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Arthroscopic release of frozen shoulder
6-minute read
What is frozen shoulder?
Frozen shoulder is a stiff and painful shoulder caused by inflammation, swelling and contraction of your shoulder lining (capsule). It is also known as adhesive capsulitis.
The cause of frozen shoulder not known, but it is associated with diabetes, hypothyroid disease and Dupuytren’s contracture of the hand. The condition usually affects people aged 30 to 60.
It can also happen after an injury or surgery.
A frozen shoulder often gets better without surgery but the process can take up to 4 years.
- Freezing phase – The capsular lining of your shoulder joint tends to become swollen and inflamed. This is often so painful that sleeping is impossible and simple painkillers such as paracetamol do not help.
- Frozen phase – The joint becomes less painful but stiff and difficult to move.
- Thawing phase – Movement gradually improves.
What are the benefits of surgery?
You should have less pain and be able to use your shoulder better.
Are there any alternatives to surgery?
Simple painkillers and anti-inflammatory painkillers such as ibuprofen can help control the pain but you will usually need stronger painkillers. A steroid injection into your shoulder joint can sometimes reduce pain and stiffness. Physiotherapy is often helpful in improving movement if the pain can be controlled. Arthrographic hydrodilatation (stretching of the capsule by a high-pressure injection) has been shown to help.
It is possible to have a manipulation under anaesthesia (MUA) instead of a capsular release operation.
What will happen if I decide not to have the operation?
You will usually need strong painkillers and physiotherapy. Your shoulder will often settle without surgery but it can take up to 4 years to be free of pain and to regain your shoulder movement.
What does the operation involve?
Various anaesthetic techniques are possible.
The operation usually takes 30 minutes to an hour. Your surgeon will make two small cuts, about half a centimetre long, one at the front and one at the back of your shoulder. They will insert a small telescope through one of the cuts so they can examine the joint. They will insert surgical instruments through the other cut to divide the tight, thickened capsule to improve the range of movement of your shoulder.
How can I prepare myself for the operation?
If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.
Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.
Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.
Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.
What complications can happen?
The healthcare team will try to reduce the risk of complications.
Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, you are a smoker or have other health problems. These health problems include diabetes, heart disease or lung disease.
Some complications can be serious and may even cause death.
General complications of any operation
- Bleeding during or after the operation.
- Infection of the surgical site (wound).
- Allergic reaction to the equipment, materials or medication.
- Chest infection — your risk will be lower if you have stopped smoking and you are free of Covid-19 (coronavirus) symptoms for at least 7 weeks before the operation.
Specific complications of this operation
- Infection in your shoulder joint.
- Continued stiff shoulder.
- Damage to nerves around your shoulder, leading to weakness, numbness or pain in your shoulder or arm. This usually gets better but may be permanent.
- Difficulty passing urine. If it gets worse (bladder retention) you may need to go home with a urinary catheter and come back to hospital to have it removed around 2 weeks later.
Consequences of this procedure
- pain
- unsightly scarring of your skin
How soon will I recover?
You should be able to go home the same day.
You do not need to wear a sling and aim to use your shoulder as much as possible. It usually takes about 6 months to get a good range of movement.
Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.
Most people make a good recovery, have less pain and can use their shoulder better.
Summary
Frozen shoulder can cause severe pain and stiffness. An arthroscopic capsular release should reduce your pain and help you to move your shoulder more easily.
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