Adhesive Capsulitis Capsular Release

53y/o female with idiopathic adhesive capsulitis. Beach chair position. Extensively thickened capsule makes entrance into glenohumeral joint difficult. Initially careful evaluation of the arthroscope allows determination of landmarks.

1. Supraspinatus
2. Long head of biceps tendon
3. Humeral head.

Using an inside out technique with a switching stick a cannula is established in the rotator interval and an electrocautery probe is placed into the joint.

1. Long head of biceps tendon
2. Electrocautery probe
3. Humeral head

Removal of the rotator interval increases the available space.

1. Long head of biceps tendon
2. Electrocautery probe
3. Humeral head
4. Suscapularis

The rotator interval is cleared of any intervening tissue until the coracoid process is well exposed.

1. Long head of biceps tendon
2. Coracoid process
3. Humeral head
4. Suscapularis

The subscapularis is typically extensively scarred into the thickened capsule. A hook-tipped electrode is used to release the capsule anteriorly to the 5:30 position, including release of the anterior band of the inferior GH ligament.

1. Subscapularis
2. Anterior labrum
3. Petechial hemorrhaging in the thickened scared capsule
4. Humeral head

1. Supraspinatus
2. Humeral head

The posterior capsule is released from just posterior to the biceps insertion to the 8o'clock position.
Gentle manipulation allows release of the remaining inferior capsule.