抄録
The purpose of this study was to reveal the clinical outcomes after arthroscopic pan-capsular release for refractory adhesive capsulitis of the shoulder. The patients who were diagnosed with frozen shoulder were treated with conservative treatment which included medications for pain and physiotherapy. Steroid injection to the glenohumeral joint has been utilized for pain relief since 2006. Subjects consisted of 35 patients who failed to respond to the conservative treatment and underwent arthroscopic pan-capsular release and who were followed for a minimum of 1 year. There were 20 males and 15 females with a mean age of 56.6 years old. Among them, 14 patients who had diabetes were deemed to have secondary frozen shoulder and the rest, 21 patients, were deemed to have as a primary frozen shoulder. Clinical outcomes were investigated using JOA score and ranges of motion (ROM) pre and post-operatively were also evaluated at the final follow-up which was at 19 months on average. Preoperatively, significant pain relief was obtained in patients who received steroid injections. The JOA score and ROM were significantly improved postoperatively in all patients. Postoperative ROM for internal rotation was significantly better in patients with primary frozen shoulder compared to those with secondary frozen shoulder. Further, although statistical difference was not observed, flexion and external rotation was also better in the primary group than in the secondary group. Since hyperglycemia leads to an increase in the cross-linkages in collagen, which may be responsible for the stiffness of the connective tissue, the patients with diabetic frozen shoulder would be more recalcitrant for treatments. In conclusion, steroid injection to the glenohumeral joint induces significant preoperative pain relief for patients with frozen shoulder. Arthroscopic pan-capsular release works well for both primary and secondary frozen shoulder without any complications. However, diabetic frozen shoulder is more recalcitrant in terms of ROM recovery even after the index procedure.
