Frozen Shoulder / Adhesive Capsulitis

Frozen Shoulder (Adhesive Capsulitis) is a common cause of pain and stiffness.

This condition leads to a global reduction in the range of motion of the your shoulder (stiffness). It may occur for no apparent reason or may follow an injury or surgery to your shoulder. It is more common in women and diabetics (when it is often bilateral and resistant to treatment).

There are three recognized stages of development. The duration of each stage is variable and they overlap to some degree.

Stages:
Freezing
Frozen
Thawing

1. Freezing

Often, the first sign of “frozen shoulder” is pain. This can be severe and can waken you at night. The pain is "within the shoulder". The shoulder is painful to move, particularly into internal rotation (reaching behind the back) and external rotation (turning the hand away from the body. This stage may last 2 – 10 months.

2. Frozen

As the condition progresses the pain in your shoulder subsides but the stiffness may increase. The stiffness may be so severe that your shoulder has almost no movement. This stage can last a further 12 months

3. Thawing
The stiffness may then improve over an 18 month to 2 year period following onset of symptoms. Sometimes you may be left with a residual loss of motion. If no treatment is given, most shoulders will gradually improve over 2 – 4 years. However treatment is available to shorten the duration of the disease process.

If pain is the most pressing problem, then treatment can comprise of
(i) Peri-articular steroid injection
(ii) Hydrodilataion of Shoulder
(iii) Physiotherapy

If stiffness is the most major problem, then I perform Arthroscopic Capsular Release.

Arthroscopic Capsular Release

This procedure entails precise tailored excision / division of contractures of the shoulder capsule to allow increased range of movement. It is recommended that you stop aspirin or similar medications 7 days prior to surgery, if it is safe to do so.

The Procedure

The operation is arthroscopic (keyhole) and is performed under general anaesthetic. My anaesthetist will often perform a brachial plexus nerve blockade or insert an indwelling brachial plexus catheter at the same time. This allows intensive, painfree in-patient physiotherapy for 24 – 48 hours post surgery in order to maximize surgical outcome.

You will have 2 small (5mm) length incisions, one behind and one in front of the shoulder joint. The interior of the shoulder joint is visualized with a keyhole camera system through the posterior portal (incision). The anterior incision is used to pass a radiofrequency probe and other instruments to surgically resect the contracted capsule.

Post-operative Care

When you have come around from your anaesthetic I will be able to demonstrate to you the range of motion achieved.

Following your surgery:
- you will have an absorbent dressing covering you shoulder for 24 hours to absorb the arthroscopic fluid that was pumped through your shoulder during the procedure.
- you will have an icepack to help reduce post op inflammation. I recommend it is applied for 30-45 minutes and then removed for 2 hours before being re-applied. This has been shown to be effective for up to 72 hours post surgery.
- Sutures are not routinely inserted. Surgical dressings over the wounds should not be removed for 2 weeks.
- a physiotherapist will begin your rehabilitation and mobilize your shoulder as frequently as possible
- You will normally stay in hospital one to two days post surgery for maximum supervised physiotherapy and can be discharged whenever the nerve block has worn off.
- When you get home it is important to continue to exercise your shoulder as often as possible. You may need to take regular analgesia to reduce your pain and allow rehabilitative exercise.

Capsular Release

Outcome

There is some medical evidence available that shows that over the next 6 months, the gains achieved by surgery can sometimes diminish by up 50% but then improve again.

Complications

Complications of arthroscopic capsular release are rare but can include increased pain, infection, nerve damage and fracture.