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Posterior Capsular Contracture of the Shoulder

Dr. Bach is Resident, Department of Orthopaedic Surgery, University of Illinois–Chicago, Chicago, IL. Dr. Goldberg is Assistant Professor, Department of Orthopaedic Surgery, University of Illinois–Chicago, and Senior Attending Surgeon, Division of Orthopaedic Surgery, Cook County Hospital, Chicago.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Bach and Dr. Goldberg.

Reprint requests: Dr. Goldberg, Department of Orthopaedic Surgery, University of Illinois–Chicago, 835 S Wolcott Avenue, M/C 844, Chicago, IL 60612.

Posterior capsular contracture is a common cause of shoulder pain in which the patient presents with restricted internal rotation and reproduction of pain. Increased anterosuperior translation of the humeral head occurs with forward flexion and can mimic the pain reported with impingement syndrome; however, the patient with impingement syndrome presents with normal range of motion. Initial management of posterior capsular contracture should be nonsurgical, emphasizing range-of-motion stretching with the goal of restoring normal motion. For patients who fail nonsurgical management, arthroscopic posterior capsule release can result in improved motion and pain relief. In the throwing athlete, repetitive forces on the posteroinferior capsule may cause posteroinferior capsular hypertrophy and limited internal rotation. This may be the initial pathologic event in the so-called dead arm syndrome, leading to a superior labrum anteroposterior lesion and, possibly, rotator cuff tear. Management involves regaining internal rotation such that the loss of internal rotation is not greater than the increase in external rotation. In the athlete who fails nonsurgical management, a selective posteroinferior capsulotomy can improve motion, reduce pain, and prevent further shoulder injury.

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