Introduction
Frozen shoulder is a painful and debilitating condition. Most cases can be treated effectively without surgery, however where these non-surgical treatments are not effective, surgery is an option. The surgery is called 'arthroscopic capsular release' – arthroscopic surgery is a minimally invasive procedure, where small incisions are made around the shoulder to allow a miniature video camera and special surgical instruments into the shoulder joint, rather than 'open surgery' where one large incision is required. The benefits of this approach are generally shorter operations, quicker recovery and minimal scarring.
Preoperative Instructions
- Existing medication(s) – some medications can impact surgery, especially any anti-coagulant medication and medicine for diabetes; we will advise if any of your medication needs to be stopped (and when) well ahead of the day of surgery. Any other medication should be taken the morning of surgery with a little water (half a cup maximum).
- You should not shave (or wax) skin near where any surgical incisions will be made.
- No solid foods (cow's milk and drinks containing cow's milk are considered food) should be consumed within 6 hours of surgery; clear fluids (e.g. water, cordial) may be consumed until 3 hours before surgery and then nil by mouth from that point.
- Please advise us if you have a cold or fever, a cough or any other injuries or infections (e.g.: urinary tract infection or cuts / tears to the skin) – your procedure may need to be postponed as any of these may make anaesthesia or surgery unsafe.
- Please bring all imaging (e.g. x-rays / CT scans / MRI scans) with you to hospital.
- Please come to hospital at least one hour before your planned surgery, unless we advise you otherwise.
In very general terms make sure you follow a healthy and balanced diet before surgery and continue any regular physical activity up until the day of the procedure. If you smoke, you should ideally stop smoking at least four weeks before the procedure and otherwise as a minimum at least one week before.
Procedure
The procedure is conducted under either a general or local anaesthetic and takes around 45 minutes to complete. Two small incisions are made to the front and the back of the shoulder and the video camera and instruments are inserted via these 'ports'. The shoulder capsule is then cut away to allow the joint more freedom of movement. Once this is complete the instruments are removed, and the incisions closed.
Postoperative Instructions
As with most arthroscopic procedures, patients are generally allowed to go home the same day after a short period of observation. Patients are strongly advised not to drive, return to work or make any important decisions until the next day, due to the continuing effect of the anaesthetic.
There is normally some pain after an arthroscopic procedure, so pain medication is supplied. There is no requirement for a sling and in fact patients are encouraged to use the affected shoulder joint immediately after surgery. You will be advised what sorts of exercise will be beneficial and which to avoid after the procedure. Most patients have made a complete recovery and regained their previous range of movement of the shoulder around 4-6 months after surgery.
Risks
As with any surgery there is always a risk of:
- Pain.
- Bleeding.
- Scarring.
- Infection (of the incision site, or in the chest).
- Blood clot (leg or lung).
- Stroke.
- Heart attack.
- Damage to nerves / blood vessels.
A specific risk of arthroscopic capsular release is that the procedure does not work and there is continued (or worsened) stiffness and pain in the shoulder.