Frozen Shoulder Repair – Adhesive Capsular Release

What is a frozen shoulder?

Frozen shoulder occurs when the connective tissues surrounding the shoulder joint (shoulder capsule) thicken and shorten due to chronic inflammation.  This condition is also known as adhesive capsulitis; frozen shoulder causes pain and motion loss in the affected shoulder.  In more severe cases, there is a complete loss of shoulder function; simple activities of daily living (hygiene, sleep, dressing, eating) can be  difficult and painful.

Frozen shoulder typically has an insidious onset. Although the development of adhesive capsulitis is not completely understood, some underlying health conditions are associated with an increased risk of developing a frozen shoulder. They are as follows:

• A lack of shoulder movement for an extended period, often from a prior injury or surgery, can cause a frozen shoulder.
• Age and sex. A frozen shoulder is more commonly seen in women over the age of 40.
• A frozen shoulder is seen more often in patients with diabetes; these patients typically experience a more severe form of the disease and longer-lasting symptoms.
• Prior surgery to the shoulder girdle or chest area (breast reconstruction).
• Radiation therapy

What are the stages of adhesive capsulitis or frozen shoulder?

There are four stages in the gradual development of adhesive capsulitis:

• Inflammatory phase: characterized by increasing pain with little motion loss. Sleep in difficult.
• Freezing phase: shoulder pain increases resulting in disuse of the affected limb and progression motion loss
• Frozen phase: The affected shoulder is significantly less painful but function is limited because of the motion loss associated with this phase.
• Thawing phase: the patient slowly recovers shoulder motion as the condition wanes.

Most patients will progress through these phases over 2 years without intervention.

What is the treatment for a frozen shoulder?

Patients with a frozen shoulder are generally able to recover with conservative therapy. The goal of conservative treatment is the resolution of shoulder inflammation and the restoration of shoulder range of motion. A combination of rest, ice, and non-steroidal anti-inflammatory medications (NSAIDs) can be used as part of an initial treatment strategy. The judicious use of intraarticular injections of corticosteroids can also be of great value in treating symptomatic adhesive capsulitis patients. Corticosteroids are effective agents that work to decrease the excessive inflammatory process that is characteristic of frozen shoulder joints. Once the inflammation and associated pain have diminished, physical therapy and a home exercise and stretching program are indicated.

What is shoulder arthroscopy with capsular release?

In those circumstances where conservative measures fail to adequately alleviate symptoms, surgical intervention may be necessary to treat the affected shoulder. Surgery for adhesive capsulitis is geared toward removing inflammatory tissues, releasing the shoulder capsule and restoring normal shoulder range of motion. Surgical repair is typically performed at the “freezing” or “frozen” stage of adhesive capsulitis. Frozen shoulder repair is also known as arthroscopic shoulder capsule release. Manual manipulation of the shoulder and an arthroscopic release of the tight ligament around the shoulder are performed together to restore normal shoulder kinematics. Dr. Riley J. Williams, orthopedic shoulder doctor, treats patients in Manhattan, Brooklyn, New York City, NY and surrounding areas, who have experienced a frozen shoulder and need surgical repair.

How is a frozen shoulder surgery/capsular release performed?

The surgery to repair a frozen shoulder is generally performed as an outpatient procedure as an overnight hospital stay is not required for recovery. Prior to the procedure, the patient is sedated and regional anesthesia is administered.  Dr. Williams then manipulates the shoulder and carefully moves the shoulder through a sequence of positions to restore range of motion and stretch the inflamed connective tissues. This manual manipulation of the shoulder releases the tight shoulder capsule, improves range of motion of the shoulder, and decreases shoulder pain. Once the manual manipulation is complete, Dr. Williams creates small “keyhole” incisions surrounding the shoulder. A continuous circulation of a sterile solution is introduced into the shoulder joint to enhance visualization of the shoulder joint structures. A small camera (arthroscope) is then inserted through a portal and the images are relayed onto a screen for Dr. Williams to methodically examine the muscles, tendons, and ligaments of the shoulder joint. A radiofrequency probe is then introduced when the shoulder capsule has been identified. This probe uses radiofrequency waves to sever and cauterize the tissue capsule allowing the joint to move more freely. This device is also used to cauterize all inflamed appearing tissues in the shoulder. Once the shoulder capsule has been stretched and released, the arthroscope and surgical instruments are removed, and the incisions are closed with sutures or steri-strips. The shoulder is once again manipulated to confirm the restoration of full passive range of motion of the shoulder joint.

Why is shoulder manipulation important?

Shoulder manipulation under anesthesia as a single operation was the standard procedure for patients with a frozen shoulder. This manual manipulation of the shoulder releases the tight shoulder capsule, improves range of motion of the shoulder, and decreases shoulder pain. When shoulder manipulation was later combined with the arthroscopic capsular release procedure, patients had more successful recovery outcomes.

What are the benefits of arthroscopic capsular release surgery?

Dr. Williams favors the arthroscopic surgical approach as the arthroscope allows for a precise and well-controlled release of the shoulder capsule. The radiofrequency probe implemented in this procedure cauterizes the tissue as it cuts, therefore reducing the bleeding within the joint. Due to the small incisions, this minimally invasive procedure results in a faster recovery period compared to open procedures. Arthroscopic capsular release also minimizes the risk of blood loss and infection as well as decreased pain and inflammation following surgery.

What are the benefits of arthroscopic capsular release surgery?

Dr. Williams favors the arthroscopic surgical approach as the arthroscope allows for a precise and well-controlled release of the shoulder capsule. The radiofrequency probe implemented in this procedure cauterizes the tissue as it cuts, therefore reducing the bleeding within the joint. Due to the small incisions, this minimally invasive procedure results in a faster recovery period compared to open procedures. Arthroscopic capsular release also minimizes the risk of blood loss and infection as well as decreased pain and inflammation following surgery.

For more information on frozen shoulder repair, or to discuss your frozen shoulder treatment options, please contact the office of Riley J. Williams, MD, orthopedic shoulder doctor at the Hospital for Special Surgery (HSS), serving Manhattan, Brooklyn, New York City, NY and surrounding areas.