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Supraspinatus tear completion and repair
21%
338/1589
Rotator interval release
50%
798/1589
Capsular plication
4%
69/1589
Subacromial decompression
22%
350/1589
Distal clavicle resection
1%
10/1589
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This patient has adhesive capsulitis and has failed conservative measures. The next step in treatment should be a circumferential arthroscopic capsular release and manipulation under anesthesia. Adhesive capsulitis is characterized by functional loss of both passive and active shoulder range of motion. This occurs most commonly in middle-aged women and has a high association with hypothyroidism and diabetes. Treatment typically consists of physical therapy with a focus on stretching, however, manipulation under anesthesia (MUA) or arthroscopic capsular release may be needed for recalcitrant cases (>3-6 months). Diabetics have a 50% failure rate following MUA, and this is not a recommended treatment. The rotator interval, a triangular region between the anterior border of the supraspinatus and the superior border of the subscapularis, is a common source of restricted tissue and must be released during the circumferential arthroscopic capsular release. Neviaser et al. review the diagnosis and treatment of adhesive capsulitis. They report that other shoulder pathology may also produce similar symptoms, however, adhesive capsulitis must always be considered. They conclude that while most cases are self-limiting, continued functional deficits after >6 months of physical therapy warrant discussion about operative intervention. Neviaser et al. review the current treatment options for adhesive capsulitis. They report the importance of diagnosis and history, with adhesive capsulitis being characterized as a painful, gradual loss of both passive and active range of motion. They conclude that variable nomenclature, inconsistent staging, and various treatment options have likely led to confusing and contradictory recommendations in the literature. Incorrect Answers: Answer 1: Partial articular sided tears of 6mm or 50% may be treated with completion and repair. However, this patient’s primary issue is adhesive capsulitis and not rotator cuff pathology. Answer 3: Capsular plication is a tightening of the capsule and is commonly done for instability, not adhesive capsulitis. Answer 4: Subacromial bursectomy is typically performed for adhesive capsulitis, but an acromioplasty is not. Answer 5: Distal clavicle resection is performed for symptomatic AC joint arthritis, not adhesive capsulitis.
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