The technique
The video below sets out the technique used for arthroscopic 360° capsular release in severe frozen shoulder. The procedure releases the contracted joint capsule circumferentially, through a full 360 degrees, using keyhole instruments.
When it is indicated
The indication is debilitating functional restriction due to a capsular contracture limiting external rotation to less than 30°. In other words, it is considered where the capsule has tightened to the point that the shoulder cannot be rotated outwards past that point and the resulting loss of function is no longer tolerable.
Why the capsule is released all the way around
In a frozen shoulder the capsule surrounding the joint becomes inflamed, thickened and contracted. Because the contracture affects the capsule in more than one place, releasing only part of it leaves tight tissue behind and limits what movement can be recovered. A circumferential release addresses the capsule at the front, below and behind the joint.
Surgery is not the first step
Most frozen shoulders are managed without an operation. Analgesia, a guided physiotherapy programme and corticosteroid injection are the usual starting points, and many shoulders settle over time with those measures alone. Surgical release is generally reserved for shoulders that remain stiff and functionally restricted despite a reasonable period of non-surgical treatment.
Afterwards
Range of movement gained in theatre has to be maintained, so physiotherapy beginning promptly after surgery is an important part of the treatment rather than an optional extra. Our rehabilitation page sets out what that involves.
Related information
See our frozen shoulder page for the condition itself and frozen shoulder release for the treatment. We have also written about the published work on this technique in freeing frozen shoulders: the 360° release.