Frozen Shoulder Release

Frozen shoulder, also known as adhesive capsulitis, is a painful condition marked by stiffness and restricted motion of the shoulder joint. Initially described by Codman, it affects 2–5% of the population, with peak incidence between ages 40 and 60. Patients often experience chronic shoulder pain and significant limitations in daily activities such as dressing, driving, or lifting.

The condition can arise without a clear cause (idiopathic), or as a consequence of surgery (post-operative) or injury (post-traumatic). While most cases improve with non-surgical treatment, some persist despite physical therapy and medications. For these stubborn cases, arthroscopic capsular release offers a promising surgical solution.

What Is Arthroscopic Capsular Release?

Arthroscopic capsular release is a minimally invasive surgery performed using small instruments and a camera inserted into the shoulder joint. The goal is to cut and release the tight portions of the shoulder capsule that restrict motion. This surgery is typically considered for patients who:

• Have failed to improve after at least 4 months of physical therapy.
• Have intact rotator cuff tendons.
• Experience significant pain and limited shoulder function.

Who Benefits Most from Surgery?

A study involving 78 patients categorized frozen shoulder into three types:

• Idiopathic (no known cause): 46.2%
• Post-operative (after shoulder surgery): 39.7%
• Post-traumatic (after injury): 14.1%

Results indicated that patients with idiopathic frozen shoulder had the best outcomes following arthroscopic release, including greater range of motion and shoulder strength recovery.

The Surgical Technique

Performed under regional anesthesia with the patient lying on their side, the procedure involves the following steps:

1. The surgeon inserts an arthroscope through the back of the shoulder.
2. A detailed inspection of the joint is done to identify tight, inflamed, or scarred tissues.
3. The surgeon releases:
   • The rotator interval.
   • The anterior capsule.
   • The coracohumeral ligament.
   • Portions of the joint capsule as needed (avoiding over-release).

The axillary nerve is carefully protected, especially when releasing the lower capsule.

Postoperative Care

Recovery begins almost immediately:

• Day 1: Passive range-of-motion exercises.
• Week 1: Active and assisted motion begins.
• Week 3: Strength training starts.

A combination of anti-inflammatory drugs and mild opioids is used for pain control. Patients typically return to:

• Work: Within 2 months.
• Sports: Within 2.5 months.

Outcomes: Pain Relief and Motion Restoration

The study demonstrated impressive improvements:

• Shoulder Flexion: Increased from 109° to 168°.
• Abduction: Increased from 88° to 167°.
• External Rotation: Increased significantly.
• CMS (Constant-Murley Score): Jumped from 32.8 to 88.9, which is nearly 100% of normal for age and sex.

Notably, 98.7% of patients were satisfied with the surgery and would undergo it again.

Psychological Benefits

Frozen shoulder often leads to depression, anxiety, and poor sleep. After surgery:

• HADS Anxiety Score (HADS-A): 2.5
• HADS Depression Score (HADS-D): 2.2

These scores are considered normal, indicating that patients generally feel better emotionally and physically after recovering from surgery.

Differences Based on Cause

Patients with idiopathic frozen shoulder showed slightly better outcomes than those with postoperative or posttraumatic causes:

• CMS Improvement:
  • Idiopathic: +58.9
  • Post-operative: +53.9
  • Post-traumatic: +53.1
• Pain and Satisfaction Scores: Slightly more favorable in the idiopathic group.

These results highlight the importance of identifying the underlying cause to predict surgical outcomes accurately.

Safety and Complications

Arthroscopic capsular release is very safe:

• No intraoperative complications occurred.
• 5.1% of patients required steroid injections after surgery.
• Only 1 patient (1.3%) needed revision surgery for persistent stiffness.

Key Takeaways for Patients

• Arthroscopic capsular release is highly effective in restoring shoulder mobility and reducing pain in frozen shoulder.
• Patients generally resume normal activities within 2–3 months.
• Idiopathic cases tend to have the best outcomes, but all groups benefit from surgery.
• The procedure is minimally invasive, low-risk, and associated with high patient satisfaction.

Is This Surgery Right for You?

If you’ve been suffering from a frozen shoulder that hasn’t improved with therapy, you may be a candidate for arthroscopic capsular release. Factors that suggest good outcomes include:

• No previous surgery or trauma.
• Preserved rotator cuff.
• Persistent symptoms despite 4+ months of non-surgical care.

 

Do you have more questions?

Q. What is frozen shoulder release surgery?
A. Frozen shoulder release surgery is a procedure to treat adhesive capsulitis by releasing the tight and thickened shoulder capsule to improve range of motion and reduce pain.

Q. When is frozen shoulder release surgery recommended?
A. It is recommended when non-surgical treatments such as physical therapy and medications have not improved shoulder mobility or pain after several months.

Q. How is frozen shoulder release surgery performed?
A. The surgery is usually done arthroscopically by inserting a small camera and instruments through tiny incisions to release the contracted capsule and scar tissue.

Q. What are the benefits of frozen shoulder release surgery?
A. Benefits include improved shoulder movement, decreased pain, and faster recovery compared to traditional open surgery.

Q. What should I expect during recovery after frozen shoulder release surgery?
A. Early physical therapy is crucial to maintain motion gains. Most patients regain significant shoulder mobility within weeks to months after surgery.

Q. Are there any risks associated with frozen shoulder release surgery?
A. Risks include infection, bleeding, nerve injury, stiffness recurrence, and complications related to anesthesia.

Q. How long does the surgery take?
A. The procedure usually takes about 30 to 60 minutes.

Q. Is frozen shoulder release surgery done under general anesthesia?
A. Yes, it is typically performed under general anesthesia, sometimes combined with a regional nerve block for pain control.

Q. Will I need physical therapy after surgery?
A. Yes, physical therapy is essential after surgery to regain and maintain shoulder motion and strength.

Q. How soon can I return to normal activities after frozen shoulder release surgery?
A. Most patients can resume daily activities within a few weeks but should avoid heavy lifting or overhead activities until cleared by their surgeon.

Q. Can frozen shoulder release surgery completely cure frozen shoulder?
A. While it greatly improves motion and reduces pain, some patients may still have residual stiffness and require ongoing therapy.

Q. What are alternative treatments to frozen shoulder release surgery?
A. Alternatives include physical therapy, corticosteroid injections, manipulation under anesthesia, and oral medications.

Q. How effective is arthroscopic frozen shoulder release compared to other treatments?
A. Arthroscopic release often provides quicker and more lasting improvement in range of motion compared to manipulation or conservative therapy alone.

Q. Will frozen shoulder release surgery affect my shoulder strength?
A. Strength typically improves as pain decreases and mobility returns with rehabilitation after surgery.

Q. What should I do to prepare for frozen shoulder release surgery?
A. Follow your surgeon’s instructions, which may include medical evaluations, stopping certain medications, and arranging post-surgery physical therapy.

Q. How soon after surgery will I feel pain relief?
A. Pain usually begins to improve within days after surgery, although some soreness is expected during recovery.

Q. Can frozen shoulder release surgery be repeated if stiffness returns?
A. Repeat surgery is rare but may be considered if stiffness recurs and limits function despite therapy.

Q. Are there any specific complications unique to frozen shoulder release surgery?
A. Possible complications include damage to nearby nerves or blood vessels and failure to achieve full motion restoration.

Q. Is frozen shoulder release surgery suitable for all patients with frozen shoulder?
A. It is generally reserved for patients who do not respond to conservative treatment and who have persistent pain and motion loss.

Q. How long is the typical hospital stay after frozen shoulder release surgery?
A. The surgery is usually outpatient, and patients go home the same day.