Review Question - QID 210158

Release of the posterior capsule (label H) would result in improved cross-body adduction (adduction of the forward-flexed shoulder) intra-operatively.

Adhesive capsulitis (frozen shoulder) is a fibroblastic proliferation of capsular tissue of unknown etiology resulting in pain and loss of both passive and active shoulder range of motion. While nonoperative management is successful in the majority of patients, surgery may be considered in recalcitrant cases. Classically, the rotator interval is released to improve external rotation, while the posterior capsule is released to improve internal rotation and cross-body adduction.

Kim et al. performed a randomized controlled trial of 75 patients with shoulder stiffness to compare outcomes in patients with and without posterior extended capsular release. Despite intra-operative improvements, at final follow-up, the authors found no difference in forward flexion, external rotation, and internal rotation between the groups. They concluded that posterior extended capsular release may not be necessary in the arthroscopic management of shoulder stiffness.

Snow et al. evaluated the efficacy of posterior arthroscopic release in 48 patients with frozen shoulder. The authors found that, compared to the group that underwent only an anterior and inferior release, patients who also had a posterior release had no difference in Constant Scores and range of motion, particularly internal rotation. They concluded there was no significant difference in outcome with the addition of a posterior release in patients with a frozen shoulder.

Illustration A shows the capsular and ligamentous structures important for glenohumeral stability.

Incorrect Answers:
Answer 1: A shows the long head of the biceps. While its role as a pain generator in various shoulder pathologies has been debated, release of the long head of the biceps would not increase cross-body adduction.
Answer 2: C shows the middle glenohumeral ligament (MGHL). The MGHL resists anterior and posterior translation in ~45 degrees of abduction.
Answer 4: E shows the anterior band of the inferior glenohumeral ligament (AB-IGHL), while C shows the MGHL. The AB-IGHL is the primary restraint to anterior and inferior translation with the arm at 90 degrees abduction and maximum external rotation.
Answer 5: B shows the superior glenohumeral ligament (SGHL), while D shows the anterior capsule. The SGHL is a restraint to inferior translation at 0 degrees of abduction.