Review Question - QID 213965

The coracoacromial ligament is not released during arthroscopic release for adhesive capsulitis. Instead, this is used as a landmark for complete release of the rotator interval.

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 (lasting >3-6 months). 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 arthroscopic capsular release. The SGHL and coracohumeral ligaments are both structures within the rotator interval. The coracoacromial ligament is used as a superficial landmark for a complete interval release.

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.

Tetro et al. review arthroscopic release of the rotator interval and coracohumeral ligament in a cadaveric model. They report that arthroscopic release from the supraspinatus to the subscapularis resulted in complete resection of the coracohumeral ligament in all specimens without injury to the biceps tendon, supraspinatus, subscapularis or conjoint tendons. They conclude that arthroscopic rotator interval release leads to complete release of the coracohumeral ligament if the dissection is taken superficially to the level of the coracoacromial ligament.

Incorrect Answers:
Answers 1-4: The superior glenohumeral ligament, middle glenohumeral ligament, inferior glenohumeral ligament, and coracohumeral ligament are all released when performing arthroscopic release for adhesive capsulitis.