Shoulder Surgery

Frozen Shoulder Arthroscopic Release

Frozen Shoulder Arthroscopic Release

Frozen shoulder arthroscopic release is a minimally invasive keyhole procedure to treat frozen shoulder. It is also referred to as a capsular release – as the tight/inflamed capsule in the shoulder joint is released during surgery. It is often done as a part of other keyhole procedures in the shoulder, such as a subacromial decompression, biceps tenodesis and/or rotator cuff repair. After an isolated frozen shoulder arthroscopic release  a sling is worn for 1-2 weeks; and JPL therapy commences immediately after surgery. Strengthening is allowed at 4-6 weeks; and full unrestricted activity is possible at  6-12 weeks after surgery. This pathway is modified if other procedures are carried out at the same time.

This is a keyhole procedure that uses cameras and small instruments inside the shoulder to release the tight shoulder joint capsule to improve range of motion; and treat any other pain generators in the shoulder at the same time. Physiotherapy is commenced immediately after surgery and the procedure can be done as a day stay or with an overnight admission.

Most patients improve without surgery over 6-12 months. Surgery is suitable for those patients who are not responding to non-surgical treatments and find that:

  • Their range of motion is not improving or even going backwards resulting in worsening shoulder stiffness
  • Unrelenting pain despite cortisone injections and regular analgesia
  • Associated rotator cuff tear or biceps tendon dislocation necessitating more urgent repair (whilst addressing the frozen shoulder at the same time)

 

If your symptoms have persisted for six months and your condition is deteriorating then surgery is a good option (particularly for the younger patient). 

 

  • The procedure is under a General Anaesthetic where you will be positioned on your side and an examination and manipulation of the shoulder is performed carefully.
  • The affected arm is secured in a special arm holder.
  • Small key-hole incisions (about 1cm) are made and the camera and surgical instruments are placed inside the shoulder. 
    • Usually 3-4 small  incisions are enough (depending on what else needs to be repaired)
  • A thorough 15-point examination of the shoulder joint, capsule, and labrum is made via the arthroscopic camera and pictures are taken to document findings. 
  • The rotator interval is released and the biceps tendon is inspected. 
  • The thickened and inflamed capsule is carefully released as required (front, back, and top of the joint). Usually a 360 degree release is performed. The nerves that are close to the shoulder joint capsule are protected throughout the case. 
  • Any other unexpected injuries/tears are noted and repaired via key-hole at the same time if needed (such as the biceps tendon, rotator cuff tears, shoulder spurs, and AC joint arthritis) 
  • The key-hole incisions and biceps incision are closed with sutures, dressings applied and a sling used to position the arm correctly.
  • Dr Pant will then organise close follow up at regular intervals and liaise with your Physiotherapist to maximise recovery.

There are three essential components to a good outcome from your surgery:

  • Your surgeon
  • You as a patient
  • Your physiotherapist

Post-operative physiotherapy

Dr Pant utilises the JPL pathway for most patients and this will form the basis of your rehabilitation after surgery; it will be modified to suit your individual circumstance.

The JPL pathway allows for self-directed, early passive shoulder range of movement:

  • Passive = assisted with your other arm
  • Active = you move the affected arm independently

Therapy overview 

After the surgery you will be in a sling and protect your shoulder to allow the shoulder to heal. Dr Pant will see you the day after your surgery and discuss the JPL rehabilitation protocol with you. This JPL physiotherapy protocol will commence immediately after your surgery.

The therapy program will focus on flexibility and range of motion exercises initially. These gentle stretches will improve your range of motion and prevent shoulder stiffness. The aim is to progress along this pathway and commence active shoulder range of movement over 1-2 weeks.


Sling

A sling may be worn for up to 6 weeks after your surgery. However, after a frozen shoulder release, Dr Pant will encourage you to come out of the sling as much as possible – to commence immediate physiotherapy and minimise re-scarring (re-freezing) your shoulder joint capsule. 

Driving after shoulder surgery

  • After shoulder surgery you will be in a sling and you may be unable to drive
  • This does vary depending on the complexity of your surgery and the patient. Some patients may be able to drive at 1-2 weeks; and some may not be able to drive for the full 6-12 weeks. This will be discussed at your follow up appointments.

Showering and getting dressed

  • You may take the sling off to shower
  • Lean forward and allow your arm to “dangle” to wash under your arms
  • The dressings applied are waterproof and you may shower with them on
  • Usually before you are discharged from Hospital, your dressings are changed after your morning shower.
  • These “new” dressings are then kept intact until your review at 10-14 days
  • If the dressings start to peel at the edges – you may reinforce them
  • If the dressings discolour with discharge (yellow or green) you may have a wound infection; do not be alarmed just yet – please notify SSU (02 9215 6100 or admin@drpant.com.au) and we will give you a plan.
  • When getting dressed, you may use your good arm to move your affected (operated arm) to place your arms through the sleeves carefully

Sleeping after Shoulder Surgery

  • Most patients find it difficult to lie flat after shoulder surgery (especially after rotator cuff repair)
  • Consider using a few pillows to prop yourself up and sleep at a slight incline; this may be necessary for 4-6 weeks after surgery. If you have had an isolated Frozen Shoulder Release, you may take your sling off to sleep.

Elbow and hand movement

  • Keep your elbow and hands joints moving and supple for the duration of time you are in the sling
  • The best time to move your elbow (into full extension and flexion) is when you are in the shower, just out of the shower and about to get dressed.

 

Surgery is a carefully choreographed process and you are being treated by a sub-specialist shoulder surgeon and a highly experienced team; however, all surgeries inherently carry some risk of complications. 

The risk of complications after Frozen Shoulder release surgery are less than 1% in the Sydney Shoulder Unit experience. 

 

General risks: 

  • Infection
  • Bleeding
  • Wound healing problems
  • Damage to blood vessels or nerves
  • Sensory changes around the surgical scar

 

Specific risks relating to Frozen Shoulder surgery: 

  • Neurovascular injury during surgery
  • Rescarring of the joint capsule and shoulder stiffness

Patients who smoke, use tobacco products, have diabetes, or elderly are at higher risk of complications both during and after surgery. They are also more likely to have problems with wound and bone healing.

With careful patient selection, surgical release and consistent physiotherapy patients report improved range of motion and less pain. Range of motion will improve with both forward elevation and external rotation. In a small number of patients the capsule may rescar and become stiff, requiring a second keyhole release. 

Patient results

Frozen Shoulder Release

This gentleman in his 60s suffered from a frozen shoulder for almost a year; his symptoms were unrelenting and he failed to improve over time despite non-surgical treatment. Examination and MRI imaging confirmed ongoing frozen shoulder as well as biceps tendonitis, subacromial bursitis, and AC joint arthritis; thankfully his rotator cuff was intact. 

He underwent arthroscopic frozen shoulder surgery (capsular release) and a biceps tenodesis, subacromial decompression and excision of his AC joint. Range of motion exercises were commenced immediately after surgery using the JPL protocol.

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