Arthroscopic Trans-Intermuscular Septum Approach for Severe Adhesive Capsulitis of the Shoulder

Lu Zhenfei; Wang Qin; Zhou Hongxia; Liu Lei

Abstract：Objective To explore the application of the arthroscopic trans-intermuscular septum approach in the treatment of severe adhesive capsulitis of the shoulder.Methods A prospective study was conducted on 35 patients with severe adhesive capsulitis of the shoulder treated at Wuxi Hospital of Traditional Chinese Medicine from July 2018 to December 2021.The cohort included 16 males and 19 females,with a mean age of(61.1±7.9)years(range,51 to 81 years).The mean duration of symptoms was(12.5±3.8)months(range,8 to 23 months),and the mean duration of conservative treatment before surgery was(8.2±2.1)months(range,6 to 12 months).All patients underwent arthroscopic capsular release via the trans-intermuscular septum approach.Shoulder function and pain were evaluated using the visual analogue scale(VAS),the American shoulder and elbow surgeons(ASES)score,and active/passive range of motion(ROM)before and after surgery.Results All patients were followed up for 2 years.No complications such as infection,hematoma,thrombosis,vascular injury,axillary nerve injury,or recurrent stiffness occurred.Postoperative MRI at 6 weeks showed no rotator cuff injury.At 6 weeks postoperatively,the active ROM in flexion,abduction,and external rotation significantly improved compared with preoperative values(P＜0.01),and further improvement was observed at 2 years(P＜0.05).The VAS scores significantly decreased at 6 weeks(P＜0.01)and further decreased at 2 years(P＜0.01).The ASES scores significantly increased at 6 weeks(P＜0.01)and further increased at 2 years(P＜0.05).Conclusion The arthroscopic trans-intermuscular septum approach for treating severe adhesive capsulitis of the shoulder ensures smooth access to the glenohumeral joint,facilitates precise anterior and posterior portal placement,and simplifies capsular release under arthroscopy.It achieves excellent clinical outcomes,is safe,and has strong operability.