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      Clinical outcome of arthroscopic capsular release for frozen shoulder: essential technical points in 255 patients

      research-article
      Journal of Orthopaedic Surgery and Research
      BioMed Central
      Frozen shoulder, Arthroscopic capsular release, LHB, CH ligament

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          Abstract

          Background

          The purpose of this study was to investigate the long-term clinical outcome and its related factors regarding the severity of adhesion of CH ligament over long head of biceps (LHB) after shoulder arthroscopic capsular release for frozen shoulder with technical points in 255 patients.

          Methods

          We performed arthroscopic capsular release for frozen shoulder in 267 shoulders of 255 patients, 112 males and 143 females, with mean age of 56.39 years, mean disease duration periods of 0.934 years for conservative treatment, and mean follow-up periods of 5.6 years. The frozen shoulders were divided based on the severity of adhesion between CH ligament over LHB: those with slight degree of synovitis, no adhesion by obtuse rod, and slight thickness of the released capsule (type A), those with moderate degree of synovitis, moderate adhesion of the LHB by obtuse rod, and moderate thickness of the released capsule (type B), and those with severe degree of synovitis, severe adhesion of the LHB by obtuse rod, and severe thickness of the released capsule adhesion and a flatly shaped LHB (type C). We assessed the clinical factors related to the scoring of the shoulders by the criteria of the American Shoulder and Elbow Surgeons (ASES) and the relationship with severity of LHB adhesion.

          Results

          The ASES scores improved at 5 years postoperatively in all three groups significantly. The range of motion also significantly improved in all three groups significantly. The severity of the LHB adhesion over the CH ligament was confirmed to influence the ASES scores before and after the arthroscopic capsular release. There was a significant difference between type A and type B ( p < 0.0001) or type C ( p < 0.0001) before and after surgery. Logistic regression analysis showed disease duration, diabetes mellitus (DM), and ASES score were significantly associated to the severity type of LHB, especially DM has high odds ratio and was a risk factor for LHB adhesion. There is no adverse event including dislocation or axillary nerve injury and recurrence after arthroscopic capsular release at 5 years after surgery.

          Conclusions

          The long-term results of arthroscopic capsular release in frozen shoulder were confirmed in 255 patients. The severity of LHB adhesion over the CH ligament, a pathological condition related to DM as a risk factor, seems to play an important role in the functional outcome. Therefore, the sufficient release of LHB was essential technical point for arthroscopic capsular release in frozen shoulder.

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          Most cited references21

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          • Article: not found

          American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness.

          The purpose of this study was to examine the psychometric properties of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), patient self-report section. Patients with shoulder dysfunction (n = 63) completed the ASES, The University of Pennsylvania Shoulder Score, and the Short Form-36 during the initial evaluation, 24 to 72 hours after the initial visit, and after 3 to 4 weeks of physical therapy. The test-retest reliability (intraclass correlation coefficient[1-way random-effects], 0.84; 95% CI lower limit, 0.75) and internal consistency (Cronbach alpha, 0.86) values were acceptable. The standard error of the measure was 6.7 ASES points (90% CI, 11.0). Construct and discriminant validity was demonstrated. Responsiveness was demonstrated with a standardized response mean of 1.5 and an effect size of 1.4. The minimal detectable change was 9.7 ASES points (90% CI, 16), and the minimal clinically important difference was 6.4 ASES points. The results indicate that the ASES is a reliable, valid, and responsive outcome tool.
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            • Article: not found

            Current review of adhesive capsulitis.

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              • Record: found
              • Abstract: found
              • Article: not found

              Diagnosis and management of adhesive capsulitis

              Adhesive capsulitis is a musculoskeletal condition that has a disabling capability. This review discusses the diagnosis and both operative and nonoperative management of this shoulder condition that causes significant morbidity. Issues related to medications, rehabilitation, and post surgical considerations are discussed.
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                Author and article information

                Contributors
                +813-3810-2900 , kanbekatakori@gmail.com
                Journal
                J Orthop Surg Res
                J Orthop Surg Res
                Journal of Orthopaedic Surgery and Research
                BioMed Central (London )
                1749-799X
                16 March 2018
                16 March 2018
                2018
                : 13
                : 56
                Affiliations
                ISNI 0000 0004 1761 1035, GRID grid.413376.4, Department of Orthopaedic Surgery, , Tokyo Women’s Medical University, Medical Center East, ; 2-1-10 Nishiogu, Arakawa, Tokyo, Japan
                Author information
                http://orcid.org/0000-0002-0703-4938
                Article
                758
                10.1186/s13018-018-0758-5
                5857121
                29548325
                b9b5953c-f403-4d75-aacf-7b418fa0561b
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 13 March 2017
                : 6 March 2018
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Surgery
                frozen shoulder,arthroscopic capsular release,lhb,ch ligament
                Surgery
                frozen shoulder, arthroscopic capsular release, lhb, ch ligament

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