Shoulder > Frozen Shoulder > Treatments

   Surgical Capsular Release

Treatment Introduction

If your frozen shoulder has not responded to conservative treatment in the form of rest, anti-inflammatory medications, and physical therapy, your physician may suggest surgical capsular release. In this procedure, which usually is performed arthroscopically, a surgeon cuts through the scar tissue that has formed in your shoulder joint capsule to allow freer movement of your shoulder. Many patients find that, in conjunction with following a physical therapy program, surgical capsular release can offer permanent relief from frozen shoulder.

The decisions you make and the actions you take before surgery can be every bit as important as the procedure itself in ensuring a healthy recovery. Getting a second opinion from another qualified surgeon is often advisable, particularly in rare or unique cases.

   Make sure you have received any equipment you will need when you get home from the hospital. This may include a shoulder sling, ice packs or coolers, or heating pads. You should receive prescriptions for any of these from your doctor when your surgery is scheduled.

   Learn the potential risks and benefits of the surgery by asking your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Any physical problems, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any medication you are taking.

   If possible, discontinue the use of any anti–inflammatory medicine, especially aspirin, a week prior to surgery, to prevent excessive bleeding during the procedure.

   To reduce the risk of infection, improve healing, and decrease complications, try to quit smoking or decrease the amount you smoke. In general, smokers have a higher infection and complication rate overall.

   To check if the orthopedist performing the surgery is board-certified or eligible, call the American Board of Orthopaedic Surgery at 919-929-7103.

At most medical centers, you will go to "patient admissions" to check in for your surgical capsular release. There may be separate check-in areas for ambulatory outpatient (patients who go home the same day after surgery) and for overnight inpatient surgery, so be sure to ask your physician or an assistant about this. After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed and your shoulder may be shaved, though this is not always necessary. You will wear a hospital gown and, if applicable, remove your watch, glasses, dentures, and jewelry. You will have the opportunity to speak with your orthopedic surgeon or an assistant, and meet the anesthesiologist or anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room. Here are some important things to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under anesthesia.

   Because you may be unable to drive, arrange for someone to help take you out of the hospital and drive you home when you are released.

   Wear a soft, comfortable shirt that will not irritate your skin when worn under a shoulder sling.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

Arthroscopic surgical capsular release of your frozen shoulder normally takes one to two hours to complete.

   You will be put under general anesthesia, and you may also be given an interscalene block, which is a regional anesthetic that is administered through an injection in your neck and numbs your shoulder area.

   An arthroscope (a tiny camera about 3 1/2 millimeters in diameter) is inserted into your shoulder, and provides images on television monitors so the surgeon can see your shoulder ligaments.

   Microsurgery instruments are inserted through two or three three- to four-millimeter incisions in your shoulder.

   Using these instruments, the surgeon cuts away scar tissue that has developed in your shoulder joint capsule.

   After surgery you will receive stitches and be taken to the recovery room. The stitches in your skin are usually removed in two to three weeks.

When you awaken in the recovery room following surgical capsular release, your shoulder usually is wrapped in gauze, immobilized in a sling, and covered with an ice pack. You may feel a moderate amount of pain, depending on the severity of the dislocation. You usually stay in the recovery room for at least two hours while the anesthetic wears off. General anesthesia wears off in about an hour and regional anesthesia may take about two hours to wear off. As soon as possible after surgery, you may begin exercises using a continuous passive motion machine (CPM). Your temperature, blood pressure, and heartbeat will be monitored by a nurse, who, with the assistance of the doctor, will determine when you are ready to leave the hospital.

After surgical capsular release, you will need to take steps to reduce the pain and inflammation in your shoulder. Rest, icing, and anti-inflammatory painkillers such as ibuprofen or aspirin can ease pain and swelling. Here is what you can expect and how you can cope with a sling immobilizing your shoulder:

   The first concern is to monitor swelling for the first 48 hours while wearing your sling. Physicians generally prescribe ice packs to be applied for 20 minutes at a time, three or four times a day.

   You will need to wear the sling for three to five days, though you will able to use your shoulder and arm to perform daily functions.

   You can usually remove the gauze bandage and bathe regularly after two to seven days. You can remove the sling for brief periods to shower, but remember to avoid moving the injured arm.

   Stitches are usually removed about two weeks after surgery.

   If you develop a rash or irritated skin around your sling, call your physician.

   If you notice any abnormal wear or discomfort in the sling, contact your physician as early as possible. In general, do not try to "grin and bear it" if discomfort does not go away within a few days. The sling should not irritate your skin.

   Physical therapy exercise usually begin about 24 hours after surgery.

Once your pain has decreased enough to allow you to move your shoulder comfortably, you usually can begin performing basic stretching exercises aimed at increasing your shoulder’s range of motion. Some of these include a pendulum-like motion, in which you lean over with your affected arm hanging down and your other arm extended and resting on a table to support your body, and then make small circles with your affected arm. The next step is to perform this exercise while holding a light weight. Other exercises focus on flexing your shoulder forward and back with gentle motions, and some use apparatus such as a wand or pulley system. All involve the unaffected arm "leading" the affected arm so that the affected arm does not have to push against resistance. As in all exercises, proceed gradually. Do not pursue an aggressive exercise program if you experience pain or stiffness.

FORMAL PHYSICAL THERAPY

A physical therapist may use heat or ultrasound to ease the pain in your shoulder and allow you to exercise more comfortably and efficiently. Your physician also may suggest an injection of a long-lasting anesthetic before you perform supervised stretching exercises. Your physical therapist then takes you through a series of passive movements aimed at regaining range of motion in your shoulder.

RELATED TOPIC

   Shoulder stretching exercises

It is not uncommon for sufferers of frozen shoulder to experience residual symptoms for years after the initial diagnosis. These generally include mild pain and a small loss of range of motion in the shoulder that usually does not affect your ability to perform everyday functions. There is no way to truly protect yourself from a recurrence of frozen shoulder, but physical therapy is recommended to help strengthen and stabilize the joint.