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Open Capsular Release for Adhesive Capsulitis

Open surgical release of the glenohumeral capsule was more commonly utilized to treat patients with severe and refractory adhesive capsulitis prior to the advancement of arthroscopic techniques to treat this difficult patient population. Although the peri-operative morbidity of this open approach to treatment is now accepted to be somewhat greater than its arthroscopic counterpart, use […]

Physical Findings of Adhesive Capsulitis

The physical examination of patients with adhesive capsulitis reveals a global reduction in range of motion with a marked decrease in glenohumeral translation also present. Examination of the opposite shoulder (if normal) is performed to identify the patient’s expected normal range of motion for comparison. Evaluation for limitation of pure glenohumeral motion (best measured in […]


Glenohumeral arthrosis has been a well-described complication of various surgical procedures to correct shoulder instability. Over-tightening of the anterior structures, can result in stiffness, and drive the humeral head posteriorly, creating shear on the cartilage and early arthrosis.

Some patients paradoxically may have instability and stiffness. They feel unstable because of excessive laxity in […]

Complications and Pitfalls-Recurrence

Recurrence is the most frequently reported complication after open and arthroscopic surgery for anterior instability. Recurrence may be secondary to new trauma or to atraumatic events.Patients with traumatic recurrence of their instability usually have better post-operative results after revision surgery than patients with atraumatic recurrence. The recurrence rate is related to the number of prior […]

Rotator Interval Closure

If after repair of the labrum and IGHL and MGHLs, the shoulder shows persistent inferior or inferoposterior translation, rotator interval closure is performed. The authors close the rotator interval in all patients with MDI and posterior instability.

The arthroscope is inserted posteriorly to visualize the rotator interval. The arm should be placed in external rotation […]

Principles of Instability Surgery

The goal of treatment in both open and arthroscopic instability surgery is twofold: to restore the labrum to its anatomic attachment site and to re-establish the appropriate tension to the inferior capsuloligamentous complex of the joint. Cadaveric studies have shown that both the labrum and the capsule must be injured for a dislocation to occur.


Capsular Lesions

Traumatic intra-substance injury of the joint capsule is commonly associated with anterior dislocation. Depending on the magnitude of the anterior shear force, either plastic deformation or a complete tear of the joint capsule can occur.

The recognition of a concomitant posttraumatic capsular laxity or rupture and a Bankart lesion is essential in order to select […]

Rotator Interval

The RTI is an area of shoulder capsule that is bounded by the supraspinatus superiorly, the subscapularis inferiorly, the coracoid process medially, and the long head of the biceps tendon laterally. The floor of the RTI is variably bridged by the GH capsule, the SGHL, the CHL, and occasionally, the MGHL. This area serves as […]

Superior Glenohumeral Ligament

The SGHL originates on the supraglenoid tubercle, just anterior to the origin of the long head of the biceps, and it inserts on the proximal tip of the lesser tuberosity, on the medial ridge of the intertubercular groove. The SGHL is present in more than 90% of individuals. In an anatomical study, Steinbeck et al. […]