Fig.1X-Ray of shoulder
Fig.2The red and inflamed lining of a frozen shoulder joint seen during key hole surgery
Fig.3The same joint after arthroscopic capsular release
1. What is frozen shoulder?
The shoulder is a ‘ball and socket joint’, which is covered by ligaments and a structure called the capsule. When the capsule becomes inflamed and thick it causes pain and limitation of shoulder movements (See fig 2). This pain and limitation of shoulder movements (stiffness) is called frozen shoulder. In most patients the cause is not known, however it is more common in patients with diabetes. It can also occur after an injury to the shoulder. The stiffness is characterized by the inability to lift the arm above the head or take it behind the back.
2. How is frozen shoulder diagnosed?
The diagnosis of frozen shoulder is by the specialist Consultant taking an accurate history of your pro’blem and by detailed shoulder examination. You will need an X-ray of the shoulder to rule out other causes of shoulder stiffness (Fig. 1).
3. How is frozen shoulder treated?
Frozen shoulder can be treated both by non-surgical and surgical methods
rest, simple painkillers, injection and physiotherapy. The specialist may give you an injection of steroid and local anesthetic into the shoulder joint to help with pain relief. This may flare the discomfort in your shoulder up for 48 hours. Physiotherapy aims to improve and maintain your movements.
If the above measures fail to improve the symptoms then surgery can be considered. This is done by keyhole surgery. It is technically called arthroscopic capsular release.
See figs 2 and 3.
4. What happens during the surgery?
you could either have a general anesthetic and or a regional anesthetic. In the later the nerves supplying the shoulder and the arm is numbed by the use of local anaesthetic. You can choose to stay awake during the procedure. More information on regional anesthetic can be found in the anaesthesia section of this website and anaesthetia patient information leaflets.
The surgeon uses keyhole surgery to release the ligaments and the capsule and gently manipulates the shoulder to regain the movements of the shoulder. He may also inject the shoulder with steroid at the end of surgery. You do not normally have any stitches. We use only steristrips. Your arm will be in a sling after surgery.
5. What are the benefits and risks of surgery?
reduced pain and improved function of the shoulder
Risks of surgery:
Infection, stiffness of the shoulder, recurrent or persistent pain and fracture during manipulation, incomplete restoration of shoulder movements, injury to nerves or blood vessels, which may weaken shoulder movements. This operation is about 90% successful.
6. What happens after surgery?
In most instances you can go home on the same day of surgery. You will have a sling, which can be removed after a day. Swelling around the shoulder is normal after this surgery. However it will settle down after a few days.
this is a very important part of the treatment after surgery. You will see a physiotherapist who will teach you exercises to help you regain and maintain your movement and the strength after surgery. Swimming is very useful and can be commenced after the wound has healed.
2- 3 weeks after the operation. However if you drive HGV it is advisable to delay driving till your shoulder is pain free and strong, normally after 4 weeks.
Returning to work:
light duties, like office work; 3-4 weeks after surgery. Heavy work; 6 weeks after surgery. Follow-up appointments: 2 weeks after surgery you will have to see a nurse to check your wound. This may be at the hospital or may be your practice nurse. You will usually see the Consultant 6 weeks after surgery but please ring on the number on the contact us page if you have any problems and we will arrange to see you earlier if necessary.
We hope this information is useful and if you have any more questions please feel free to discuss these with your Consultant or call the number on the contact us page.