a magnetic resonanceimaging study of the shoulder, noted the subscapularisto have approximately 4 to 6 tendon slips that arosemedially deep within the muscle. These slips convergelaterally to form a stout main tendon that had itsinsertion along the superior aspect of the lesser tuber-osity. Cooper et al.29 observed the superior portion ofthe subscapularis tendon to be intra-articular whenviewed arthroscopically. Pearsall et al.30 showed thatthe location of the intra-articular release of the sub-scapularis tendon is lateral to the muscle-tendonjunction. At this point, the sagittal diameter of theintra-articular portion of the subscapularis tendon(IASS) averages 5 mm, which represents approxi-mately 86% of the entire subscapularis sagittal diam-eter.30 The IASS constitutes only 25% of the entirecehpalad-caudad length of the subscapularis at thislocation (Fig 7). Upon IASS release, it was observed incadaveric dissections that the entire anterior muscle-tendon anatomy is undistorted and an anterior layer ofmuscle is left intact (30) (Fig 8).

Despite some authors advocating that the IASS beleft intact during arthroscopic shoulder capsular re-lease, other authors have cited its release as animportant step in improving glenohumeral externalrotation.18,24,31-33 Although several reports have de-scribed rupture of the intra-articular subscapularistendon after manipulation for frozen shoulder, theauthors are not aware of any reports describing signifi-cant symptoms of instability after manipulation.18,32Inthe current study, the authors incorporated a completerelease of the IASS. At an average follow-up of 22months after capsular and IASS release, all patients inthe current study described decreased pain and im-proved motion and functional scores. In addition,despite release of the IASS, 97% of patients describedminimal or no symptoms of instability. Based on thiswork, we do not believe that release of the IASSjeopardizes anterior shoulder stability or function.

Selective arthroscopic capsular release enables thesurgeon to precisely release specific capsular struc-tures without the nonspecific capsular destruction and


bleeding that occur with manipulation. In addition, theprocedure is safe. Ogilive-Harris et al.18 cited thesafety of the procedure and the decreased postopera-tive morbidity noted in the arthroscopically treated

patients. In the current study, there were no instancesof humeral fracture, nerve injury, or postoperativedislocations as a result of subscapular tendon release.Another benefit is the capability to determine any

FIGURE 7. Anatomic photograph and drawing demonstrating the subscapularis muscle and tendon in its entirety. The arrow indicates the areaof arthroscopic intra-articular tendon release. Note that significant muscle is present anteriorly, even after complete release of the tendon.

FIGURE 8. Anatomic drawing of the subscapularis musculotendinous junction viewed from anterior. Despite complete intra-articularsubscapularis tendon release, the musculotendinous continuity has not been disturbed.


concurrent diagnoses during routine inspection of thejoint. Similarly, the subacromial space can be in-spected for evidence of impingement and/or subacro-mial fibrosis. Finally, by means of a preoperativeinterscalene block, the patient receives prolongedpostoperative pain relief, in addition to a sympatheticblockade. The latter may provide relief for any sympa-thetic pain component of frozen shoulder that mayexist.

In conclusion, the refractory frozen shoulder is achallenging problem, even to the most experiencedshoulder surgeon. Numerous treatment methods havebeen tried in the past with mixed results. The authorsbelieve that selected arthroscopic capsular release is atechnique that enables the shoulder surgeon to addressthe clinical problems of diminished glenohumeralmotion and associated shoulder pain, while minimiz-ing postoperative bleeding, the risk of humeral frac-ture, and rehabilitation time. With decreased hemiar-throsis and swelling, patients can then be mobilizedmore quickly to optimize functional results.

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An Arthroscopic Technique for Treating Patients With Frozen Shoulder

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