Frozen shoulder is a common condition that affects the working population. The longevity and severity of symptoms often results in great economic burden to health services and absence from work. This prospective cohort study aimed to investigate whether early intervention with arthroscopic capsular release resulted in improvement of symptoms and any potential economic benefit to society. Patients were recruited prospectively. Data was gathered by way of questionnaire to ascertain demographics, previous primary care treatment and absence from work. Oxford Shoulder Score (OSS) was also calculated. Arthroscopic capsular release was performed and further data gathered at four week post-operative follow up. Economic impact of delay to treatment and cost of intervention was calculated using government data from the national tariff which costs different forms of treatment. Statistical analysis was then performed on the results. Twenty five patients enrolled. Mean pre-operative OSS: 37.4 (range 27–58, SD 7.4). Mean post-operative OSS: 15.9 (range 12–22, SD 2.3). P<0.01. Mean improvement in OSS: 21.5 (range 12–38, SD 7.1). The cost of non-operative treatment per patient was £3954. The cost of arthroscopic capsular release per patient was £1861, a difference of £2093. There were no complications. Arthroscopic capsular release improved shoulder function on OSS within four weeks. The cost of arthroscopic capsular release is significantly less than the cost of treating the patients non-operatively. Early surgical intervention may improve symptoms quickly and reduce economic burden of the disease. A randomised controlled trial comparing timings of intervention would further elucidate potential benefits

Introduction: Significant internal rotation limitation is thought to be due to posterior capsular thickening and therefore adding a posterior release to the anterior and inferior releases seems sensible. However, this is technically more difficult. Aims: To assess the overall outcome of arthroscopic capsular release and to establish whether inclusion of a posterior capsular release has an additional beneficial. Methods: 48 patients with primary or secondary frozen shoulder in whom conservative physiotherapy had failed were included. 27 had an anterior and inferior release only, whilst the 21 included a posterior release. All data was collected prospectively. Results: Aetiology of the frozen shoulder was primary (22), diabetic (7), post-traumatic (7) and post-operative (11). There a highly significant improvement in Constant score (P < 0.001) and range of motion (P< 0.001) by 5 months in both groups. The mean satisfaction score (minimum 1 and maximum 10) was 7 post-operatively. There was no significant difference in Constant Score between the two groups (P = 0.56) and no significant difference in the improvement of the range of motion, in particular internal rotation (P=0.35). Conclusion: There was an overall rapid significant improvement following arthroscopic capsular release, but no significant difference in the overall outcome with the addition of a posterior release. Clinical relevance: Adding a posterior release to an arthroscopic capsulectomy does not seem to add any significant benefit to the outcome

Introduction: Upper root injuries (C5–C6±C7) account for 75 % of all obstetric brachial plexus palsies (OBPP). Among them, about thirty percent develop a medial contracture of the shoulder due to an imbalance between strong internal rotators and weak external rotators. This causes glenohumeral deformities. To decrease the internal contracture it had been proposed either to release the subscapularis (Sever procedure) or to perform a capsular release (Fairbank procedure). Arthroscopic capsular release was proposed in young patient to reduce the medial contracture. Material & methods: Six children with an average age of 23 months and 1 case aged 12 years old, had a medial contracture of the shoulder secondary to a C5–C6 ( 3 cases) or C5–C7 (4 cases) obstetrical palsy. An arthroscopic evaluation of the deformities was performed in 3 cases. Next a surgical subscapularis release was applied in association with a latissimus dorsi transfer. An arthroscopic evaluation of the joint associated with an arthroscopic capsular release (release of the coracohumeral ligament) was performed in 4 cases. In addition, the latissimus dorsi was transfered. Pre and Post operative passive external rotation were measured in degrees in R1 position. Pre and post operative medial rotation were evaluated according to the Mallet classification. A comparative evaluation of the glenohumeral deformities were performed between pre-operative MRI and arthroscopic results. Results: An arthroscopic evaluation of the glenohumeral joint was performed in 6 cases. In one case the arthroscopic evaluation could not be performed. In the 6 cases, arthroscopy confirmed the MRI lesion : 3 posterior subluxations, 1 posterior luxation and 2 normal joints. The subscapularis release allowed an increase in the passive lateral rotation of an average of 50°. However, a decrease of 1 point in the medial rotation was noted according to Mallet evaluation. The coracohumeral ligament arthroscopic release allowed an increase in the passive lateral rotation of an average of 60° without decreasing the passive medial rotation. Whatever the method used, a reduction of the subluxation of the glenohumeral joint was obtained. Discussion & Conclusion: Medial contracture of the shoulder may begin in the first two years of life and an early reduction with muscular release and transfers was proposed. However, the precise nature of the progressive limitation of the external passive rotation remains unclear. Is the limitation due to a contracture of the medial rotators or a capsular retraction or a combination of both? Harryman demonstrated the role of the rotator interval capsule and coracohumeral ligament in limiting the external rotation. Our hypothesis was that capsular retraction occurred before the muscular contracture. As a result we decided to perform a capsular release in patients under 24 months. The results on the passive external rotation were similar with both methods. Although, the technique of an arthroscopic release was difficult and demanding, it appears that this technique is beneficial as it allows an evaluation of the joint deformity and treatment of the contracture in the same time. Arthroscopic release is a safe but demanding technique which allows an increase in the external passive rotation in OBPP. It should be noted that this technique requires a significant practice

Background. Frozen Shoulder is a common condition which causes significant morbidity in people of working age. The 2 most popular forms of surgical treatment for this condition are Manipulation under Anaesthesia (MUA) or MUA plus Arthroscopic Capsular Release (ACR). Both treatment modalities are known to give good results, but no-one has compared the two to see which is better. Aim. To compare the outcome in patients with primary frozen shoulder, who are treated by either MUA or MUA plus ACR. Methods. 56 patients with primary frozen shoulder were treated by either MUA or MUA plus ACR. Each patient had their American Shoulder and Elbow Score (ASES), and their Oxford Shoulder Score (OSS) measured pre- and post-operatively. Results. The patients who had MUA plus ACR had a mean ASES of 19.6 pre-operatively, 78.3 at 6 months, and a mean of 80.1 at 12 months. The mean OSS was 32.5 pre-operatively, 53.6 at 6 months and 53.8 at 12 months. The patients who had a MUA had a mean ASES of 28.7 pre-operatively, 57.9 at 6 months and 58 at 12 months. The mean OSS was 33 pre-operatively, 42.5 at 6 months and 48 at 12 months. Conclusions. Both treatments give good results; MUA plus ACR give significantly superior results at 6 to 12 months post-operatively. However, there is no significant difference beyond 12 months

Background – Frozen Shoulder is a common condition which causes significant morbidity in people of working age. The 2 most popular forms of surgical treatment for this condition are Manipulation under Anaesthesia (MUA) or MUA plus Arthroscopic Capsular Release (ACR). Both treatment modalities are known to give good results, but no-one has compared the 2 to see which is better. Aim – To compare the outcome in patients with primary frozen shoulder, who are treated by either MUA or MUA plus ACR. Method – 61 patients with primary frozen shoulder were treated by either MUA or MUA plus ACR. Each patient had their American Shoulder and Elbow Score (ASES), and their Oxford Shoulder Score (OSS) measured pre and post-operatively. Results – The patients who had MUA plus ACR had a mean ASES of 24.8 preoperatively, 64 at 4 months, and a mean of 75.4 at 12 months. The mean OSS was 32.5 pre-operatively, 48.5 at 4 months and 53.4 at 12months. The patients who had a MUA had a mean ASES of 28.7 pre-operatively, 60.9 at 4months and 69.6 at 12months. The mean OSS was 33 preoperatively, 46.5 at 4 months and 50.9 at 12 months. Conclusions – Both treatments give good results. MUA plus ACR give superior numerical results at 6 to 12 months post-operatively, however, these figures did not reach statistical significance

Introduction: Idiopathic Adhesive capsulitis [IAC] of the shoulder is a self limited condition that can cause significant morbidity. Most patients (90%) respond to conservative management and those who fails (10%) undergo manipulation under anaesthesia (MUA) Patients who are refractory to both treatments, benefits from arthroscopic capsular release. Aim: To assess the efficacy of arthroscopic capsular release in patients with IAC refractory to physiotherapy and MUA. Also to compare the clinical outcome between arthroscopic capsular release and MUA. Materials and methods: We studied 59 patients with IAC, divided into 2 groups. Group A [36patients] had MUA and Group B [23 patients] underwent arthroscopic capsular release. The mean age was (54years). The mean follow up was 21 and 9 months for group A and B respectively. Results: We assessed our results according to three parameters:. Final outcome using the Constant and Murley score. The improvement in the score averaged 42 and 47 points in group A and B respectively. Early Post operative pain using visual analogue score (VAS) average of 6 and 3 in group A and B respectively. Overall patient satisfaction: 81% in group A and 89% in group B. Conclusion:. Patients with IAC who fails to respond physiotherapy and MUA do well after arthroscopic capsular release with little operative morbidity. Complete normal functional outcome of shoulder is not a prerequisite for patient satisfaction

Aims. This systematic review places a recently completed multicentre randomized controlled trial (RCT), UK FROST, in the context of existing randomized evidence for the management of primary frozen shoulder. UK FROST compared the effectiveness of pre-specified physiotherapy techniques with a steroid injection (PTSI), manipulation under anaesthesia (MUA) with a steroid injection, and arthroscopic capsular release (ACR). This review updates a 2012 review focusing on the effectiveness of MUA, ACR, hydrodilatation, and PTSI. Methods. MEDLINE, Embase, PEDro, Science Citation Index, Clinicaltrials.gov, CENTRAL, and the World Health Organization (WHO) International Clinical Trials Registry were searched up to December 2018. Reference lists of included studies were screened. No language restrictions applied. Eligible studies were RCTs comparing the effectiveness of MUA, ACR, PTSI, and hydrodilatation against each other, or supportive care or no treatment, for the management of primary frozen shoulder. Results. Nine RCTs were included. The primary outcome of patient-reported shoulder function at long-term follow-up (> 6 months and ≤ 12 months) was reported for five treatment comparisons across four studies. Standardized mean differences (SMD) were: ACR versus MUA: 0.21 (95% confidence interval (CI) 0.00 to 0.42), ACR versus supportive care: -0.13 (95% CI -1.10 to 0.83), and ACR versus PTSI: 0.33 (95% CI 0.07 to 0.59) and 0.25 (95% CI -0.34 to 0.85), all favouring ACR; MUA versus supportive care: 0 (95% CI -0.44 to 0.44) not favouring either; and MUA versus PTSI: 0.12 (95% CI -0.14 to 0.37) favouring MUA. None of these differences met the threshold of clinical significance agreed for the UK FROST and most confidence intervals included zero. Conclusion. The findings from a recent multicentre RCT provided the strongest evidence that, when compared with each other, neither PTSI, MUA, nor ACR are clinically superior. Evidence from smaller RCTs did not change this conclusion. The effectiveness of hydrodilatation based on four RCTs was inconclusive and there remains an evidence gap. Cite this article: Bone Jt Open 2021;2(9):773–784

There is little published information on the health impact of frozen shoulder. The purpose of this study was to assess the functional and health-related quality of life outcomes following arthroscopic capsular release (ACR) for contracture of the shoulder. Between January 2010 and January 2012 all patients who had failed non-operative treatment including anti-inflammatory medication, physiotherapy and glenohumeral joint injections for contracture of the shoulder and who subsequently underwent an ACR were enrolled in the study. A total of 100 patients were eligible; 68 underwent ACR alone and 32 had ACR with a subacromial decompression (ASD). ACR resulted in a highly significant improvement in the range of movement and functional outcome, as measured by the Oxford shoulder score and EuroQol EQ-5D index. The mean cost of a quality-adjusted life year (QALY) for an ACR and ACR with an ASD was £2563 and £3189, respectively. . ACR is thus a cost-effective procedure that can restore relatively normal function and health-related quality of life in most patients with a contracture of the shoulder within six months after surgery; and the beneficial effects are not related to the duration of the presenting symptoms. Cite this article: Bone Joint J 2013;95-B:942–6

The February 2023 Shoulder & Elbow Roundup. 360. looks at: Arthroscopic capsular release or manipulation under anaesthesia for frozen shoulder?; Distal biceps repair through a single incision?; Distal biceps tendon ruptures: diagnostic strategy through physical examination; Postoperative multimodal opioid-sparing protocol vs standard opioid prescribing after knee or shoulder arthroscopy: a randomized clinical trial; Graft healing is more important than graft technique in massive rotator cuff tear; Subscapularis tenotomy versus peel after anatomic shoulder arthroplasty; Previous rotator cuff repair increases the risk of revision surgery for periprosthetic joint infection after reverse shoulder arthroplasty; Conservative versus operative treatment of acromial and scapular spine fractures following reverse total shoulder arthroplasty

Aims. A pragmatic multicentre randomized controlled trial, UK FROzen Shoulder Trial (UK FROST), was conducted in the UK NHS comparing the cost-effectiveness of commonly used treatments for adults with primary frozen shoulder in secondary care. Methods. A cost utility analysis from the NHS perspective was performed. Differences between manipulation under anaesthesia (MUA), arthroscopic capsular release (ACR), and early structured physiotherapy plus steroid injection (ESP) in costs (2018 GBP price base) and quality adjusted life years (QALYs) at one year were used to estimate the cost-effectiveness of the treatments using regression methods. Results. ACR was £1,734 more costly than ESP ((95% confidence intervals (CIs) £1,529 to £1,938)) and £1,457 more costly than MUA (95% CI £1,283 to £1,632). MUA was £276 (95% CI £66 to £487) more expensive than ESP. Overall, ACR had worse QALYs compared with MUA (-0.0293; 95% CI -0.0616 to 0.0030) and MUA had better QALYs compared with ESP (0.0396; 95% CI -0.0008 to 0.0800). At a £20,000 per QALY willingness-to-pay threshold, MUA had the highest probability of being cost-effective (0.8632) then ESP (0.1366) and ACR (0.0002). The results were robust to sensitivity analyses. Conclusion. While ESP was less costly, MUA was the most cost-effective option. ACR was not cost-effective. Cite this article: Bone Jt Open 2021;2(8):685–695

Aims. The primary aim of this study was to evaluate the efficacy of distension arthrography in the treatment of adhesive capsulitis of the shoulder. The secondary aim was to assess which patient and procedural factors predicted the recurrence of symptoms after the procedure. Methods. All patients referred to our shoulder clinic over a ten-year period, between 2008 and 2018, with a clinical diagnosis of capsulitis and symptoms persisting for more than six months, were offered treatment with a distension arthrogram. All procedures were performed by one of five musculoskeletal radiologists, with a combination of steroid, local anaesthetic, and a distention volume of 10 ml, 30 ml, or 50 ml. Patient demographics, procedural details, recurrence of symptoms, and the need for further intervention were evaluated. Results. A total of 2,432 distension arthrograms were performed during the study period. The mean time between arthrography and analysis was 5.4 years (SD 4.4; 1 to 11). Recurrent symptoms occurred in 184 cases (7.6%), all of whom had a repeat distension arthrogram at a median of nine months (interquartile range (IQR) 6.0 to 15.3). The requirement for further intervention for persistent symptoms following arthrography was significantly associated with diabetes (p < 0.001) and bilateral capsulitis (p < 0.001). The volume of distension, either with air or saline, showed a dose-dependent advantage. Distension of 50 ml versus 30 ml showed a significantly decreased odds ratio for recurrence of 2.2 (95% confidence interval (CI) 1.6 to 3.0; p < 0.001). Capsule rupture (p = 0.615) or steroid dose (p = 0.275) did not significantly affect the rate of recurrence. There were no infections or neurovascular injuries. Following the second distension arthrogram, the symptoms resolved in 137 cases (74.5%) with no further intervention being required. An arthroscopic capsular release was ultimately required in 41 cases, comprising 1.7% of the entire cohort. Conclusion. We found a low rate of repeat intervention following distension arthrography in patients with adhesive capsulitis of the shoulder, at long term follow-up. Greater volumes of distension are associated with lower rates of recurrence independent of capsule rupture. Cite this article: Bone Joint J 2020;102-B(5):606–610

The April 2014 Shoulder & Elbow Roundup. 360 . looks at: arthroscopic capsular release successful after six months; MCIC in cuff surgery; analgesia following arthroscopic cuff repair; platelet-rich fibrin; and cuff tear and suprascapular nerve neuropathy?

Aim: The purpose of this study was to evaluate the results of arthroscopic capsular release in patients with primary adhesive capsulitis of the glenohumeral joint. Methods: Twenty-eight shoulders in 27 patients with adhesive capsulitis of the glenohumeral joint were treated with manipulation and arthroscopic capsular release. Their average age was 54.5 years (range, 39–67). During surgery, synovectomy and a combined anterior, posterior and inferior arthroscopic release using electrocautery or laser was performed. Range of motion and evaluation with the Constant score before and after surgery was performed in all patients. Results: The mean follow-up was 32 months (24–63). The mean Constant score significantly improved from 44.6 (28–52) preoperatively to 86.3 (73–52) postoperatively (p< 0.001, paired t-test). Range of motion for all planes significantly improved. Abduction improved from 72° preoperatively to 165° postoperatively; Internal rotation improved from 13° to 60° and external rotation from 10° to 75°. Subjectively all patients had remarkably less pain, and there were no complications. Conclusions: Our study suggest that arthroscopic treatment of primary adhesive capsulitis with capsular release is an effective and reliable method for restoring a painless motion of the glenohumeral joint

Frozen shoulder is a recognised complication following simple arthroscopic shoulder procedures, but its exact incidence has not been reported. Our aim was to analyse a single-surgeon series of patients undergoing arthroscopic subacromial decompression (ASD; group 1) or ASD in combination with arthroscopic acromioclavicular joint (ACJ) excision (group 2), to establish the incidence of frozen shoulder post-operatively. Our secondary aim was to identify associated risk factors and to compare this cohort with a group of patients with primary frozen shoulder. We undertook a retrospective analysis of 200 consecutive procedures performed between August 2011 and November 2013. Group 1 included 96 procedures and group 2 104 procedures. Frozen shoulder was diagnosed post-operatively using the British Elbow and Shoulder Society criteria. A comparative group from the same institution involved 136 patients undergoing arthroscopic capsular release for primary idiopathic frozen shoulder. . The incidence of frozen shoulder was 5.21% in group 1 and 5.71% in group 2. Age between 46 and 60 years (p = 0.002) and a previous idiopathic contralateral frozen shoulder (p < 0.001) were statistically significant risk factors for the development of secondary frozen shoulder. Comparison of baseline characteristics against the comparator groups showed no statistically significant differences for age, gender, diabetes and previous contralateral frozen shoulder. . These results suggest that the risk of frozen shoulder following simple arthroscopic procedures is just over 5%, with no increased risk if the ACJ is also excised. Patients aged between 46 and 60 years and a previous history of frozen shoulder increase the relative risk of secondary frozen shoulder by 7.8 (95% confidence interval (CI) 2.1 to 28.3)and 18.5 (95% CI 7.4 to 46.3) respectively. Cite this article: Bone Joint J 2015; 97-B:963–6

Frozen shoulder is commonly encountered in general orthopaedic practice. It may arise spontaneously without an obvious predisposing cause, or be associated with a variety of local or systemic disorders. Diagnosis is based upon the recognition of the characteristic features of the pain, and selective limitation of passive external rotation. The macroscopic and histological features of the capsular contracture are well-defined, but the underlying pathological processes remain poorly understood. It may cause protracted disability, and imposes a considerable burden on health service resources. Most patients are still managed by physiotherapy in primary care, and only the more refractory cases are referred for specialist intervention. Targeted therapy is not possible and treatment remains predominantly symptomatic. However, over the last ten years, more active interventions that may shorten the clinical course, such as capsular distension arthrography and arthroscopic capsular release, have become more popular. . This review describes the clinical and pathological features of frozen shoulder. We also outline the current treatment options, review the published results and present our own treatment algorithm.

Shoulder arthritis in the young adult is a deceptive title. The literature is filled with articles that separate outcomes based on an arbitrary age threshold and attempt to provide recommendations for management and even potential criteria for implanting one strategy over another using age as the primary determinant. However, under the age of 50, as few as one out of five patients will have arthritis that can be accurately classified as osteoarthritis. Other conditions such as post-traumatic arthritis, post-surgical arthritis including capsulorrhaphy arthropathy, and rheumatoid arthritis create a mosaic of pathologic bone and soft tissue changes in our younger patients that distort the conclusions regarding “shoulder arthritis” in the young adult. In addition, we are now seeing more patients with unique conditions that are still poorly understood, including arthritis of the pharmacologically performance-enhanced shoulder. Early arthritis in the young adult is often recognised at the time of arthroscopic surgery performed for other preoperative indications. Palliative treatment is the first option, which equals “debridement.” If the procedure fails to resolve the symptoms, and the symptoms can be localised to an intra-articular source, then additional treatment options may include a variety of cartilage restoration procedures that have been developed primarily for the knee and then subsequently used in the shoulder, including microfracture, and osteochondral grafting. The results of these treatments have been rarely reported with only case series and expert opinion to support their use. When arthritis is moderate or severe in young adults, non-arthroplasty interventions have included arthroscopic capsular release, debridement, acromioplasty, distal clavicle resection, microfracture, osteophyte debridement, axillary nerve neurolysis, and bicep tenotomy or tenodesis, or some combination of these techniques. Again, the literature is very limited, with most case series less than 5 years of follow-up. The results are typically acceptable for pain relief, some functional improvement, but not restoration to completely normal function from the patient's perspective. Attempts to resurface the arthritic joint have resulted in limited benefits over a short period of time in most studies. While a few remarkable procedures have provided reasonable outcomes, they are typically in the hands of the developer of the procedure and subsequently, other surgeons fail to achieve the same results. This has been the case with fascia lata grafting of the glenoid, dermal allografts, meniscal allografts, and even biologic resurfacing with large osteochondral grafts for osteoarthritis. Most surgical interventions that show high value in terms of improvement in quality of life require 10-year follow-up. It is unlikely that any of these arthroscopic procedures or resurfacing procedures will provide outcomes that would be valuable in terms of population healthcare; they are currently used on an individual basis to try to delay progression to arthroplasty, with surgeon bias based on personal experience, training, or expert opinion. Arthroplasty in the young adult remains controversial. Without question, study after study supports total shoulder arthroplasty over hemiarthroplasty once the decision has been made that joint replacement is the only remaining option

Shoulder resurfacing arthroplasty is a bone conserving option for patients with glenohumeral arthritis. We report the early results of this procedure at our unit with a minimum follow up of 2 years (mean follow up of 36 months). A historical analysis of prospectively collected clinical data was reviewed on a consecutive series of 22 patients (mean age of 73 years) with end stage gleno-humeral arthrosis who had undergone humeral resurfacing hemiarthroplasty performed by a single surgeon. Pain and function were assessed using the Oxford shoulder score and patient satisfaction was recorded. Radiographs were evaluated for implant loosening. 82% of patients had significant improvement in their oxford shoulder score from pre-operatively to two years post-operatively. Complications included one case of intra-operative conversion to a stemmed hemiarthroplasty due to fracture of the humeral head, one case of adhesive capsulitis that required MUA and arthroscopic capsular release and two cases of revision to a total shoulder replacement for pain. Humeral resurfacing arthroplasty is a viable treatment option for glenohumeral arthritis with good short term results

Background: The treatment of post-traumatic elbow stiffness has seen many important changes over the years, particularly greater the development of arthroscopy. In this study mid-term clinical results of arthroscopy for post-traumatic elbow stiffness are evaluated in 15 sporting patients, with an average age of 32. Methods: 8 patients reported post-traumatic stiffness due to fracture of the radial head, 3 to fracture-dislocation, 1 to fracture of the radial diaphysis complicated by osteosynthesis, and the remaining 3 patients to stress syndromes with osteochondral detachment. Surgical treatment consists in debridment, arthroscopic capsular release, and removal of bone fragments by arthroscopy. Patients were followed-up from 4 up to 36 months, with a mean follow-up time of 18 months. Results: Results obtained have been good to excellent in 84% of cases with a average range in post-operative movement of 13–137° and reduction in pain symptomatology. Conclusion: In light of our mid-term clinical results on a small series of cases, arthroscopic surgical treatment would appear to be an acceptable option in management of the post-traumatic stiff elbow

Background. Adhesive capsulitis (frozen shoulder) is a debilitating condition affecting 2–5% of the adult population. Its aetiology is still unclear and there is no consensus on the most effective treatment. The aim of this retrospective study was to investigate the mid-term functional outcome of one specific treatment protocol. Methods. Patients with a diagnosis of idiopathic adhesive capsulitis treated by one orthopaedic surgeon between 2004 and 2008 were identified from outpatient clinic letters. All patients had initially received conservative treatment, consisting of physiotherapy with capsular stretches and subacromial injections. Patients in whom conservative treatment failed underwent an arthroscopic capsular release. At a minimum of two years following diagnosis patients were sent the Oxford Shoulder Score (OSS [0 to 48]), Western Ontario Rotator Cuff Index (WORC [0 to 2100]) and a satisfaction questionnaire by post. In addition case notes were reviewed and type of treatment and range of movement (ROM) recorded. Results. 60 patients with the diagnosis of idiopathic adhesive capsulitis were identified. 42 patients (70%) returned the completed questionnaires. Range of movement data was available from 43 patients (72%). Mean OSS was 41 (SD 10.7) and mean WORC 307 (SD 437.1). Analysis showed that patients in whom conservative treatment was successful had significantly better functional outcome scores in OSS and WORC and better ROM than patients who underwent surgery. Overall 33 patients (79%) were satisfied or very satisfied with the outcome of their treatment. Conclusion. This study shows that patients who respond to conservative treatment have a better functional outcome than patients who undergo surgery following failed conservative treatment. Further studies are needed to directly compare the two types of treatment

To assess the indication and role of shoulder arthroscopy for the problem shoulder arthroplasty. Between 1995–2000, 28 patients who had excessive pain or limitation of motion following a shoulder arthroplasty underwent arthroscopy. A pre-operative diagnosis was made in 13 out of the 28 patients. Of the 13 patients who had a pre-operative diagnosis an impingement syndrome was confirmed and successfully treated by arthroscopic subacromial decompression in 10, a rotator cuff tear was confirmed and debrided in two and in one loose bodies removed. Of the 15 patients who did not have a pre-operative diagnosis a post-arthroplasty capsular fibrosis was found in seven, six undergoing a successful arthroscopic capsular release. Loose or worn components were found in four of the shoulders, a small cuff tear was identified in one, a florid synovitis was present in another, loose cement was found in a further patient and in one no abnormality could be found. During the procedures orientation within the joint was often hindered by the reflection from the prosthesis making it difficult to differentiate between the real and mirror images of both the tissues and arthroscopic instruments. Access was also often compromised. Arthroscopy following shoulder arthroplasty is useful for the diagnosis and treatment of pain and loss of motion in selected patients, but can be technically demanding. Diagnostic arthroscopy following shoulder arthroplasty should be considered for patients suffering from pain in whom no cause can be found using less invasive investigations