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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 3. (a) Synovial proliferation in the rotator interval and the superomedial capsule. (b) The CHL from the coracoid process to the LHB was thickened and inflamed.
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fig3: Arthroscopic findings in Case 3. (a) Synovial proliferation in the rotator interval and the superomedial capsule. (b) The CHL from the coracoid process to the LHB was thickened and inflamed.

Mentions: A 53-year-old Japanese male with no past medical history visited our hospital with discomfort in the right shoulder. A physical examination indicated that there was moderate limitation in the ROM (Table 1), and the patient was diagnosed with frozen shoulder. The patient received physical therapy for 2 months and while ROM was restored in flexion and external rotation, the internal rotation ROM was not restored. The patient was unsatisfied with these results and requested arthroscopic capsular release. The arthroscopic findings revealed slight synovial proliferation in the rotator interval and the superomedial capsule and that the CHL from the coracoid process to the LHB was thickened and inflamed (Figures 3(a) and 3(b)). A resection of the thickened CHL, coupled with superomedial capsular release, was performed in the same manner as in the previous cases. 3.3 months after the operation, all ROMs, including internal rotation, were regained and the patient could perform daily life activities and job without pain (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 3. (a) Synovial proliferation in the rotator interval and the superomedial capsule. (b) The CHL from the coracoid process to the LHB was thickened and inflamed.
© Copyright Policy
Related In: Results  -  Collection

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

fig3: Arthroscopic findings in Case 3. (a) Synovial proliferation in the rotator interval and the superomedial capsule. (b) The CHL from the coracoid process to the LHB was thickened and inflamed.
Mentions: A 53-year-old Japanese male with no past medical history visited our hospital with discomfort in the right shoulder. A physical examination indicated that there was moderate limitation in the ROM (Table 1), and the patient was diagnosed with frozen shoulder. The patient received physical therapy for 2 months and while ROM was restored in flexion and external rotation, the internal rotation ROM was not restored. The patient was unsatisfied with these results and requested arthroscopic capsular release. The arthroscopic findings revealed slight synovial proliferation in the rotator interval and the superomedial capsule and that the CHL from the coracoid process to the LHB was thickened and inflamed (Figures 3(a) and 3(b)). A resection of the thickened CHL, coupled with superomedial capsular release, was performed in the same manner as in the previous cases. 3.3 months after the operation, all ROMs, including internal rotation, were regained and the patient could perform daily life activities and job without pain (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