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Capsular Release para sa Frozen Shoulder

PDF Evidence Consent

Arthroscopic capsular release frees a stiff shoulder (frozen shoulder) when physiotherapy and injections fail.

Updated Sep 2026
Ilustrasyon ng isang tao na gumagamit ng over-door pulley upang itaas ang isang braso.
Ang kasukasuan ng balikat ay matatagpuan sa loob ng isang matibay na fibrous capsule (na ipinapakitang distended dito). Sa frozen shoulder, ang capsule na ito ay lumiliit at humihigpit; pinuputol ng capsular release ang contracted tissue upang palayain ang kasukasuan. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Bakit iminungkahi ang operasyong ito

Si Dr Kieran Hirpara, isang upper-limb surgeon sa Mater Private Hospital Rockhampton, ay nagsisimula sa mga opsyon na hindi gaanong invasive na angkop sa iyong kondisyon. Ang mga pasyente ay karaniwang nirerefer sa aming klinika ng kanilang GP; kung iminungkahi ng isang physiotherapist na magpatingin sa amin, kakailanganin mo pa rin ng referral mula sa iyong GP upang maging eligible para sa Medicare rebate. Sa iyong appointment, kumukuha kami ng history, sinusuri ang iyong balikat, at nagsasaayos ng imaging kung kinakailangan upang kumpirmahin ang diagnosis.

Ang frozen shoulder ay nagdudulot ng sakit at paninigas dahil ang capsule, ang nababanat na lining sa paligid ng joint, ay namamagat at humihigpit. Karaniwan kaming nagsisimula sa non-operative care tulad ng physiotherapy, stretching, at mga injection. Isinasaalang-alang ang surgery kapag hindi sapat ang pagbuti mula rito. Ang capsular release ay nangangahulugan ng pagputol sa mga mahihigpit na bahagi ng lining na iyon upang ang balikat ay muling makagalaw nang malaya. Iminumungkahi namin ito kapag ang isang steroid injection ay hindi nakapagbigay sa iyo ng sapat na ginhawa, sa halip na paghintayin ka ng takdang bilang ng buwan, at ginagawa ito bilang isang keyhole operation sa pamamagitan ng maliliit na incisions sa paligid ng balikat. Karamihan sa mga tao ay nakapapansin ng mas kaunting sakit at mas malayang paggalaw agad pagkatapos ng surgery, at layunin ng operasyon na ibalik ang paggalaw, bawasan ang sakit, at ibalik ang iyong balikat sa pang-araw-araw na paggamit.

Bago ang operasyon

Bibigyan ka ng iyong surgeon ng malinaw na mga tagubilin sa mga linggo bago ang operasyon. Kakailanganin mong itigil ang pagkain at pag-inom pitong oras bago ito. Humihingi kami ng pito sa halip na anim upang maaaring mapabilis ang iyong operasyon kung maagang matapos ang listahan sa theatre. Sabihin sa iyong surgeon ang lahat ng gamot na iyong iniinom, kabilang ang mga blood thinner, dahil ang ilan ay maaaring kailangang itigil muna. Magdala ng nakasulat na listahan ng mga ito sa araw ng operasyon. Mag-ayos ng taong maghahatid sa iyo pauwi pagkatapos, at magsuot ng maluwag at komportableng damit na madaling hubarin. Ang imaging tulad ng X-ray, ultrasound o MRI scan ay nakatutulong sa pagpaplano ng operasyon at nagpapakita ng kondisyon ng iyong balikat. Kung mayroon kang iba pang kondisyong medikal, maaaring kailanganin mo ng mga blood test o pagsusuri kasama ang anaesthetist.

Sa araw ng operasyon

Darating ka sa surgical admissions unit ng ospital, kung saan ka ire-rehistro at ihahanda para sa theatre. Pagkatapos ay makikipagkita ka sa anaesthetist, ang doktor na mamamahala sa iyong anaesthetic at pain relief. Ang operasyong ito ay ginagawa sa ilalim ng general anaesthetic na pinagsama sa isang regional nerve block. Ikaw ay tulog nang tuluyan para sa operasyon, at ang block (isang injection na nagpamanhid sa mga nerve na nagsusuplay sa braso bago ka magising) ay nagbibigay ng pain relief para sa unang 12 hanggang 24 oras pagkatapos ng surgery. Makikipagkita sa iyo ang anaesthetist bago ang operasyon at ipapaliwanag sa iyo ang dalawang bahaging ito.

Pagkatapos ay dadalhin ka sa operating theatre, kung saan isasagawa ang operasyon. Kapag natapos na ito, magigising ka sa recovery area, kung saan babantayan ka ng mga nurse habang nawawala ang bisa ng anaesthetic. Kapag stable ka na, maaaring pumunta ka sa ward o uuwi na, depende sa procedure at sa iyong recovery.

Ano ang kinapapalooban ng operasyon

Isinasagawa ng iyong surgeon ang operasyong ito bilang isang keyhole procedure. May ilang maliliit na hiwa na gagawin sa paligid ng iyong balikat, kabilang ang isa sa likuran. Isang manipis na tubo na may maliit na camera ang ipapasok sa loob ng joint upang makita ng surgeon sa isang screen ang capsule, ang masikip na lining sa paligid ng joint.

Ang mga masisikip na banda ng tissue ay puputulin upang palayain ang balikat. Pinapalaya ng surgeon ang mga mahihigpit na bahagi ng lining, karaniwang simula sa harap at itaas ng balikat at pababa at paikot hanggang sa lawak na kailangan dahil sa paninigas. Ang pagputol sa isang bahagi lamang ng capsule ay nagpapalaya ng paggalaw sa isang direksyon lamang, kaya ang release ay isinasagawa hanggang sa lawak na kinakailangan; ang hindi gaanong malawak na release ay tila nagbibigay ng resultang kasing-mabuti, kung hindi mas mabuti, kaysa sa paghahati sa buong capsule. Ang mga namamagang tissue sa loob ng joint ay maaari ring linisin. Nag-iingat malapit sa mga nerve na dumadaan malapit sa ibaba ng joint, at ang release ay ginagawa nang patong-patong (in layers) upang protektahan ang mga ito.

Kapag nailabas na ang masikip na tissue, dahan-dahang igagalaw ang iyong balikat upang suriin ang bagong range of motion. Ang mga maliliit na hiwa ay sasaraun gamit ang mga tahi, at lalagyan ng dressing sa ibabaw ng mga ito.

Simple lang ang layunin: putulin ang anumang masikip upang ang joint ay muling makagalaw nang malaya.

Pagkatapos ng operasyon

Karamihan sa mga pasyente ay nananatili ng isang gabi sa ospital pagkatapos ng operasyong ito, bagaman ang ilan ay nakakauwi sa mismong araw. Magigising ka sa recovery area, pagkatapos ay ililipat sa ward. Maaari kang gumamit ng isang simpleng sling para sa ginhawa sa unang isa o dalawang araw; walang repair na kailangang protektahan, kaya malaya mong magagamit ang braso. Tuturuan ka ng isang physiotherapist ng mga paggalaw na sisimulan agad, at ipagpapatuloy mo ang mga ito sa buong araw. Ang pain relief ay nakaplano na bago ka magising, kaya para sa karamihan, ang unang isa o dalawang araw ay kayang dalhin. Dapat may kasama ka sa unang 24 oras. Hahayaan naming nakalagay ang dressing sa loob ng humigit-kumulang 10 araw; pakiusap na huwag itong tatanggalin bago ang panahong iyon maliban kung sinabi namin sa iyo. Papalitan o tatanggalin namin ito kapag nakita ka na namin.

Paggaling

Karamihan sa mga tao ay nakapapansin ng pagbabago agad-agad. Ang masikip at kumakagat na sakit na nagpapahirap sa pagtulog at pagbibihis ay madalas na nababawasan mula pa sa mga unang araw. Mananatiling masakit ang iyong braso, at ang balikat ay maaaring makaramdam ng pasa at pamamaga kung saan ginawa ang operasyon. Nawawala ito sa loob ng unang dalawang linggo. Nakatutulong ang pagpapatuloy ng iyong mga paggalaw, paggamit ng pain relief na ibinigay sa iyo, at malayang paggamit ng braso sa pagitan ng mga oras ng ehersisyo.

Ang iyong mga araw ay magpopokus sa simple at madalas na ehersisyo. Tuturuan ka ng isang physiotherapist ng mga unang paggalaw bago ka lumabas ng ospital, at uulitin mo ang mga ito sa buong araw upang maiwasan ang muling paninigas ng bagong galaw. Pagkatapos ay gagabayan ng iyong physiotherapist ang iyong programa, mula sa mga banayad na assisted stretches hanggang sa mga paggalaw na gagawin mo nang mag-isa. Anumang sling ay para lamang sa ginhawa, sa unang isa o dalawang araw. Maaari kang gumalaw nang malaya sa loob ng bahay, ngunit maghintay hanggang sa payagan ka ng iyong surgeon bago magmaneho, karaniwan ay sa six-week review. Ang aming gabay sa driving after upper-limb surgery ay nagpapaliwanag nito nang mas detalyado.

Habang bumabalik ang paggalaw, ang mga pang-araw-araw na gawain ay babalik sa mga yugto: pag-abot sa iyong likuran, pagtaas ng iyong braso sa itaas ng ulo, at pagkatapos ay pagbabalik sa trabaho at sa mga aktibidad na iyong kinagigiliwan. Ang paggaling ay nag-iiba depende sa tao, at ang iyong timeline ay maaaring magkaiba. Gagabayan ka ng iyong surgeon at physiotherapist sa bawat review.

Ano ang maaaring maging problema

Karamihan sa mga pasyente ay gumagaling nang maayos, ngunit paminsan-minsan ay maaaring magkaroon ng mga problema. Binabantayan kayo nang maigi ng inyong surgeon at ng team upang maagapan ang anumang isyu.

Ang maliliit na hiwa sa paligid ng iyong balikat ay maaaring maimpeksyon. Bantayan ang pamumula na kumakalat mula sa sugat, pamamaga na lumalala, o likidong lumalabas mula sa site. Ang malalim at tumitibok na sakit na hindi nawawala sa simpleng painkiller ay isa pang babala. Kung mapansin ang alinman sa mga ito, tumawag sa klinika sa halip na maghintay para sa iyong susunod na bisita. Ang impeksyong naagapan nang maaga ay karaniwang gumagaling sa pamamagitan ng drainage at kurso ng mga antibiotic tablet.

May mga nerve na dumadaan malapit sa balikat, at ang operasyon malapit sa mga ito ay maaaring magdulot ng pansamantalang iritasyon. Maaari kang makaramdam ng pangingilig, parang tinutusok ng karayom, o mga bahaging manhid sa braso. May ilang tao na nakararamdam na ang bahagi ng braso ay nanghihina o mabagal tumugon. Ang mga pagbabagong ito ay karaniwang pansamantala at nawawala nang kusa sa loob ng ilang araw hanggang buwan. Banggitin ang anumang bagong pamamanhid o pangingilig sa iyong review, o tumawag sa klinika kung ito ay biglaang lumitaw.

Ang buto at ang makinis na lining ng joint ay maaaring mapinsala habang isinasagawa ang operasyon. Mapapansin mo ito bilang sakit na naiiba sa karaniwang hapdi pagkatapos ng operasyon, o isang pakiramdam na may pumipitik (clicking) o kumakaskas (grinding) kapag gumagalaw. Ipaalam ito sa iyong susunod na review upang masuri ito.

Ang rotator cuff, ang grupo ng mga tendon na tumutulong sa iyo na iangat at i-rotate ang iyong braso, ay maaari ring maapektuhan. Ito ay nararamdaman bilang isang malalim na kirot sa gilid ng balikat, kasama ang panghihina kapag itinataas ang braso o inaabot ang itaas. Ang mga simpleng gawain tulad ng pagbibihis ay maaaring magmukhang mas mahirap kaysa sa inaasahan. Sabihan ang iyong surgeon o physiotherapist kung hindi ito bumubuti ayon sa inaasahan, upang masuri nila ito at mai-adjust ang iyong programa.

Kung may anumang nakababahala sa iyo sa pagitan ng mga review, tumawag sa klinika. Ang table ng mga komplikasyon sa pahinang ito ay naglilista ng mga tipikal na rate kung gusto mo ang mga detalye.

Kailan dapat tumawag sa amin

Tumawag agad sa klinika kung ikaw ay may lagnat, o kung lumalala ang pamumula, pamamaga, o pagtagas ng likido mula sa sugat. Tumawag sa amin kung mapansin ang biglaang matinding sakit, bagong pamamanhid o pangingilig, o kung hindi mo maigalaw ang iyong braso. Pumunta sa emergency kung may pamamaga o sakit sa binti (calf), o kung nahihirapang huminga, dahil ang mga ito ay maaaring senyales ng blood clot. Kung may anumang nakababahala sa iyo at hindi ka sigurado, tumawag sa amin. Mas gusto naming malaman ito nang maaga.

Saan maaaring magbasa nang higit pa tungkol sa kondisyon

Ang pahinang ito ay tungkol sa operasyon mismo. Ang kondisyong ginagamot nito, kabilang ang kung ano ang ipinapakita ng ebidensya tungkol sa kung kailan nakatutulong ang operasyon at kung kailan hindi, ay tinalakay nang mas detalyado sa pahinang Frozen Shoulder.

Reviewed by Dr Kieran Hirpara · 7 August 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Anatomy & Pathophysiology

Bony Anatomy

  • The proximal humerus comprises four main parts: the humeral head, greater tuberosity, lesser tuberosity, and humeral shaft [3].
  • The articular head of the humerus is spherical with a diameter of 37 to 57 mm [3].
  • The most superior portion of the articular surface of the humeral head averages 8 mm above the greater tuberosity [3].
  • Humeral version averages 29.8 degrees, with a range of 10 to 55 degrees [3].
  • The humeral head is inclined approximately 130 degrees with respect to the humeral shaft [3].
  • The neck-shaft angle measures an average of 135 degrees [4].
  • The humeral head is retroverted an average of 30 degrees [4].
  • The glenoid is a convex structure of shallow depth shaped like an inverted pear [3].
  • The glenoid cavity is a shallow socket, approximately one third the size of the humeral head [4].
  • The subchondral bone of the glenoid is relatively flat, with the articular concavity augmented by cartilage and a circumferential labrum [6].
  • The glenoid averages 5° of retroversion in relation to the axis of the scapular body [6].
  • The acromion, coracoacromial ligament, and coracoid process form the coracoacromial arch, a rigid bony-ligamentous structure that imparts stability to the shoulder girdle [3].
  • The scapula is attached to the axial skeleton by the acromioclavicular and sternoclavicular joints [5].
  • The scapula is separated from the chest wall by thin gliding fibro-fatty tissue, allowing its smooth excursion over the chest wall [5].
  • The lateral pillar connects the inferior border of the glenoid with the inferior angle of the scapula [5].
  • The spinal pillar arises from the central part of the glenoid and continues medially to become part of the base of the scapular spine [5].
  • The two bony pillars connected by a markedly thinner medial border form the basic load-bearing structure of the scapular body, known as the biomechanical body of the scapula [5].
  • The weakest bone in the scapula is located primarily in the central part of the biomechanical body, specifically in the infraspinous fossa [5].
  • The weakest area of the circumference of the biomechanical body of the scapula is the spinomedial angle, which is the connection of the scapular spine and the medial border of the scapula [5].

Soft Tissue Anatomy

  • The greater tuberosity serves as the attachment site for the supraspinatus, infraspinatus, and teres minor tendons of the rotator cuff [3].
  • The lesser tuberosity serves as the attachment site for the subscapularis tendon [3].
  • The bicipital groove lies between the greater and lesser tuberosities and serves as a pathway for the long head of the biceps [3].
  • The rotator cuff consists of four muscles: the subscapularis, supraspinatus, infraspinatus, and teres minor [4].
  • The infraspinatus and teres minor are external rotators, while the subscapularis is an internal rotator of the humerus [4].
  • The rotator cuff muscles serve as depressors of the humeral head to allow the deltoid to efficiently abduct the humerus [4].
  • The subscapular bursa lies between the subscapularis tendon and the neck of the scapula and communicates with the joint cavity between the superior and middle glenohumeral ligaments [7].
  • The rotator interval is defined medially by the base of the coracoid, superiorly by the supraspinatus tendon, and inferiorly by the subscapularis tendon [6].
  • The rotator interval contains the coracohumeral ligament, the superior glenohumeral ligament, and the intra-articular portion of the long head of the biceps tendon [6].
  • The coracohumeral ligament restricts external rotation in adduction and is a static restraint to inferior and posterior translation in adduction and external rotation [6].
  • The superior glenohumeral ligament is a primary static restraint against anterior translation with the arm at the side [6].
  • The middle glenohumeral ligament is a primary static restraint against anterior translation with the arm in external rotation and 45° of abduction [6].
  • The anterior band of the inferior glenohumeral ligament is a primary static restraint against anterior-inferior dislocation of the glenohumeral joint in 90° of abduction and external rotation [6].
  • The posterior band of the inferior glenohumeral ligament is a primary static restraint against posterior-inferior translation in internal rotation and adduction [6].
  • The glenoid labrum provides concavity and up to 50% of marginal glenoid socket depth [6].

Vascular Anatomy

  • The proximal humerus receives its blood supply from the anterior and posterior humeral circumflex branches from the third division of the axillary artery [3].
  • The anterior humeral circumflex artery provides vascular inflow to the humeral head by way of its terminal anterolateral branch known as the artery of Laing, also known as the arcuate artery [3].
  • The ascending branch of the anterior humeral circumflex artery courses parallel to the lateral aspect of the long head biceps tendon and enters the humeral head at the interface of the bicipital groove and greater tuberosity [3].
  • The anterolateral ascending branch of the anterior humeral circumflex artery provides the primary blood supply to the humeral head [6].
  • Injury to the arcuate artery may result in osteonecrosis of the humeral head [3].
  • Additional extraosseous collateral branches can permit humeral head perfusion despite complete ligation of the arcuate artery [3].

Pathophysiology of Frozen Shoulder

  • Frozen shoulder, also known as adhesive capsulitis, is characterized by pain and restricted glenohumeral joint motion, especially external rotation [15].
  • The essential lesion in frozen shoulder involves the coracohumeral ligament and the rotator interval capsule [15].
  • Histologically, frozen shoulder shows evidence of inflammation and fibrosis with a dense matrix of type III collagen containing fibroblasts and myofibroblasts [15].
  • The histological findings in frozen shoulder appear similar to findings in Dupuytren disease [15].
  • Laxity of the rotator interval results in inferior laxity, while contracture of the interval is seen with adhesive capsulitis [6].
  • Posttraumatic or postsurgical stiffness results from excessive scar formation [15].
  • Motion loss in posttraumatic or postsurgical stiffness may involve the humeroscapular motion interface between the proximal humerus and overlying deltoid and conjoined tendon, as well as contracture of the rotator cuff and capsule [15].
  • The pathogenesis of a stiff shoulder is still elusive, though ongoing basic science research has provided insight into cellular and biochemical pathways resulting in shoulder stiffness [1].

Investigations

General Principles

  • The diagnosis of a stiff shoulder depends on awareness of the problem, with history and physical examination being paramount [1].
  • Ancillary studies may be helpful in certain circumstances for the diagnosis of a stiff shoulder [1].
  • The purpose of imaging the shoulder is to help establish the diagnosis, determine the severity of the pathoanatomy, assist in surgical planning, and enable the surgeon to illustrate the condition to the patient [2].
  • Unless a specific research protocol is in place, the temptation to "overimage" should be resisted by obtaining only the scans or reconstructions necessary for patient care [2].
  • Proper radiographic technique is as important as proper surgical technique to achieve the desired outcome [2].
  • A robust approach to imaging the shoulder must recognize that the shoulder is a three-dimensional structure that cannot be represented by a single planar view [13].
  • Critical relationships, such as the degree of centering of the humeral head, change with the position of the arm [13].
  • Shoulder pathology may be found in a large number of different bones and soft tissues [13].
  • Overlying and superimposed structures as well as metallic implants may complicate imaging the structures of interest [13].
  • Surgeons need to develop a judicious approach to imaging that yields necessary information while avoiding the tendency to "over-image" [13].

Radiographic Evaluation

  • Standardized plain films are almost always sufficient to garner the information needed for shoulder care [2].
  • CT scans may offer a few degrees of increased precision in the measurement of glenoid version, but this precision does not improve the quality of the surgery or the clinical outcome [2].
  • There is information that can be gathered from properly taken plain films that cannot be obtained from CT scans [2].
  • The first key radiographic view is the anteroposterior (AP) view in the plane of the scapula taken so that the x-ray beam passes through the glenohumeral joint [2].
  • The AP view in the plane of the scapula shows the superoinferior position of the humeral head relative to the glenoid [2].
  • The AP view in the plane of the scapula shows the presence of osteophytes on the humeral head and glenoid [2].
  • The AP view in the plane of the scapula shows narrowing of the joint space [2].
  • The AP view in the plane of the scapula shows the degree of medial displacement of the humerus in relation to the lateral acromial line [2].
  • The AP view in the plane of the scapula shows the quality of the humeral and glenoid bone [2].
  • The AP view in the plane of the scapula shows the presence of loose bodies [2].
  • The AP view in the plane of the scapula shows whether there is humeral head collapse or deformity [2].
  • The second key radiographic view is the axillary view taken with the arm in the functional position of elevation in the plane of the scapula [2].
  • The axillary view is oriented so that both the spinoglenoid notch and the scapular neck are visible [2].
  • The axillary view shows a different perspective of the humeral anatomy [2].
  • The axillary view shows the amount of glenoid bone [2].
  • The axillary view shows the shape of the glenoid [2].
  • The axillary view shows the version of the glenoid in relation to the plane of the scapula [2].
  • The axillary view shows the relationship of the humeral head to the glenoid fossa [2].
  • The standardized axillary view is referred to as the "truth view" because it demonstrates glenohumeral relationships in the functional position of elevation [2].
  • CT scans have the disadvantage of being taken with the arm in the adducted position [2].
  • Many "axillary views" sent for consultation are taken without standardization, making it impossible to determine important features of the glenohumeral joint [2].
  • When taken properly, standardized anteroposterior and axillary views indicate the thickness of the cartilage space between the humerus and the glenoid [2].
  • When taken properly, standardized anteroposterior and axillary views indicate relative positions of the humeral head and the glenoid [2].
  • When taken properly, standardized anteroposterior and axillary views indicate the presence of osteophytes [2].
  • When taken properly, standardized anteroposterior and axillary views indicate the degree of osteopenia [2].
  • When taken properly, standardized anteroposterior and axillary views indicate the extent of bony deformity and erosion [2].
  • Joint space narrowing is most evident on the axillary truth view as opposed to images made with the arm at the side [2].
  • The axillary truth view can show posterior subluxation or "functional decentering" that is not evident in images taken with the arm at the side [2].
  • The degree of posterior subluxation can be measured as the position of the center of the humeral head in relation to the plane of the scapula [2].
  • The degree of posterior subluxation can be measured as the position of the center of the humeral head in relation to the glenoid face [2].
  • The degree of posterior subluxation can be measured as the point of contact of the humeral articular surface on the glenoid articular surface [2].
  • The point of contact of the humeral articular surface on the glenoid articular surface reflects the degree of centering of the net humeral joint reaction force on the glenoid [2].
  • Malcentering of the joint reaction force leads to posterior instability, posterior glenoid wear, and "rocking horse" loosening of prosthetic glenoid components [2].
  • At least two X-ray views should be obtained: an anteroposterior in the plane of the glenoid and an axillary projection with the arm in abduction [11].
  • The axillary projection with the arm in abduction shows the relationship of the humeral head to the glenoid [11].

Magnetic Resonance Imaging

  • Magnetic resonance imaging (MRI) is useful to identify osteonecrosis of the humeral head [11].
  • Magnetic resonance imaging (MRI) is useful to identify a bone tumour [11].
  • Magnetic resonance imaging (MRI) can identify labral tears [11].
  • Magnetic resonance imaging (MRI) can identify rotator cuff tears [11].
  • The accuracy of MRI for identifying labral tears and rotator cuff tears is enhanced by combining the scan with arthrography [11].
  • Findings of adhesive capsulitis and an intact labrum on magnetic resonance arthrography were independent predictors for pain relief after glenohumeral corticosteroid injections [14].

Computed Tomography

  • Computed tomography (CT) is helpful for planning fracture surgery [11].
  • Computed tomography (CT) is helpful for planning shoulder joint replacement [11].

Ultrasonography

  • Ultrasonography is a simple and accurate test for identifying rotator cuff tears [11].
  • Ultrasonography is a simple and accurate test for identifying calcific tendinitis [11].
  • Ultrasonography can be useful in guiding injections [11].
  • Ultrasonography can be useful in guiding barbotage, which involves aspirating calcific deposits in the rotator cuff [11].
  • The most commonly performed joint examination using ultrasonography is the shoulder examination [9].
  • The accuracy of shoulder ultrasonography depends on the skill of the scanner operator and an awareness of pitfalls that are encountered [9].

References

[1] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > SUMMARY.

[2] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > Radiographic Evaluation.

[3] Rockwood And Matsen S The Shoulder. Shoulder and Elbow Specialty Clinic Workers’ Survey > ANATOMY.

[4] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 2Musculoskeletal Trauma Surgery > SHOULDER AND ARM INJURIES.

[5] Rockwood And Green S Fractures In Adults. 29: Principles of Nonunion and Bone Defect Treatment > Applied Anatomy Related to Scapular Fractures.

[6] Aaos Comprehensive Orthopaedic Review 3. Anatomy of the Shoulder, Arm, and Elbow > I. Shoulder.

[7] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > Bursae.

[9] Orthopaedic Knowledge Update Sports Medicine 6. Diagnostic Ultrasonography and Ultrasonography-­Guided Procedures > Annotated References.

[11] Apley And Solomon S Concise System Of Orthopaedics And Trauma. INVESTIGATION.

[13] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > SENIOR EDITOR COMMENTARY.

[14] Orthopaedic Knowledge Update Sports Medicine 6. Magnetic Resonance Imaging of the Glenohumeral Joint > Annotated References.

[15] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > SHOULDER STIFFNESS > 1. A stiff shoulder may be posttraumatic, postsurgical, or the result of adhesive capsulitis.

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Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

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