What is adhesive capsulitis arthroscopy?

An arthroscopic capsular release is a minimally invasive surgical procedure used to relieve the pain of adhesive capsulitis. It involves a 'keyhole' approach through two or three small incisions using equipment similar to a thin telescope (an arthroscope).

What is adhesive capsulitis?

It is also referred to as "frozen shoulder." It causes pain in the shoulder and a limitation of movement. The tissues surrounding the shoulder joint, or the capsule, become inflamed, thicken, and start sticking to the joint and tendons surrounding it. Gradually, the most common feature is an inability to use your arm usually. Pain can be caused by such motions as reaching overhead or behind your back. It may also disturb your sleep.

Frozen shoulder has three stages:

Stage 1: The freezing of the shoulder

This is an inflammatory phase resulting in progressive shoulder stiffening. In the inflammatory stage, patients experience increased shoulder pain, which can be severe at times, both during the day and at night. It is also accompanied by intense pain in the back of the neck.

Stage 2: frozen shoulder

It is also known as the plateau stage, when the pain decreases, but the shoulder is still stiff.

Stage 3: Shoulder Thawing

This is the rehabilitation time. The stiffness in the shoulder begins to decrease. This can take as long as 18 months to two years.

Adhesive capsulitis heals naturally in most patients and that too in a couple of years. However, early treatment always brings better results.

Are there alternatives to surgery?

In most cases, physiotherapy and a steroid injection into the joint will be attempted first in an attempt to see if that can reduce the pain. Physical therapy and specific stretches can significantly assist in loosening the shoulder capsule and the pain. It's essential to move the shoulder as carefully as possible. This motion does not damage the shoulder but may irritate tissues and cause pain. Sometimes, the more sedentary you are, the tighter the capsule may become. Careful movements of the shoulder are painful but should not damage the shoulder.

If administered in the early stages, it can completely reverse adhesive capsulitis. It may be ineffective, however, in the later stages. Many people choose to live with it and wait it out. You could modify your lifestyle regarding how you use your arm for activity. Surgery would be the next resort of treatment if you tried all of these options.

Do I need to have an arthroscopic capsular release?

Most patients recover and do not require intervention, but some are considered for surgery to help the 'lining' of the joint become less adhesive. This is to enhance the thawing/recovery phase, and it has a particularly strong effect on releasing the stiffness. The arthroscopic capsular release is done to improve the shoulder's range of movement (the stiffness) and reduce the amount of pain.

What is done in arthroscopic capsular release?

During your procedure, you are often positioned upright in a beach chair type position. The surgery is carried out with keyhole surgery (arthroscopy). The surgeon places a camera in to your shoulder from a small incision and views the images on a TV screen. Photographs are usually taken of the diagnosis.

The inflamed and "stuck" capsule is then released through a second incision divided with a small, accurate cutting instrument. A steroid injection into the joint may be an adjunctive part of the procedure, and stitches or staples might be used to close the wound.

Will I feel any pain after surgery?

Your arm will be numb due to the nerve block/local anesthetic used during your surgery, but this should have worn off within the first 24 hours after your surgery. You may feel some pain after the surgery, and you'll be given medicine to help with reducing the pain.

What are the risks after surgery?

Shoulder arthroscopy carries some risk but has been deemed safe with few complications, like any surgery.

Arthroscopic capsular release is widely performed and, in most cases, is a very safe operation. When considering recommending the procedure, your orthopedic surgeon will assess the benefits and disadvantages of the procedure. You, though, must be aware of potential complications and side effects of most surgical procedures so that you might make a well-informed decision and consent.

Possible complications include:

• Infection is a severe complication, and considerable steps are taken to prevent it. For example, you will be prescribed antibiotics to try to prevent it.
• Nerve injury – the risk of this is scarce, but further treatment or surgery may be required if damage does occur.
• Bleeding—This rarely occurs as arthroscopic capsular release is a 'keyhole' procedure, and there is very little blood loss.
• Thrombosis/blood clot is rarely a problem with shoulder surgery.
• Stiffness recurs—it is uncommon, but occasionally, if the stiffness is distressing, it will be necessary to re-do the operation.

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