Frozen shoulder is a common clinical disease of shoulder joint, which occurs frequently in women around 50 years old. The incidence of normal people is about 2% - 5%. Frozen shoulder is a multiple bursal disease, involving glenohumeral joint capsule, subacromial or deltoid muscle, bursa of long head tendon of biceps brachii, etc. The early lesions were hyperemia, edema and exudation of the bursa. Therefore, the early treatment of this disease is mainly conservative. With the functional exercise and the use of nonsteroidal anti-inflammatory drugs, most of the patients can obtain satisfactory results after conservative treatment within 6 months; for patients who fail to respond to conservative treatment, arthroscopic release is an effective treatment method. However, in clinical arthroscopic release, for a few severe patients, the glenohumeral joint adhesion is severe and the joint space is extremely narrow. It is not only difficult to complete manual release under preoperative anesthesia, but also impossible for arthroscopy to enter the glenohumeral joint space through posterior approach. At this point, it is necessary to use double posterior approaches to release the glenohumeral joint capsule under arthroscopy. Objective To study the effectiveness of shoulder arthroscopic double posterior approaches combined with anterior approach in the treatment of severe primary frozen shoulder.

From January 2013 to December 2016, 16 patients with severe primary frozen shoulder underwent arthroscopic glenohumeral capsule release through double posterior approaches combined with anterior approach. There were 2 males and 14 females (4 left shoulders and 12 right shoulders) with an average age of 46.6 years. Six patients had a history of diabetes mellitus. Two patients had a history of hypothyroidism. X-ray films of shoulder joint and supraspinatus outlet as well as shoulder MRI were taken before operation. All patients underwent arthroscopic glenohumeral capsule release through double posterior approaches and subacromial decompression as well. VAS pain score, Constant-Murley score and UCLA score were used for assessment before operation and at the final follow-up after operation.

The follow-up time w as 10-37 months with an average of 26 months. The mean UCLA scores before and after operation and at the last follow-up were (10.3±3.2) , (28.2±3.3) and (31.2±5.3) . The difference was statistically significant (P<0.01) . The mean Constant-Murley scores were (38.3±4.2) , (89.2±4.5) and (95.2±3.3) (P<0.01) . The mean VAS scores were (6.3±1.9) , (1.3±0.3) and (1.0±0.2) (P<0.01) . There were 12 excellent cases and 4 good cases. All patients were satisfied with the results of operation.

Arthroscopic glenohumeral joint release through double posterior approaches combined with anterior approach is an effective method for treatment of severe primary frozen shoulder.