Arthroscopic release and manipulation under anaesthetic of frozen shoulder

This information will help you gain the maximum benefit from your procedure. It is not a substitute for professional medical care and should be used in conjunction with your medical treatment. 

The shoulder joint

The shoulder is designed to give a large range of movement. Movement occurs both between the ball and socket joint and also between the shoulder blade and chest wall. Most of the shoulder movement occurs between the ball and socket joint. The ball at the top of the arm bone (head of humerus) fits into a shallow socket (glenoid) which is part of the shoulder blade (scapula). The shoulder joint (glenohumeral joint) is surrounded by a joint capsule or lining. The shoulder joint is further supported by ligaments and muscles. 

Frozen shoulder

Frozen shoulder is a painful and stiff condition of the shoulder joint. It occurs slightly more commonly in females than males and most commonly in the 40 to 60 year old age group. It often comes on out of the blue but may also come on after a minor injury or after a shoulder operation. It is more common in patients with diabetes. 

Frozen shoulder is characterised by an abnormality in the lining (capsule) of the shoulder joint. The capsule becomes inflamed and therefore very painful, as well as also fibrotic (scarred and stiff). The natural history of this condition is for it to improve with time, but studies have shown it can take a number of months or even over three years in some cases for it to resolve.

Inflamed shoulder joint capsule

You characteristically go through three phases:

  • an initial painful phase
  • a painful and stiff phase
  • a resolving stiff phase. 

Normally frozen shoulder does resolve with time and treatment is aimed at controlling pain and gradually increasing movement as the shoulder moves out of the painful phase and into the stiff phase.

This condition can be severely debilitating and may last a long period of time. Intra-articular (into the joint) steroid injections with hydrodilitation (stretching the joint with fluid) have been shown to improve symptoms of frozen shoulder and speed up the recovery.

If this fails to improve significant symptoms in the shoulder, then arthroscopic (keyhole) release of the lining of the shoulder joint (capsule) and manipulation of the shoulder joint under anaesthetic may be offered to try and speed up the recovery from this condition. 

About your arthroscopic release and manipulation under anaesthetic

The aim of this operation is to try and improve the pain and range of movement in the frozen shoulder. The operation is performed under a general anaesthetic and interscaline nerve block and is often performed as a day case procedure or overnight stay. It is performed as a keyhole procedure with a camera inserted into the back of the shoulder and a probe into the front of the shoulder. The tight capsule of the shoulder is surgically released and then the shoulder is stretched and manipulated to regain the maximum range of movement.

The success rate for this procedure is around 70 to 80% and may take a few months with physiotherapy to see the full benefit. 

Risks and complications

All operations involve an element of risk. The risk of complications after this procedure is small, but it is important to know what they are. Please discuss any concerns with the doctors/consultant.

Anaesthetic risks

There are very small risks associated with anaesthesia the anaesthetist will discuss these with you on the day.

Surgical risks

There is a small risk of infection, probably less than 1%. 

There is a small risk of worse pain and stiffness around the shoulder in the form of a frozen shoulder, which can occasionally occur after shoulder surgery in about 1% of cases. 

There is a very small risk of damage to the nerves and blood vessels around the shoulder, less than 1%. 

There is a small risk of damage the bone and the joint but this is less than 1%. 

There is a 70 to 80% chance of improving the pain and range of movement of the shoulder, which means that there is a 20 to 30% chance of failing to see significant improvement.