Orthopaedic Surgery, Hospital San Juan de Dios – Mutua Maz, Pamplona, Spain

Purpose: In 1945 Julius Neviaser described the pathology of adhesive capsulitis as a thickening and retraction of the capsule which “sticks “around the humeral head. One of the treatments advocated for the Frozen Shoulder is manipulation under

GA. In those cases arthrolisis is achieved, tears of the capsule are confirmed arthroscopically in an area between 4 and 8 o'clock. However, when an MUA is performed, not always is it possible to achieve arthrolisis. In this group of patients with unsuccessful MUA, arthroscopy showed a marked thickening and obliteration of the normal aspect of the rotator interval: no visualization of the subscapularis and the GHM ligament. Aims : To present two types of capsular pathology in frozen shoulder and to perform the

treatment according to those types.

Material and Methods: Between 2000 and 2008, 63 patients (63 shoulders) diagnosed of idiopathic frozen shoulder underwent MUA and arthroscopy. Constant pre op and post op performed. Prospective study.

Results: Fifty-one were easily manipulated and arthrolisis achieved. All of them showed a torn capsule and the rotator interval area was visible. Twelve shoulders could not be manipulated. Arthroscopy showed a thickening of the rotator interval and obliteration of the subscapularis view. The treatment in those cases was a resection of the thick tissue with the Vapr until an anatomical aspect (visualization of subscapularis) was achieved. All shoulder regained good range of movement : forward flexion was 160º, abduction 160º, internal rotation L2 and external rotation 30º. Pain disappeared in all of them. Constant moved from 47 pre op to an 85 post op.

Conclusion: In 2007 Uhthoff & Boileau suggested that fibroplasias (involving the entire joint capsule) and contracture (involving anterior capsular structures) are two distinct processes. Our results seem to agree to those observations. The group of patients which manipulation was achieved and the rotator interval was visible will belong to the fibroplasia group. The other group (no MUA and obliteration of the rotator interval) will belong to the contracture group. MUA could be achieved in most frozen shoulders. However, in case of contracture, arthroscopic release should be performed to remove tissue at the interval area until a normal anatomic aspect is achieved. Since 2000 all our shoulder are prepared for MUA and arthroscopy.