Miscellaneous

Arthrolysis of the shoulder should be considered when conservative treatment over 6 months failed and symptoms of acute inflammation are absent. Neurological and anatomical disorders are ruled out by neurological examination and MRI/CT imaging. Mobilization under anesthesia has a high risk of neurovascular and structural damage of the surrounding soft tissue and should not be performed as single routine. After written consent, the patient is examined under anesthesia and the range of motion is documented. Interscalene block is mandatory for intra- and postoperative pain management. The patient is positioned in beach chair position with the arm rested in an arm holder. Arthroscopy begins in the standard posterior portal. An anterosuperior portal is established, and the arthrolysis is started according to lack of motion. Resection of the rotator interval, superior glenohumeral ligament, long head of biceps tendon, medial glenohumeral ligament, and anteroinferior capsule is performed with an electrothermal device. Resection of humeral osteophytes with a burr and release of the axillary nerve (that should be performed with high caution, since the nerve might be easily injured) are optional. By changing the camera to the anterosuperior portal, the 360° release of the capsule can be completed through the posterior portal. After operation, the arm should be positioned in alternating positions in maximum external and internal rotation in 90° of abduction with a modified Gilchrist bandage. Intensive physiotherapy is started twice a day. Discharge of the hospital is possible, if the pain is tolerable after stopping the interscalene block and self-exercises are sufficiently established.