This document discusses the surgical management of shoulder stiffness. It notes that 89.5% of cases can be treated non-operatively, while 10% may require release within 12 months. The main options for surgeons are manipulation under anesthesia (MUA) and arthroscopic capsular release. MUA involves manually moving the joint to break up adhesions, while arthroscopic release allows visual inspection and cutting of restrictive tissue. Both have advantages and disadvantages, and arthroscopic release aims to precisely release the capsule under direct visualization.

1. Surgical
management of
stiffness
Puneet Monga
Wrightington Upper Limb Unit

2. Scope of the talk
• Surgical management

3. Management
• Options?

4. Operative treatment
• 89.5% can be treated non-operatively
• 10% pts’ needed release at 12 months
from the onset of symptoms
Levine WN, Kashyap CP, Bak SF, Ahmad CS, Blaine TA, Bigliani LU. Nonoperative management of idiopathic adhesive capsulitis.J
Shoulder Elbow Surg. 2007 Sep-Oct;16(5):569-73.

5. Options for a
Surgeon
• MUA
• Arthroscopic Release

6. MUA
Principle
The Codman’s Paradox
Image courtesy:
orthop.washington.edu

7. MUA
• Procedure
• Advantages
• Disadvantages
Image courtesy:
www.zadeh.co.uk

8. A’scopic capsular
release
Principle
Release under vision

9. Examination under
Anesthesia

10. Examination under Anesthesia: Normal

11. Portals

12. Normal A’scopy

13. Normal Rotator Interval

14. A’scopic images

19. I Boutros, M Snow, L Funk. Posterior Arthroscopic Capsular Release in Frozen Shoulder, a Prospective Cohort Study. Arthroscopy. 2009
Jan;25(1):19-23.

20. Examination after release

21. A Thought....
• Stiffness for Patients is very distressing
• Capsular release is very empowering

22. Thanks........