Abstract
Purpose of the study: The rate of recurrence after conventional manipulation procedures and arthroscopic debridement for idiopathic adhesive capsulitis of the shoulder is rather high. Arthroscopic release using a radiofrequency method might improve results. The purpose of this prospective study was to compare results of two athroscopic methods: manipulation and debridement versus radiofrequency release.
Material and methods: Thirty patients underwent arthroscopic treatment for shoulder pain six months after a conventional treatment for idiopathic adhesive capsulitis. In group A (n=15 patients), manipulation under anesthesia was followed by arthroscopic joint debridement. In group B (n=15 patients) arthroscopic section of the contracted structures was followed by radiofrequency section of the rotator interval and the anterior and posterior capsule. The coracohumeral ligament was sectioned in all cases. Subacromial decompression was achieved arthroscopically in four of the cases in group A and in two in group B. Age, gender and preoperative joint motion were similar in the two groups.
Results: Follow-up data at six weeks and at 3, 6, and 12 months were assessed in 27 patients (12 group A and 14 group B). Pain, joint stiffness, and function (UCLA and Constant) were assessed. Recurrence required revision in two patients in group A. There was no significant difference for pain (VAS) but there was an improvement in joint motion at three and six months for patients in group B. The outcome was satisfactory in all patients except one.
Discussion and conclusion: Radiofrequency release appears to yield better results than manipulation and arthroscopic debridement. The radiofrequency technique enables section of the rotator interval, the coracohumeral ligament and the capsule to prevent early adhesions and allow more rapid recovery of function.
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