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Arthroscopic Capsular Release for Frozen Shoulder

This operation is performed under general anaesthetic and a regional nerve block.  It involves two main steps: Arthroscopic release and manipulation.

First, an area at the front of the shoulder joint called the rotator interval is completely cleared of the inflamed thickened capsule. The superior capsule is then carefully released beneath your rotator cuff tendons and the anterior-inferior capsule is partially released to create 'a plane of weakness' (a bit like perforations on a piece of paper) that directs the tearing of the rest of the capsule during the subsequent manipulation of your shoulder.  By doing this keyhole step first, risk of injury to the arm bone and the structures inside your shoulder is minimised.

Top - Thickened, inflamed rotator interval.  Bottom Left - a radiofrequency probe is inserted and used to excise the thick and inflamed tissue.  The image on the right shows the completed capsular release.  At this point the arthroscope is withdrawn and the shoulder is manipulated. The manipulation involves your surgeon carefully taking your shoulder through a range of motion with enough force to complete the rupture of the residual tight capsule. 

What is my recovery after surgery?

Patients generally stay in overnight so that they can rest their arm in an elevation sling.  It also gives the physiotherpists a chance to see you before you go home.

Please take your painkillers regularly and start them before your nerve block wears off.  

You can discard your sling after a few days and you should begin your shoulder rehabilitation programme as soon as you can.  

Please take down your bulky padded dressings on day 3 after surgery, but keep your waterproof dressings on for 12 days.  Showering is fine after four days as long as your waterproof dressings are on securely.

Patients' recovery varies, but in general you can expect to return to:

Office work after two weeks if your pain is manageable.  Light physical work after six weeks.  Heavy labour or overhead sport may take more time

Driving is allowed once you are confident and competent to control a car -  this will probably be a few weeks.

Will I need physiotherapy after my operation?

Physiotherapy is vital after this procedure.  This is because it is important to maintain range of motion in your shoulder as you heal from the surgery.  If you do not, the risk is that your stiffness will recur.  The hospital physiotherapist will see you while you are in with us and we will ensure you have your ongoing therapy sessions arranged.

I will see you two weeks after your operation to check on your progress.  Thereafter your follow up will be tailored to your progress, but patients can often be discharged at three months.

What is my prognosis?

This operation works well.  85% of patients will enjoy significant improvement in both their pain and their range of motion.  A minority will require further treatment. Diabetics are slightly more resistant to treatment for frozen shoulder.

Although recurrence of frozen shoulder is rare on the same side, it is common (up to 40% chance) for patients to develop frozen shoulder on their opposite side at another time. 

What can go wrong?

Shoulder surgery is generally very safe.  Specific risks of surgery for frozen shoulder are rare but include: Bleeding, infection, nerve injury, broken humerus bone and damage to structures inside your shoulder joint