Is ligation of scar tissue a suitable option to improve range of motion (ROM) in the left shoulder?

Ligation of Scar Tissue for Improving ROM in Left Shoulder

Ligation of scar tissue is not a recommended or evidence-based procedure for improving range of motion in the left shoulder, and alternative conservative treatments should be pursued first.

Assessment of Current Evidence

The available guidelines do not support "ligation" of scar tissue as a standard procedure for improving shoulder range of motion. Instead, they recommend a structured approach to shoulder pathologies that begins with conservative management.

Conservative Management Recommendations

According to the American Academy of Orthopaedic Surgeons, initial treatment for shoulder pathologies should include:

1. Conservative measures first 1:

   • Relative rest
   • Physical therapy
   • Pain management
   • Avoidance of painful movements

2. Physical therapy interventions 2, 1:

   • Stretching exercises
   • Range of motion exercises
   • Gradual strengthening
   • Avoidance of overhead pulley exercises (which can worsen pain)

3. Pain management options 1:

   • Acetaminophen (up to 4g/day) as first-line
   • NSAIDs at lowest effective dose for shortest duration if needed
   • Subacromial corticosteroid injections for inflammation-related pain

Addressing Scar Tissue Specifically

For scar tissue affecting shoulder mobility, the evidence suggests:

1. Physical management of scar tissue 3:

   • Physical scar management shows moderate-to-strong effects on improving scar-related issues
   • Benefits include improvements in pain (p=0.012), pliability (p<0.001), and thickness (p=0.022)

2. Avoiding prolonged immobilization 1:

   • Prolonged immobilization should be avoided to prevent adhesive capsulitis
   • Active, active-assisted, or passive range of motion exercises are recommended

Surgical Considerations

If conservative measures fail after an adequate trial (typically 3-6 months), surgical options may be considered 1:

1. Appropriate surgical interventions:

   • For severe contractures affecting function, surgical release may be considered
   • Muscle tendon transfers can be effective for improving active shoulder range of motion in specific pathologies 4

2. Surgical techniques for scar contracture:

   • For axillary burn scar contractures, techniques like Y-V-plasty 5 or thoracodorsal perforator-based cutaneous flaps 6 have shown effectiveness
   • These techniques are for specific types of contractures, not general shoulder ROM limitations

Important Considerations and Cautions

1. Diagnostic imaging before intervention 2:

   • Plain radiographs should be the first imaging study
   • MRI or ultrasound if soft tissue pathology is suspected

2. Potential complications of surgical intervention 4:

   • Infection
   • Hematoma
   • Failure of healing

3. Scar tissue healing biology 7:

   • Scar tissue is inherently weaker, larger, and has different biomechanical properties than normal ligament tissue
   • Simple "ligation" would not address the underlying biological differences

Conclusion

Based on the available evidence, "ligation of scar tissue" is not a standard or recommended procedure for improving shoulder ROM. The patient would benefit more from a structured physical therapy program focusing on stretching, range of motion exercises, and proper pain management. If conservative measures fail after 3-6 months, appropriate surgical consultation with a shoulder specialist should be considered to determine the most suitable intervention based on specific pathology.