AANA Lab Course 905 - 2nd Annual Fellows Course-Too Tight, Too Loose_ Arthroscopic Management of MDI & Adhesive Capsulitis-Xinning Li, M. D

Too Tight, Too Loose_ Arthroscopic Management of MDI & Adhesive Capsulitis-Xinning Li, M. D

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This presentation by Dr. Xinning (Tiger) Li addresses the arthroscopic management of two challenging shoulder conditions: adhesive capsulitis (frozen shoulder) and multidirectional instability (MDI).<br /><br />Adhesive capsulitis affects 2-5% of the population, more commonly women aged 40-60 and diabetics, and involves thickening and contracture of the joint capsule and rotator interval leading to painful loss of motion. Diagnosis is supported by imaging, especially MRI and MR arthrography, which show thickening of the coracohumeral ligament, rotator interval, and axillary pouch, as well as obliteration of the subcoracoid fat triangle — findings that have varying sensitivity and specificity. Conservative treatment for at least 6 months is recommended initially, including NSAIDs, corticosteroid injections, and physical therapy. If mechanical block and persistent pain remain, arthroscopic capsular release with lysis of adhesions is preferred over manipulation under anesthesia for its controlled release and ability to address concomitant pathology. Postoperative rehab is important and may take up to 6 months for functional recovery, though full normalcy may not always be achieved.<br /><br />MDI is characterized by symptomatic shoulder instability in multiple directions due to ligamentous laxity, either congenital (e.g., Ehlers-Danlos) or acquired. Symptoms vary with direction—anterior, posterior, inferior—and patients often present with pain, weakness, and apprehension in midrange motion. Physical exam features include sulcus sign and generalized hyperlaxity (Beighton score). Nonoperative management with extensive physical therapy focusing on scapular stabilization and rotator cuff strengthening is first line, but failure rates up to 25% are noted. Surgical options include arthroscopic capsular plication or shift and open inferior capsular shift, with similar failure rates (~7.5-7.8%). Postoperative care includes prolonged immobilization and gradual rehabilitation over months.<br /><br />Overall, Dr. Li emphasizes thorough diagnosis, initial conservative management, and precise arthroscopic surgical techniques tailored to pathology extent, while recognizing the prolonged recovery and occasional imperfect outcomes inherent to these complex shoulder disorders.

Keywords

adhesive capsulitis

frozen shoulder

multidirectional instability

MDI

arthroscopic capsular release

shoulder instability

rotator cuff strengthening

physical therapy

capsular plication

postoperative rehabilitation