Arthroscopic treatment of frozen shoulder: Techniques, pearls, and pitfalls

Frozen shoulder (FS) is one of the most commonly occurring shoulder disorders and one that most orthopaedic surgeons will face on a regular basis. While traditionally considered a minor problem that resolves over time without treatment, scientific studies show that a large number of patients with FS have lasting problems that affect their ability to work. This is especially troublesome for blue-collar workers engaged in manual labour. Cortisone injections and/or prednisolone medication may be helpful in the early phase when inflammation prevails. When a non-operative regime for FS fails surgery may be indicated. For orthopaedic surgeons proficient in shoulder surgery, we recommend performing an arthroscopic capsulectomy. For this technical review, we have drawn upon our extensive clinical experience (with intra-operative pictures) and online PubMed searches on frozen shoulder and adhesive capsulitis. The goal of arthroscopic FS surgery is to re-establish normal ROM by a capsulotomy. In this presentation, we aim to describe in detail how FS can be treated arthroscopically with a capsulotomy. This technical manual/review provides a step-by-step description of the surgical technique of arthroscopic treatment of FS and highlights some pearls of wisdom and potential pitfalls, based on our extensive experience. Proficiency in shoulder arthroscopy is a prerequisite, especially because the capsule is tight and the joint space small. For an orthopaedic surgeon already familiar with arthroscopy of this joint, the techniques presented should be rather easily incorporated into his or her surgical armamentarium.