Surgical Management of Frozen Shoulder!

Surgical Management of Frozen Shoulder

 

What is frozen shoulder?

Frozen Shoulder (adhesive capsulitis) is an extremely painful condition in which the shoulder is completely or partially unmovable.

Frozen shoulder often starts out of the blue, but may be triggered by a mild injury to the shoulder. The condition usually goes through three phases, starting with pain, then stiffness and finally a stage of resolution as the pain eases and most of the movement returns. This process may take a long time, sometimes as long as two or more years.

The lining of the shoulder joint, known as the ‘capsule’, is normally a very flexible elastic structure. Its looseness and elasticity allows the huge range of motion that the shoulder has. With a frozen shoulder this capsule (and its ligaments) becomes inflamed, swollen, red and contracted. The normal elasticity is lost and pain and stiffness set in.

If normal conservative treatment (physiotherapy, injections) do not work then surgical intervention is usually needed. The 2 main operations are an arthroscopic Capsular Release or Manipulation under Anaesthetic (MUA).

Manipulation under Anaesthetic

Your surgery is performed under a general anaesthetic. This means that you will be asleep throughout the operation. A nerve block may also be used. This is an injection that numbs your shoulder and arm providing good pain relief for the arm. It also results in a loss of sensation and movement in the arm.

During the procedure the joint will be stretched by the surgeon to regain maximum movement in the shoulder joint. They may also put an injection of local anaesthetic or steroid into the joint to help with pain relief.

After the surgery

Returning to work will all depend on what type of job you do manual workers may not be able to return to lifting duties for 2-4 weeks, however if you have a desk based job then you may return to work sooner. Your physiotherapist or surgeon can give you further advice. You can normally start to drive within a week of the operation. You must have the strength and comfort required to drive safely.

Intensive physiotherapy is essential after to maintain the full range of motion, strengthen the muscles and progress your exercise program as necessary.

Capsular Release

The operation aims to reduce the recovery time by freeing the joint to gain full range of movement and reduce pain. This is keyhole surgery where the tight capsule of the joint is released with a special radio-frequency probe.

The capsular release is performed with increased precision by key hole surgery, and is called an arthroscopic capsular release. The results are successful in over 80% of patients and the freedom from pain is quicker than MUA. Arthroscopic capsular release also allows the surgeon to look around the shoulder joint with the arthroscope for any other lesions or injuries.  Capsular release is safer and more effective than MUA for people who have developed a resistant stiff (frozen) shoulder after injury, trauma or fractures, as well as for diabetics.

Capsular Release involves cutting and removing the thickened, swollen inflamed abnormal capsule. A special radiofrequency thermal probe is used to cut and remove abnormal capsule tissue. The tight, constricted capsular ligaments are cut, thus freeing the joint again.

This is a keyhole operation usually done through two or three 5mm puncture wounds. There will be no stitches only small sticking plaster strips over the wounds. These should be kept dry until healed. This usually takes 5 to 7 days.

After the surgery

You will return from theatre wearing a sling. This is for comfort only and should be discarded as soon as possible (usually within the first 2 to 4 days). Some people find it helpful to continue to wear the sling at night for a little longer if the shoulder feels tender.

Returning to work will all depend on what type of job you do manual workers may not be able to return to lifting duties for 2-4 weeks, however if you have a desk based job then you may return to work sooner. Your physiotherapist or surgeon can give you further advice. You can normally start to drive within a week of the operation. You must have the strength and comfort required to drive safely.

Intensive physiotherapy is essential after to maintain the full range of motion, strengthen the muscles and progress your exercise program as necessary in the transition back to normal daily function and back to leisure activities.

 

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