Arthroscopic Release Of Contracture
If a capsulitis or Frozen Shoulders does not settle with non-operative measures such as injections and physiotherapy, surgery does have a role. Indeed, it is an operation that can give very quick and satisfying results.
The operation undertaken is an arthroscopic (key hole) release of the shoulder contracture. This offers an effective way to manage both the pain and stiffness associated with the condition. The procedure is undertaken through two small 1cm incisions at the front and back of the shoulder. Any capsular contractures that are restricting the shoulder movement are divided and released. Depending on when the surgical procedure is undertaken in the life cycle of the frozen shoulder, the contractures are comprised of either dense inflammatory tissue or alternatively, mature scar tissue. By removing this contacted inflammatory / scar tissue enveloping the shoulder, a greater range of motion is immediately possible and this can be easily demonstrated after the operation. A post-operative physiotherapy programme is always needed after this procedure as it is an essential part of the treatment.
Information for patients / operative Information
Risks and complications
- Nerve injury
- Continued discomfort
- Recurrent/residual stiffness
- Please bring any X-rays or scans with you to the hospital
- No food for 6 hours, or drink for 4 hours, prior to surgery.
- Please avoid smoking for 12 hours prior to surgery
- A capsular release can be performed as either a day case procedure or as a brief in-patient stay depending on the physiotherapy requirements that will be necessary after your operation.
- Two incisions, each approximately 1 cm in length, are made around the shoulder. These are closed with dissolving sutures and Steri-strips.
- Splash proof dressings will be applied but the wound should remain dry for 10 days.
- Prior to your discharge from hospital, a physiotherapist will demonstrate some simple exercises as part of your rehabilitation protocol. These exercises should be undertaken when you’re at home and will help your shoulder recover from the surgery before your outpatient physiotherapy commences.
What to Expect
- Swelling; Immediately after an arthroscopic procedure there can be quite a lot of swelling around the shoulder but this settles after approximately 24 hours. A cryocuff or alternative cold therapy compress can be helpful in minimising swelling and inflammation.
- Pain; An Interscalene Block will usually be used to reduce immediate post-operative pain. This has the added benefit in that it allows the arm to supported in a Bradford sling after the operation. This position would not have been achievable prior to the procedure but from this position a physiotherapy led exercise programme can be commenced. Occasionally, and sometimes in revision cases, the Intercalene Block can be maintained for 1 -2 days following the procedure to aid the exercise programme. After this period simple oral analgesics can be taken to manage any on-going discomfort.
- Bleeding; There may be some oozing through the bandages but this should settle soon after the operation.
- A sling will be provided to help rest the shoulder. This is usually used for the first 1-2 days post surgery. To use it any longer only encourages recurrent stiffness. Furthermore, you should remove any belt that might have been fitted to your within 24 hours after your operation. If the belt is retained, undue stiffness will develop.
- The wounds should be kept dry for 10 days.
- At ten days the dressing and paper Steristrips can be gently removed. If the wound is ‘dry’ then it is all right to wash the wound. If not, please consult Mr Falworth or your GP for further advice.
- The most important part of your post-operative care is to start an early ‘aggressive’ stretching exercise programme, which the ward physiotherapist will have commenced prior to discharge from hospital. This will maximise the benefit of your operation and will need to be continued at home and as an out-patient.
- You will be reviewed in clinic approximately 3 weeks following your surgery.
Estimated return to functional activities
- Driving Usually 1-2 weeks
- Light duties Usually 1-2 weeks
- Return to work Varies depending on occupation
- Heavy Lifting 3- 4 weeks
- Repetitive overhead activity/sport 8 - 12 weeks