Management of the Stiff Shoulder With Arthroscopic Circumferential Capsulotomy and Axillary Nerve Release  Matthew A. Tao, M.D., Vasili Karas, M.D., Jonathan C. Riboh, M.D., Lior Laver, M.D., Grant E. Garrigues, M.D.  Arthroscopy Techniques  Volume 6, Issue 2, Pages e319-e324 (April 2017) DOI: 10.1016/j.eats.2016.10.005 Copyright © 2016 Terms and Conditions

Fig 1 Initial arthroscopic visualization of stiff shoulder. (A) We begin by using a posterior viewing portal; synovitis and adhesions are shown. (B) The superior capsule is released from the superior labrum/biceps anchor. (C) We then transition to viewing anteriorly and working posteriorly with an up-biting duckbill basket (asterisk) through the aforementioned posterior portal. This instrument is used bluntly initially to separate the capsule and is then used as a biter to divide it superiorly to the prior level of release and inferiorly to the axillary pouch. (D) Once the capsule has been fully released posteriorly, the muscle belly of the infraspinatus should be readily visible. Arthroscopy Techniques 2017 6, e319-e324DOI: (10.1016/j.eats.2016.10.005) Copyright © 2016 Terms and Conditions

Fig 2 Axillary nerve release. (A) With the surgeon viewing posteriorly, an accessory posterior working portal is made to allow the optimum trajectory to work in the axillary pouch. The inferior capsule is frequently quite thick, as shown in this case. The up-biting duckbill basket (asterisk) is used bluntly to carefully separate the capsule before releasing it. Given the thickened nature and proximity of the axillary nerve, this is often the most tedious portion of the case. (B) Once the capsule has been fully released inferiorly, the view shown here should be achieved. The capsule has been divided, revealing the muscle bellies of the teres minor and subscapularis. Centrally, there is a fat stripe of the quadrilateral space, which predictably overlies the axillary nerve. (C) The decompressed axillary nerve is identified passing from anteromedial to posterolateral through the quadrilateral space. Arthroscopy Techniques 2017 6, e319-e324DOI: (10.1016/j.eats.2016.10.005) Copyright © 2016 Terms and Conditions

Fig 3 Rotator interval release. When performed appropriately, this should re-establish a triangular interval with the coracoid medially (not pictured), supraspinatus superiorly, and subscapularis inferiorly. Care is taken to leave the medial portion of the biceps sling to avoid destabilizing the biceps tendon. Arthroscopy Techniques 2017 6, e319-e324DOI: (10.1016/j.eats.2016.10.005) Copyright © 2016 Terms and Conditions