Frozen shoulder is a common cause of severe shoulder pain. This can occur with no apparent cause (primary) or related to another problem in the shoulder for example after a fracture or after a tendon injury (secondary). Arthroscopic capsular release is used where symptoms are severe and are not resolving. This has the advantage over shoulder manipulation  of being a more precise treatment of the contracted tissue giving better early pain relief.

Symptoms

• severe pain
• pain worse on sudden movement
• restriction of active and passive range of motion.

The lining (capsule) of the shoulder is contracted resulting in a reduction in the volume of the joint available for movement. The majority of the scarring occurs in the front of the joint  (rotator interval).

Using keyhole surgery the inside of the shoulder is inspected for typical features of the condition.

This picture is typical of a frozen shoulder capsule:

The contracted capsule is cut to increase volume and allow movement. The anterior, superior and posterior capsule are divided in this manner. In addition a gentle manipulation is performed to complete the release to the inaccessible inferior capsule. This gives usually gives an immediate return to normal range of motion.

At the end of the procedure the aim is to restore the normal range of motion of the shoulder. Many patients get immediate relief of pain , but for some the onset of pain relief is still variable and in some patients it can be several months before the pain relief occurs.

Postoperative physiotherapy

It is important in the early days after surgery that the exercises to maintain movement (pendular and active assist) in the shoulder are followed to prevent the shoulder from stiffening again.Click here for the postop protocol

Andrew Brooksbank