The Procedure
Frozen shoulder release is a procedure to treat patients with severe frozen shoulder. A complete 360 degree capsular release is effective at restoring up to 80% range of motion. I perform the procedure arthroscopically (keyhole) and I typically book an hour and a half of theatre time for your procedure.
Frozen shoulder, also known as adhesive capsulitis, is a condition where the capsule lining the shoulder joint becomes inflamed and thickened, which results in stiffness and aching pain. The condition resolves on its own, however it can take 12 to 18 months to resolve, sometimes several years. Frozen shoulder is a condition that is poorly understood and no treatment to cure the condition is available. While it’s not possible to cure the condition, it is possible to assist with the symptoms. For the pain, cortisone injections into the shoulder joint can be helpful in reducing the inflammation and the pain it causes. For the stiffness, it’s a matter of either waiting for the shoulder to resolve on its own or consider an arthroscopic release of the shoulder.
Pre Op
Whilst you wait for your surgery date, there are a few things to do:
- Speak to your health fund to confirm if the hospital fee for your surgery is covered on your policy
- Speak to your anaesthetist to confirm their fees
- Register your details with the hospital
- Read through, complete and return your paperwork to my office
- Plan your transport to and from the hospital. You won’t be able to drive yourself home after the surgery, so make sure you have a travel plan in place
- If required, arrange any recommended pre op physio appointments
- If required, get any pre op pathology tests (e.g., blood tests)
- Use benzoyl peroxide 5% wash on your shoulder for 5 applications: twice a day for two days, and then again on the morning of the surgery. This will help reduce your risk of infection from Cutibacterium acnes.
- Pack a bag for your hospital stay including regular medications in the original packaging, a loose button-up shirt to wear after surgery, nightwear, personal items including toiletries. If you have sleep apnoea, you must bring your CPAP machine.
- If you are on any blood thinners, ring my office and confirm when to stop taking them before the operation.
- If you are on any diabetic tablet medications, ring your anaesthetist and confirm whether you need to stop taking them before the operation
- Confirm your admission details with my office one to two business days prior to surgery
Though this can seem overwhelming, you will be provided with detailed instructions on what needs to be done so your surgery journey can be as smooth as possible.
Complications
General risks of surgery include:
- Bruising & haematoma: this will vary for each patient. Bruising is a normal side effect of surgery and usually resolves in a short time.
- Infection: infection is a rare but possible risk and is usually treated with antibiotics.
- DVT and PE: deep vein thrombosis and pulmonary embolism are blood clots that form in either the lower limbs or lungs. If left untreated, DVT and PE can have serious effects, however if treated promptly, the risks are significantly lowered. More information can be found here (hyperlink to UC Health Blood Clot pamphlet)
- Anaesthetic risks: general anaesthetic (GA) carries a number of risks, which will be discussed in detail with your anaesthetist prior to surgery. Fortunately, Australia is one of the safest places to undergo a GA. In Australia, the risk of mortality from GA is around 1 in 100,000. For context, the risk of death in a car accident in Queensland is around 1 in 10,000 per year.
- Wound issues: some superficial issues can develop in surgical wounds postoperatively, however most will require a small intervention to resolve the problem.
The FSR procedure is generally low risk. Specific risks and complications include:
- The shoulder may tighten up following the release with some of the movement gained in theatre being lost
- Nerve or blood vessel damage is extremely rare
- Shoulder instability is extremely rare
- Persistent pain: it can take some months for the aching pain to resolve
Day of Surgery
Your admission details will be confirmed one to two business days prior to surgery. You will need to make note of your admission time and your fasting time. Your admission time may be as early as 6am. If you aren’t local to Brisbane, it is usually recommended that you stay the night before in case your admission is early.
When you arrive at the hospital, you will go through the admissions process and then be taken through to the surgical waiting area. Your anaesthetist will have a short consultation with you before you go into theatre and under general anaesthetic. I will say hi to you before the surgery in the anaesthetic bay of the operating theatre and mark your operation site with you.
Your hospital stay will usually be one night. You will be discharged usually around 10am. I will see you before your discharge. I will provide you with a folder containing a detailed postoperative pack including a letter telling you what I found at surgery and exactly what I did in your operation along with information about your rehabilitation and postoperative care. Remember to have someone available to take you home from the hospital.
Post Op Recovery & Healing
Recovery after the FSR is relatively simple but can be time-intensive in the first few weeks. No sling is required, therefore patients can resume driving within a few days to a week postoperatively, once they can confidently and safely control their vehicle.
In the first two weeks, a shoulder bolster is required when resting or sleeping to avoid the joint tightening into internal rotation.
Movement and exercises are commenced immediately after the surgery to work on range of motion, and physiotherapy is required frequently in the first few weeks postoperatively. Returning to work after surgery is recommended whenever patients feel ready, however due to the intense physiotherapy requirements, it may be appropriate to take several weeks off to focus on attending appointments and performing exercises.
Rehabilitation
Rehabilitation after FSR focuses on restoring range of motion. It can take up to six months after surgery to see the full range of movement, however the range of motion is improved immediately after surgery.
Physiotherapy Guidelines
Day One Physio Guidelines
The hospital physio will demonstrate how to fit your sling and how to eat, shower & dress whilst in your sling. Please make sure you go through these things with the physio so that you get them really clear in your mind before you leave hospital.
Goals:
- Assist in the reduction of pain and inflammation.
- Achieve and maintain passive shoulder range of motion gained in surgery
- Ensure quality active movement with correct scapulohumeral rhythm.
Sling:
- Avoid use of sling to maintain external rotation range and reduce chance of post-surgical adhesions.
Shoulder Bolster:
The Blue Shoulder Bolster is used when resting and at night to position the shoulder in external rotation and to prevent the shoulder from tightening into internal rotation. It is often required to be worn at night for the first two weeks after release surgery or until the external rotation range of motion has been maintained.
Precautions: no heavy loading, above shoulder height activity or repetitive upper limb activities during this phase to avoid increase in shoulder pain.
Therapy:
- Ensure appropriate sling fit, patient taught to don/doff sling independently, hand to align to body midline
- Appropriate use of ice
- Patient usually seen day of surgery (day 0) and day of discharge (day 1)
- PROM (passive range of motion) and AAROM (active-assisted range of motion) of all GH ROMs (glenohumeral ranges of motion), aiming to achieve ROM (range of motion) achieved in surgery
- Ensure patient independent with exercises and performing 4 times a day
- Promotion of light upper limb function
- Physio – Patient must be seen as an outpatient 2-3 times a week for the first few weeks post operatively with a physiotherapist
- Manual therapy – Soft tissue release, passive stretches and manual therapy techniques to assist in ROM (range of motion) goals
- Ensure patient independent with exercises and performing 4 times a day
- Ensure good quality shoulder motion, address long term altered biomechanics
Follow up:
- With your local physio 2 to 3 times a week until you are sure that you are able to maintain the range of motion gained in theatre. I will review you with the shoulder physio at 6 weeks postop.
Results After Surgery
Frozen shoulder release surgery offers significantly positive results, with patients seeing an immediate improvement in range of motion after surgery. Typically, around 70 to 80% range of motion is restored by six months after the procedure.