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Arthroscopic Capsular Release for the Management of Adhesive Capsulitis
Supportive observation is the mainstay in the management of adhesive capsulitis. Pain can be managed with oral analgesics and intermittent intra-articular corticosteroid injections. As the patient’s pain decreases, a gentle stretching program, either a therapist-led program or a self-directed home program, may be considered. Additional intervention should be reserved for truly recalcitrant cases. In patients requiring intervention, the two most common treatment
options are manipulation under anesthesia and arthroscopic capsular release followed by manipulation. In general, patients with adhesive capsulitis should be treated with supportive therapies for 6 months before an intervention, either manipulation or surgical release, is considered. The author of this chapter prefers arthroscopic capsular release followed by manipulation over manipulation alone for several reasons. An arthroscopic approach allows the surgeon to perform selected releases dictated by the patient’s physical examination and allows for release of the biceps tendon (described later in this chapter). In addition, iatrogenic complications such as proximal humerus fractures,
nerve injuries, and rotator cuff tears may be less likely to occur when releases are performed before manipulation.