Frozen Shoulder: Why Capsular Release Surgery May Be Better

Are you experiencing ongoing pain and stiffness in your shoulder? Does it affect everyday activities like doing up a seatbelt, washing your hair or getting dressed? 

If so, there’s a chance you have ‘frozen shoulder’ or ‘adhesive capsulitis’. Luckily, with the correct diagnosis from an orthopaedic specialist, frozen shoulder can be treated effectively to restore pain-free movement. 

What is frozen shoulder?

Your shoulder joint is surrounded by a liquid called synovial fluid, which lubricates the bones so that they can they rotate smoothly. The whole joint is encased in a fibrous sac called the shoulder capsule. 

Sometimes, this capsule gets thicker and tighter, which means less fluid in the joint. It also puts pressure on the connective tissues of your shoulder, affecting its mechanical movement. The nerves in the joint can also be pinched or compressed, leading to pain and numbness. 

What causes frozen shoulder?

There are no clear causes for frozen shoulder, although we do know that it is more common in people with medical problems such as diabetes, Parkinson’s disease, cardiac disease and thyroid conditions. It’s also more likely to affect people whose shoulders have been immobilised for a while – for example, after an operation. 

What treatment options are available for frozen shoulder?

Getting a correct diagnosis is key to your recovery – so I would always advise consulting a doctor if you have pain and stiffness in your shoulder. An MRI scan is usually needed to work out the cause, and to rule out other problems. 

If frozen shoulder is diagnosed, a simple combination of physical therapy exercises and anti-inflammatories or steroid injections can release the tightness and relieve pain. 

Capsular Release Surgery

I would usually recommend trying these conservative treatments for several months before considering surgery. 

If your symptoms persist, however, keyhole (or arthroscopic) surgery can be a highly effective treatment. It involves cutting through stiff areas of the capsule and manipulating any parts of your joint that have been pinched or misaligned. 

What are the benefits of Capsular Release Surgery? 

This kind of surgery is minimally invasive – the entire operation is carried out through small cuts in your skin, using a tiny camera to see inside your joint. 

The less invasive the surgery, the easier it is for your body to recover, and the small incisions reduce the chances of infection.   

What is recovery like from Capsular Release Surgery?

In some cases, your shoulder may need to be held in a special splint after surgery, to keep the capsule stretched while it heals. 

Mostly, though, it is key to start moving your joint as quickly as possible after the operation. This helps to prevent scar tissue from building up inside your shoulder, which might bring you right back to square one. 

A physiotherapist will guide you through the exercises, massage and stretches you need to do to help rebuild strength and maintain flexibility after surgery. Recovery to a full range of movement can take three months or longer – and it’s really important to be committed to doing the physical therapy exercises at least three times a day. 

As with all joint pain that restricts your movement or affects your lifestyle, the best thing you can do is to get it diagnosed by a specialist. Often, you will be referred to a physiotherapist to do a physical examination, and give you exercises and stretches to help improve mobility and reduce pain. 

For ongoing symptoms, it is always advisable to talk to an orthopaedic specialist and get a scan of the inside of your joint. Most serious or debilitating conditions can be treated more effectively with early diagnosis and treatment. 

Simon Moyes is an internationally renowned orthopaedic surgeon and leader in the field of arthroscopic (keyhole) surgery. His Capital Orthopaedics team works from The Cromwell Hospital in London, with its state-of-the-art diagnostic and surgical equipment, and top sports medicine professionals.