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A Thickened Coracohumeral Ligament and Superomedial Capsule Limit Internal Rotation of the Shoulder Joint: Report of Three Cases.

Koide M, Hamada J, Hagiwara Y, Kanazawa K, Suzuki K - Case Rep Orthop (2016)

Bottom Line: Although the precise pathogenesis of frozen shoulder is unclear, thickened capsule and coracohumeral ligament (CHL) have been documented to be one of the most specific manifestations.Although MUA could release the posterior capsule, internal rotation did not improve in our cases.After release of the thickened CHL, range of motion of internal rotation was significantly improved.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.

ABSTRACT
Adhesive capsulitis of the shoulder (also known as frozen shoulder) is a painful and disabling disorder with an estimated prevalence ranging from 2% to 5% in the general population. Although the precise pathogenesis of frozen shoulder is unclear, thickened capsule and coracohumeral ligament (CHL) have been documented to be one of the most specific manifestations. The thickened CHL has been understood to limit external rotation of the shoulder, and restriction of internal rotation of the shoulder has been believed to be related to posterior capsular tightness. In this paper, three cases of refractory frozen shoulder treated through arthroscopic release of a contracted capsule including CHL were reported. Two cases in which there is recalcitrant severe restriction of internal rotation after manipulation under anesthesia (MUA) were finally treated with arthroscopic surgery. Although MUA could release the posterior capsule, internal rotation did not improve in our cases. After release of the thickened CHL, range of motion of internal rotation was significantly improved. This report demonstrates the role of the thickened CHL in limiting the internal rotation of the shoulder. We highlight the importance of release of thickened CHL in addition to the pancapsular release, in case of severe limitation of internal rotation of shoulder.

No MeSH data available.


Related in: MedlinePlus

Arthroscopic findings in Case 1. SSC: subscapularis; RI: rotator interval; HH: humeral head; CP: coracoid process; PIGHL: posterior band of inferior glenoid humeral ligament. (a) Arrow shows that the posterior capsule was cut with a fresh stump. (b) Thickened RI and CHL remained. (c) Thickened anterior side of the CHL can be seen from the joint side.
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fig1: Arthroscopic findings in Case 1. SSC: subscapularis; RI: rotator interval; HH: humeral head; CP: coracoid process; PIGHL: posterior band of inferior glenoid humeral ligament. (a) Arrow shows that the posterior capsule was cut with a fresh stump. (b) Thickened RI and CHL remained. (c) Thickened anterior side of the CHL can be seen from the joint side.

Mentions: Arthroscopic surgery after the manipulation showed the presence of synovial proliferation around the rotator interval, CHL, middle glenohumeral ligament, and the anterior band of the inferior glenohumeral ligament. The posterior IGHL (PIGHL) and posterior capsule had been ruptured with a fresh stump (Figure 1(a)); however, the thickened CHL remained (Figure 1(b)). After release of the rotator interval, the thickened CHL that covered both anteriorly and posteriorly the subscapularis tendon still remained. The thickened anterior side of the CHL was resected to visualize the coracoid base (Figure 1(c)), and a portion of the CHL between the subscapularis tendon and the labrum was also resected. After the complete resection of the thickened CHL, a smooth sliding movement of the subscapularis with internal and external rotation of the shoulder joint could be achieved. The sliding motion of the supraspinatus was also inhibited due to adhesion in the superomedial capsule because of synovial proliferation. The release of the adhesion between the superomedial capsule and the long head of the biceps (LHB) allowed the supraspinatus to slide smoothly. Additionally, the nonruptured anterior and inferior capsules were released by manipulation. Three weeks after the operation, the patient had almost regained full ROM in the shoulder joint and specifically internal rotation. Internal rotation ROM was fully regained and the patient reported no pain or inability to perform activities of daily life or sports activities 8.6 months after the operation (Table 1).


A Thickened Coracohumeral Ligament and Superomedial Capsule Limit Internal Rotation of the Shoulder Joint: Report of Three Cases.

Koide M, Hamada J, Hagiwara Y, Kanazawa K, Suzuki K - Case Rep Orthop (2016)

Arthroscopic findings in Case 1. SSC: subscapularis; RI: rotator interval; HH: humeral head; CP: coracoid process; PIGHL: posterior band of inferior glenoid humeral ligament. (a) Arrow shows that the posterior capsule was cut with a fresh stump. (b) Thickened RI and CHL remained. (c) Thickened anterior side of the CHL can be seen from the joint side.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4829705&req=5

fig1: Arthroscopic findings in Case 1. SSC: subscapularis; RI: rotator interval; HH: humeral head; CP: coracoid process; PIGHL: posterior band of inferior glenoid humeral ligament. (a) Arrow shows that the posterior capsule was cut with a fresh stump. (b) Thickened RI and CHL remained. (c) Thickened anterior side of the CHL can be seen from the joint side.
Mentions: Arthroscopic surgery after the manipulation showed the presence of synovial proliferation around the rotator interval, CHL, middle glenohumeral ligament, and the anterior band of the inferior glenohumeral ligament. The posterior IGHL (PIGHL) and posterior capsule had been ruptured with a fresh stump (Figure 1(a)); however, the thickened CHL remained (Figure 1(b)). After release of the rotator interval, the thickened CHL that covered both anteriorly and posteriorly the subscapularis tendon still remained. The thickened anterior side of the CHL was resected to visualize the coracoid base (Figure 1(c)), and a portion of the CHL between the subscapularis tendon and the labrum was also resected. After the complete resection of the thickened CHL, a smooth sliding movement of the subscapularis with internal and external rotation of the shoulder joint could be achieved. The sliding motion of the supraspinatus was also inhibited due to adhesion in the superomedial capsule because of synovial proliferation. The release of the adhesion between the superomedial capsule and the long head of the biceps (LHB) allowed the supraspinatus to slide smoothly. Additionally, the nonruptured anterior and inferior capsules were released by manipulation. Three weeks after the operation, the patient had almost regained full ROM in the shoulder joint and specifically internal rotation. Internal rotation ROM was fully regained and the patient reported no pain or inability to perform activities of daily life or sports activities 8.6 months after the operation (Table 1).

Bottom Line: Although the precise pathogenesis of frozen shoulder is unclear, thickened capsule and coracohumeral ligament (CHL) have been documented to be one of the most specific manifestations.Although MUA could release the posterior capsule, internal rotation did not improve in our cases.After release of the thickened CHL, range of motion of internal rotation was significantly improved.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.

ABSTRACT
Adhesive capsulitis of the shoulder (also known as frozen shoulder) is a painful and disabling disorder with an estimated prevalence ranging from 2% to 5% in the general population. Although the precise pathogenesis of frozen shoulder is unclear, thickened capsule and coracohumeral ligament (CHL) have been documented to be one of the most specific manifestations. The thickened CHL has been understood to limit external rotation of the shoulder, and restriction of internal rotation of the shoulder has been believed to be related to posterior capsular tightness. In this paper, three cases of refractory frozen shoulder treated through arthroscopic release of a contracted capsule including CHL were reported. Two cases in which there is recalcitrant severe restriction of internal rotation after manipulation under anesthesia (MUA) were finally treated with arthroscopic surgery. Although MUA could release the posterior capsule, internal rotation did not improve in our cases. After release of the thickened CHL, range of motion of internal rotation was significantly improved. This report demonstrates the role of the thickened CHL in limiting the internal rotation of the shoulder. We highlight the importance of release of thickened CHL in addition to the pancapsular release, in case of severe limitation of internal rotation of shoulder.

No MeSH data available.


Related in: MedlinePlus