Capsular release for Frozen Shoulder

This leaflet will advise you on having a capsular release and outline the recovery of your shoulder following surgery. 

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What is a frozen shoulder (or "adhesive capsulitis")? 

You may have been told that you have a frozen shoulder. This is a painful condition which results in a severe loss of motion in the shoulder because of scarring and fibrosis of the joint capsule (the deepest layer of covering of the joint). It may follow an injury to the shoulder, but usually it arises spontaneously. 

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Who is affected? 

This condition can occur at any age but is most common in the 40­60 year age group. Women are affected slightly more often than men and may affect both shoulders but not usually together. Frozen shoulder is also more common in those patients with diabetes. 

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What is the cause? 

In most instances there is no known cause and probably due to your genetic make up, though a recent injury can start the condition and it may also be associated with other shoulder problems such as bursitis or tendon injury. 

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Why do I need surgery? 

Your surgeon may offer you an operation because non-operative treatment has not worked. Non-operative treatment includes physiotherapy, steroid injections into the joint and hydrodistension (injecting water into the joint under pressure to stretch out the capsule). 

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The operation 

The aim of the operation for this condition is to regain the normal (or at least a functional) range of movement for your shoulder. The operation may just involve you being anaesthetised and the surgeon manipulating the shoulder to break down the scarred tissue. However they may have to insert a camera into the shoulder (arthroscopy) to release and remove the scarred tissue directly. After the operation it is important that you start moving the shoulder early with the help of the physiotherapists to try and retain the improvement in range of movement. There are no restrictions on movement unless you are told otherwise. 

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Potential complications 

Even when an operation goes well and achieves what it meant to do, there is a small proportion of patients (about 5%) who do not improve following surgery. Any operation has a chance of having a complication. Fortunately the chance of having a complication is small (<5%) and having a significant complication that will have a negative effect on the outcome of surgery is even smaller (<1%). The following are specific complications associated with a capsular release: 

Persistent stiffness every with full release of the scar tissue and complete mobilisation of the shoulder joint during surgery, in aggressive forms of the conditions, the scar tissue can reform quickly causing the shoulder to be stiff again. 

Infection superficial wound infections are more common and can often be treated with a short course of antibiotics. Deep infections within the joint are rare but would require you to come into hospital to have the shoulder washed out and go on intravenous antibiotics 

Fracture - very rarely the shoulder can fracture during manipulation as the surgeon has to put high forces through it to get the range of movement back. The shoulder is manipulated using a particular technique to minimised the chance of this happening. 

Nerve injury this is highly unlikely to occur as the ports made for the keyhole surgery are place away from the known position of nerves. Sometimes nerves can get compressed or squashed during this procedure which will present will numbness and weakness but this is likely to resolve within a few days 

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The shoulder after a capsular release 

Hospital stay: Normally done as a day case 

Arm immobilisation: Sling or brace for up to 4 weeks 

Total recovery period: 2 to 3 months 

Return to driving: 4 to 6 weeks 

Return to work: Desk based job - 2 to 4 weeks Manual job - 2 months 

Return to sports: Non-contact from 2 months Contact/overhead from 4 months 

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