Frozen shoulder, also called adhesive capsulitis, is an inflamed and thickened shoulder joint capsule. The thickened capsule tightens around the joint and causes stiffness together with a deep aching pain. The cause is still poorly understood and there is no cure for the underlying condition.
A frozen shoulder release is a keyhole (arthroscopic) operation in which the tight capsule is divided all the way around the joint, a complete 360-degree capsular release. Approximately 1.5 hours of theatre time is booked.
The procedure
Frozen shoulder resolves on its own in most people over 12 to 18 months, and sometimes over several years. Because of this, surgery is not the first option.
Cortisone injected into the joint can reduce the inflammation and the pain, and for many people that is enough while the condition runs its course. Where stiffness is the main problem, there are two options: wait for the shoulder to settle naturally, or consider an arthroscopic release. Which of these suits you depends on how severe your stiffness is, how long it has lasted and how much it is affecting you, and it is discussed in consultation.
During the operation the capsule is released through small keyhole incisions and the shoulder is moved through its range to confirm the release. Published series report that approximately 70 to 80% of range of motion is restored. Individual results vary, and the result depends heavily on the physiotherapy that follows.
Risks and complications
All surgery carries risk. Serious complications after this operation are uncommon, but the risks below are real and the ones that apply to you are discussed with you in consultation before any decision is made.
General surgical risks
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Bruising and haematoma. The amount of bruising varies from patient to patient. Bruising is a normal consequence of surgery and usually settles within a short time.
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Infection. Infection is rare but possible, and is usually treated with antibiotics.
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Deep vein thrombosis and pulmonary embolism. Blood clots can form in the veins of the leg and can travel to the lung. The risk of serious harm is significantly reduced when a clot is recognised and treated promptly.
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Anaesthetic risks. These are discussed with your anaesthetist before surgery. The risk of death from a general anaesthetic in Australia is approximately 1 in 100,000.
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Wound problems. Superficial wound problems can occur. Most need only a small intervention.
Risks specific to this procedure
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The shoulder tightening again. The capsule can tighten after the release, and some of the movement gained in theatre can be lost. This is the main reason physiotherapy has to start immediately and be done frequently.
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Nerve or blood vessel damage. This is rare.
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Shoulder instability. This is rare.
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Persistent aching pain. Aching can continue for some months after the release before it settles.
Before surgery
- Confirm with your health fund that the hospital fee is covered.
- Confirm the anaesthetist’s fees.
- Register your details with the hospital.
- Read, complete and return the paperwork to the office.
- Plan your transport to and from hospital. You cannot drive yourself home.
- Attend any recommended pre-operative physiotherapy.
- Complete any requested pre-operative pathology, such as blood tests.
- Confirm your admission details with the office one to two business days before surgery.
Skin preparation
Use a benzoyl peroxide 5% wash on the operative shoulder, five applications in total: twice daily for two days, then once more on the morning of surgery. This reduces the risk of infection from Cutibacterium acnes, a bacterium that lives in the skin around the shoulder.
Packing and medications
- Pack your regular medications in their original packaging, a loose button-up shirt, nightwear and toiletries. Bring your CPAP machine if you have sleep apnoea.
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Blood thinners. Call the office to confirm when to stop these before surgery.
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Diabetes tablets. Call your anaesthetist to confirm whether to stop these.
The day of surgery
Your admission details are confirmed with the office one to two business days beforehand. Note both your admission time and your fasting time. Admission can be as early as 6am, so patients who live outside Brisbane are usually advised to stay in Brisbane the night before. See accommodation for options near the hospital.
After the admissions process you wait in the surgical waiting area. You have a short consultation with your anaesthetist before your general anaesthetic, and Dr Cutbush greets you in the anaesthetic bay and marks the operation site.
The hospital stay is usually one night, with discharge around 10am. You are given a folder containing a letter describing the findings and the operation performed, together with your rehabilitation and post-operative care information. You will need someone to take you home.
Recovery and healing
Nothing was repaired during this operation, so there is no repair to protect and no sling is required. Movement and exercises start immediately. In fact the early movement is the point of the operation, because the capsule can tighten again if the shoulder is allowed to stiffen.
A shoulder bolster is worn when resting and sleeping for the first two weeks. It holds the shoulder turned outwards, which stops the front of the capsule tightening back up overnight.
Driving can usually be resumed within a few days to a week, once you can safely control the vehicle. Return to work when you feel ready; some people take several weeks off, particularly where an intensive physiotherapy schedule has to fit around work.
Physiotherapy is frequent during the first few weeks. Your post-operative review with Dr Cutbush and the shoulder physiotherapist is at six weeks.
Rehabilitation
Rehabilitation after a frozen shoulder release is about keeping the range of motion that was gained in theatre. Range improves immediately after surgery, and reaching its full extent can take up to six months. How much you keep depends largely on how consistently the exercises are done in the first weeks.
Day one
The goals on day one are to reduce pain and inflammation, to maintain the passive range of motion gained during surgery, and to establish good quality active movement with correct scapulohumeral rhythm.
A sling is deliberately not used. Keeping the arm held across the body turns the shoulder inwards, which allows the front of the capsule to tighten again and encourages adhesions to re-form. Instead, the blue shoulder bolster positions the shoulder turned outwards at rest and overnight. It is usually worn at night for the first two weeks, or until external rotation is being maintained.
You are seen by the physiotherapist on the day of surgery and again on the day of discharge, and ice is used for pain and swelling.
Exercises and precautions
Precautions during this phase:
- No heavy loading.
- No activity above shoulder height.
- No repetitive upper limb activity.
Exercises and therapy:
- Passive range of motion and active-assisted range of motion through all glenohumeral movements, aiming to match the range achieved in surgery.
- Exercises performed independently four times a day.
- Light use of the arm for everyday function is encouraged.
- Outpatient physiotherapy two to three times a week for the first few weeks.
- Manual therapy, including soft tissue release, passive stretches and manual techniques.
- Longer term, the physiotherapist addresses any altered movement patterns that developed while the shoulder was stiff.
Follow-up
- Continue with your local physiotherapist two to three times a week until your range of motion is being maintained.
- Attend the six week review with Dr Cutbush and the shoulder physiotherapist.
Results after surgery
Range of motion improves immediately after the release. Published series report that approximately 70 to 80% of range of motion is restored by six months. Aching pain can take some months to settle. Individual results vary, and the outcome depends substantially on how consistently the post-operative physiotherapy is carried out.
Next steps
This page is general information about a surgical procedure and is not a recommendation that you have it. Whether surgery is appropriate for you can only be determined after assessment. All surgery carries risk; the risks relevant to you are discussed in consultation before any decision is made.
