Arthroscopic release of frozen shoulder

A frozen shoulder (sometimes called adhesive capsulitis) occurs when the joint capsule surrounding the joint becomes thickened and swollen by the formation of scar tissue.

This process, which worsens over time, reduces the space available within the joint for the bone of the upper arm (humerus). It can be very painful and significantly reduce movement of your shoulder.

A frozen shoulder or locked shoulder can occur alongside other conditions, such as calcific tendonitis or ‘rotator cuff tear’, which affects the group of muscles that controls movements of the shoulder.

The exact causes of a frozen shoulder are often unclear. It may be due to irritation and swelling of the fluid filled sac that surrounds the shoulder joint. It may be due to the growth of bony spurs on the top of the shoulder blade; these usually occur due to osteoarthritis (the ‘wear and tear’ arthritis).

Several factors can increase your risk of developing a frozen shoulder, including:

• A previous shoulder injury (or surgery)
• If you suffer from diabetes

The two most common frozen shoulder symptoms are pain and persistent stiffness in the joint. These may range from mild to severe and may become gradually worse over time (a number of months or years).

These symptoms can make the full and free movement of the shoulder very painful. Frozen shoulder pain might impact everyday tasks, such as dressing, sleeping, driving and working, making them difficult to perform.

There are three distinct phases of the condition:

• Phase one: the ‘freezing’ begins, with the shoulder aches and is painful when the arm is extended
• Phase two: the ‘frozen’ stage, the shoulder may become stiffer, but the pain doesn’t necessarily get worse, and the shoulder muscles may begin to shrink through lack of use
• Phase three: the ‘thawing’, sees the regaining of movement and the reduction of the pain. You may not regain full movement, but everyday tasks become much easier

Early frozen shoulder diagnosis and treatment is highly recommended to help prevent the persistent stiffness and pain caused by a frozen shoulder.

Your GP should be able to diagnose a frozen shoulder after discussing your symptoms and physically examining your shoulder, assessing the range of movement you have. He may refer you to our Consultant Orthopaedic Surgeons for further tests and appropriate treatment.

Treatment includes the use of painkillers, physiotherapy, or corticosteroid injections into the joint. When the condition significantly affects daily life, you may need surgery - known as manipulation under anaesthetic and/or a shoulder arthroscopy may be required to relieve the frozen shoulder.

Subacromial decompression is an operation used to treat a frozen shoulder (or ‘shoulder impingement’). Arthroscopic describes the minimally invasive ‘keyhole’ method of carrying out the procedure, using an instrument inserted through a small incision.

Arthroscopic (or ‘keyhole’) surgery is a less invasive procedure than open surgery and usually has excellent results with a shorter recovery time. During the procedure the joint, and the area surrounding it, is inspected and treated using an arthroscope inserted through three or more small incisions in the skin around your shoulder.

If you’re suffering from subacromial impingement, the space between your shoulder blade and tendons reduces in size, causing the bone to rub against the tendons when you raise your arm, restricting movement. Subacromial decompression can open up this space by removing any swollen or misplaced tissue or bone, resulting in improved movement of the shoulder joint.

This operation is usually carried out as day surgery which means you’ll be able to return home on the same day, but you won’t be able to drive yourself.

The procedure will be carried out under a general anaesthetic so you’ll be asleep during the operation. You may also have a local anaesthetic in the nerves of the shoulder to reduce discomfort following the operation.

Arthroscopic subacromial decompression usually takes about an hour, depending on the exact cause of your condition and what needs to be carried out to treat it. The arthroscope will give the surgeon a good view of the subacromial space within your shoulder and allow any damaged or abnormal areas to be repaired or reshaped.

At the end of the operation, the incisions will usually be closed with stitches.

After the operation your shoulder will be supported in a sling and cold packs may be applied to help reduce swelling and pain. We’ll help manage any discomfort with painkillers. You’ll probably need to take several days off work, depending on your occupation.

After the operation, most patients experience much more normal movement in the shoulder joint and reduced pain. Usually patients see the most improvements in the first six months.

A programme of physiotherapy will usually be suggested to help speed recovery and maintain improvement in movement.