Shoulder > Treatments
If your frozen shoulder has not responded to
conservative treatment in the form of rest, anti-inflammatory
medications, and physical therapy, your physician may
suggest surgical capsular release. In this procedure,
which usually is performed arthroscopically, a surgeon
cuts through the scar tissue that has formed in your
shoulder joint capsule to allow freer movement of your
shoulder. Many patients find that, in conjunction with
following a physical therapy program, surgical capsular
release can offer permanent relief from frozen shoulder.
The decisions you make and the actions
you take before surgery can be every bit as important
as the procedure itself in ensuring a healthy recovery.
Getting a second opinion from another qualified surgeon
is often advisable, particularly in rare or unique cases.
sure you have received any equipment you will need when
you get home from the hospital. This may include a shoulder
sling, ice packs or coolers, or heating pads. You should
receive prescriptions for any of these from your doctor
when your surgery is scheduled.
the potential risks and benefits of the surgery by asking
your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
possible, discontinue the use of any anti–inflammatory
medicine, especially aspirin, a week prior to surgery,
to prevent excessive bleeding during the procedure.
reduce the risk of infection, improve healing, and decrease
complications, try to quit smoking or decrease the amount
you smoke. In general, smokers have a higher infection
and complication rate overall.
check if the orthopedist performing the surgery is board-certified
or eligible, call the American Board of Orthopaedic
Surgery at 919-929-7103.
At most medical centers, you will
go to "patient admissions" to check in for
your surgical capsular release. There may be separate
check-in areas for ambulatory outpatient (patients who
go home the same day after surgery) and for overnight
inpatient surgery, so be sure to ask your physician
or an assistant about this. After you have checked in
to the hospital or clinic, you will go to a holding
area where the final preparations are made. The paperwork
is completed and your shoulder may be shaved, though
this is not always necessary. You will wear a hospital
gown and, if applicable, remove your watch, glasses,
dentures, and jewelry. You will have the opportunity
to speak with your orthopedic surgeon or an assistant,
and meet the anesthesiologist or anesthetist (a nurse
who has done graduate training to provide anesthesia
under the supervision of an anesthesiologist). Then,
you will walk or ride on a stretcher to the operating
room. Most patients are not sedated until they go into
the operating room. Here are some important things to
remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under anesthesia.
you may be unable to drive, arrange for someone to help
take you out of the hospital and drive you home when
you are released.
a soft, comfortable shirt that will not irritate your
skin when worn under a shoulder sling.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
Arthroscopic surgical capsular release
of your frozen shoulder normally takes one to two hours
will be put under general anesthesia, and you may also
be given an interscalene block, which is a regional
anesthetic that is administered through an injection
in your neck and numbs your shoulder area.
arthroscope (a tiny camera about 3 1/2 millimeters in
diameter) is inserted into your shoulder, and provides
images on television monitors so the surgeon can see
your shoulder ligaments.
instruments are inserted through two or three three-
to four-millimeter incisions in your shoulder.
these instruments, the surgeon cuts away scar tissue
that has developed in your shoulder joint capsule.
surgery you will receive stitches and be taken to the
recovery room. The stitches in your skin are usually
removed in two to three weeks.
When you awaken in the recovery room
following surgical capsular release, your shoulder usually
is wrapped in gauze, immobilized in a sling, and covered
with an ice pack. You may feel a moderate amount of
pain, depending on the severity of the dislocation.
You usually stay in the recovery room for at least two
hours while the anesthetic wears off. General anesthesia
wears off in about an hour and regional anesthesia may
take about two hours to wear off. As soon as possible
after surgery, you may begin exercises using a continuous
passive motion machine (CPM). Your temperature, blood
pressure, and heartbeat will be monitored by a nurse,
who, with the assistance of the doctor, will determine
when you are ready to leave the hospital.
After surgical capsular release, you
will need to take steps to reduce the pain and inflammation
in your shoulder. Rest, icing, and anti-inflammatory
painkillers such as ibuprofen or aspirin can ease pain
and swelling. Here is what you can expect and how you
can cope with a sling immobilizing your shoulder:
first concern is to monitor swelling for the first 48
hours while wearing your sling. Physicians generally
prescribe ice packs to be applied for 20 minutes at
a time, three or four times a day.
will need to wear the sling for three to five days,
though you will able to use your shoulder and arm to
perform daily functions.
can usually remove the gauze bandage and bathe regularly
after two to seven days. You can remove the sling for
brief periods to shower, but remember to avoid moving
the injured arm.
are usually removed about two weeks after surgery.
you develop a rash or irritated skin around your sling,
call your physician.
you notice any abnormal wear or discomfort in the sling,
contact your physician as early as possible. In general,
do not try to "grin and bear it" if discomfort
does not go away within a few days. The sling should
not irritate your skin.
therapy exercise usually begin about 24 hours after
Once your pain has decreased enough
to allow you to move your shoulder comfortably, you
usually can begin performing basic stretching exercises
aimed at increasing your shoulder’s range of motion.
Some of these include a pendulum-like motion, in which
you lean over with your affected arm hanging down and
your other arm extended and resting on a table to support
your body, and then make small circles with your affected
arm. The next step is to perform this exercise while
holding a light weight. Other exercises focus on flexing
your shoulder forward and back with gentle motions,
and some use apparatus such as a wand or pulley system.
All involve the unaffected arm "leading" the
affected arm so that the affected arm does not have
to push against resistance. As in all exercises, proceed
gradually. Do not pursue an aggressive exercise program
if you experience pain or stiffness.
FORMAL PHYSICAL THERAPY
A physical therapist may use heat or ultrasound to ease
the pain in your shoulder and allow you to exercise
more comfortably and efficiently. Your physician also
may suggest an injection of a long-lasting anesthetic
before you perform supervised stretching exercises.
Your physical therapist then takes you through a series
of passive movements aimed at regaining range of motion
in your shoulder.
It is not uncommon for sufferers of
frozen shoulder to experience residual symptoms for
years after the initial diagnosis. These generally include
mild pain and a small loss of range of motion in the
shoulder that usually does not affect your ability to
perform everyday functions. There is no way to truly
protect yourself from a recurrence of frozen shoulder,
but physical therapy is recommended to help strengthen
and stabilize the joint.