Arthroscopic Capsular Release
When should I consider surgery for my painful frozen shoulder?
There are a subset of patients diagnosed with frozen shoulder who have persistent symptoms of pain and stiffness despite attempts at home exercises, physical therapy, medications, and injections. We know that the majority of patients treated successfully nonsurgically with frozen shoulder will have resolution of symptoms within three or so months of the diagnosis, as long as the treatment plan is tailored to the specific patient(1). By contrast, patients that have persistent symptoms past three months or so have an increasingly guarded prognosis for any further improvements and therefore intervention to correct the problem may be warranted.
The arthroscopic capsular release is a minimally invasive procedure where tiny incisions are used under anesthesia to precisely lengthen and separate the inflamed and contracted shoulder capsule, which is effectively thought of as a tight, leathery sheath that holds the ball and socket of the shoulder together. This is performed with a radiofrequency wand, which limits any injury to surrounding tissues such as nerves and tendons. Evidence and experience dictate that release of the lower portion of the capsule, which while slightly more technically demanding, yields the best results(2). After the shoulder capsule is released, the rotator cuff and biceps are evaluated and treated as necessary. Once the arthroscopic portion of the procedure is completed, the arthroscope is removed and the shoulder motion is evaluated, often with profound notable improvements. The terminal limits of motion are achieved and confirmed with slight pressure on the shoulder throughout a range of motion in what is called a manipulation.
The arthroscopic portion of the procedure is less than one hour, and patients are discharged from the ambulatory facility shortly thereafter. Patients are placed in a sling for one to three weeks for comfort only, and are encouraged to discontinue the sling as soon as possible as pain permits for daily activities. Physical therapy following the release is arranged to start one to three days after the procedure and focuses on maintaining the motion achieved at the time of the release with sustained stretches. This protocol has been shown to generate excellent long term outcomes, resolution of symptoms, and restoration of motion to match that of the other normal shoulder(3).
Historically, prior to the advent of advanced arthroscopic techniques discussed above, the shoulder was manipulated “blindly” under anesthesia without surgery and complications were observed. These included fractures, rotator cuff tears, dislocations, and nerve injuries(4). All of these injuries can largely be avoided with careful and precise arthroscopic technique. An experienced arthroscopist such as shoulder surgeon Dr. Obermeyer performs many of these procedures and can minimize your risk of complications to ensure resolution of the condition and return to a full, painless range of motion of your shoulder.
References
- Levine WN, Kashyap CP, Bak SF, Ahmad CS, Blaine TA, Bigliani LU. Nonoperative management of idiopathic adhesive capsulitis. J Shoulder Elbow Surg. 2007 Sep-Oct;16(5):569-73. doi: 10.1016/j.jse.2006.12.007. Epub 2007 May 24. PMID: 17531513.
- Miyazaki AN, Santos PD, Silva LA, Sella GD, Carrenho L, Checchia SL. Clinical evaluation of arthroscopic treatment of shoulder adhesive capsulitis. Rev Bras Ortop. 2016 Dec 20;52(1):61-68. doi: 10.1016/j.rboe.2016.12.004. PMID: 28194383; PMCID: PMC5290132.
- Le Lievre HM, Murrell GA. Long-term outcomes after arthroscopic capsular release for idiopathic adhesive capsulitis. J Bone Joint Surg Am. 2012 Jul 3;94(13):1208-16. doi: 10.2106/JBJS.J.00952. PMID: 22760389.
- Loew M, Heichel TO, Lehner B. Intraarticular lesions in primary frozen shoulder after manipulation under general anesthesia. J Shoulder Elbow Surg. 2005 Jan-Feb;14(1):16-21. doi: 10.1016/j.jse.2004.04.004. PMID: 15723009.
At a Glance
Dr. Thomas Obermeyer
- 15+ years of training and experience treating complex shoulder and sports medicine conditions
- Expert subspecialized and board-certified orthopedic care
- Award-winning outstanding patient satisfaction scores
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