Arthroscopic treatment of shoulder stiffness

The optimal treatment of shoulder stiffness remains controversial. The current authors reviewed the results of arthroscopic capsular release of 45 stiff shoulders in 45 patients that was done after the patients did not respond to conservative treatment. There were nine idiopathic frozen shoulders, 21 that had postoperative stiffness, and 15 shoulders with stiffness after trauma. At a mean followup of 26 months (minimum, 12 months), arthroscopic capsular release improved the subjective shoulder value from 25% to 68% and the age- and gender-adjusted Constant-Murley score from 41% to 75%. Pain improved from 4.7 to 10.9 of 15 points. Active, pain-free anterior elevation increased from 90 degrees to 128 degrees and external rotation increased from 14 degrees to 31 degrees. The quality of sleep improved from 0.5 to 1.6 on a two-point scale. The only improvement that did not reach statistical significance was the improvement in the ability to work. A retrospective analysis of the results stratified according to the etiology of stiffness showed that the outcome after treatment of idiopathic stiffness was better than after postoperative stiffness and that the results of treatment for posttraumatic stiffness were least favorable. The difference between preoperative state and followup, however, was not statistically significantly different from one group to another. All groups improved significantly and to a similar degree but the final outcome was related to the initial degree of disability. Arthroscopic release is an effective method for treatment of shoulder stiffness; however, the ultimate outcome is related directly to the severity of stiffness regardless of the etiology.