E2418. Complications of Arthroscopic Capsular Release and Manipulation Under Anesthesia for Adhesive Capsulitis of Shoulder: A Pictorial Review
Authors
Bhari Thippeswamy Pushpa;
Ganga Medical Centre and Hospitals
Raksha Algeri;
Ganga Medical Centre and Hospitals
Terence Dsouza;
Ganga Medical Centre and Hospitals
S. R. Sundararajan;
Ganga Medical Centre and Hospitals
Ramakanth Rajagopalakrishnan;
Ganga Medical Centre and Hospitals
S. Rajasekaran;
Ganga Medical Centre and Hospitals
Background
This exhibit concerns imaging of post-procedure complications after arthroscopic capsular release (ACR) and manipulation under anesthesia (MUA) for adhesive capsulitis of the shoulder arthroscopic capsular release (ACR) and manipulation under anesthesia (MUA) have been widely used in the treatment of frozen shoulder (FS) with varying results. However, there is only limited level-I evidence to prefer ACR over MUA. The purpose of our study was to conduct a prospective randomized trial comparing ACR versus MUA to assess improvement in pain and range of movements (ROM), analyze the complications, and also to determine the cost-effectiveness of both procedures.
Educational Goals / Teaching Points
Illustrate expected post-procedure changes in patients after ACR and MUA in shoulder MRI, and describe surgical complications characteristic to ACR and MUA.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
ACR and MUA are widely used in the treatment of frozen shoulder. Postprocedure magnetic resonance imaging (MRI) plays an important role in the evaluation of patients with residual symptoms. We review the imaging of 85 patients who underwent follow-up MRI 3 weeks post-procedure; of which 44 underwent ACR and 41, underwent MUA. Those with pre-existing glenohumeral arthritis, full-thickness cuff tears, and a history of trauma and prior surgery were excluded. A comparison was made with a pre-procedure MRI. A mild increase in joint fluid and capsular sprain were expected following MUA. Rotator cuff tear, severe capsular edema, and complete tear of capsule and labrum were abnormal findings suggestive of complication. Following arthroscopic capsular release, a mild increase in subacromial bursal effusion, port-tract-related muscle edema, and minor bone bruising were expected. Large areas of bone bruising at the infraspinatus footprint, injury or hematoma of infraspinatus and supraspinatus muscles and tendon were abnormal.
Conclusion
Awareness of complications that can arise after ACR and MUA are performed for adhesive capsulitis of shoulder can better equip the radiologist to recognize them and improve patient outcomes. Both ACR and MUA resulted in good improvement in pain and shoulder function. Good outcomes, comparable complication rate, simple technique, and better cost-effectiveness would make MUA an attractive option over ACR for treating frozen shoulder.
