Frozen Shoulder Surgery: Weighing the Pros and Cons

Understanding Frozen Shoulder Surgery

Adhesive Capsulitis, commonly known as frozen shoulder, is an inflammatory condition in which the body develops excessive scar tissue and inflammation in the shoulder joint, causing pain and severe restrictions of arm and shoulder movements.

When dealing with adhesive capsulitis, surgery may become an option if non-surgical treatments fail to provide relief. However, deciding to undergo surgery is a significant decision that requires a comprehensive understanding of the potential risks and complications that could arise.

Surgical Considerations

Surgery for frozen shoulder, including manipulation under anesthesia and arthroscopic capsular release, is typically considered in severe cases or when conservative treatments have proven unsuccessful. The procedure might involve manipulating the shoulder in the operating room to break down the scarring, and in some cases, an arthroscope may be used to directly cut or release the capsular adhesions. Physical therapy usually begins on the same day or the day after the manipulation.

Success Rates and Outcomes

When it comes to surgical treatment for adhesive capsulitis, studies have shown promising results.

For instance, in a retrospective study of manipulation under anesthesia in 32 patients, 97% experienced relief of pain and near-complete recovery of motion within an average recovery time of 13 weeks. Only 8% of patients required a second manipulation for successful results (PubMed). Another study demonstrated 85% patient satisfaction after manipulation under anesthesia for frozen shoulder, with a considerable increase in range of motion of the shoulder and a significant reduction in pain after the procedure (NCBI).

Arthroscopic capsular release for frozen shoulder has also shown excellent short-, mid-, and long-term results. One study found that patients with early stages of frozen shoulder and a duration of symptoms <10 months made greater improvements in shoulder functionality following arthroscopic capsular release, when compared with patients who had a longer duration of symptoms (NCBI).

However, outcomes after ACR were found to be inferior in diabetic patients compared to non-diabetic patients. Therefore, adequate pain control and structured physical therapy are essential for a complete recovery post-operatively.

The choice between surgical and non-surgical approaches depends on individual patient factors, including the severity of symptoms, the duration of symptoms, and the patient's overall health status.

Surgical vs. Non-Surgical Efficacy

Most patients with frozen shoulder respond well to a combination of conservative treatments, with symptoms gradually resolving within 12-18 months (Mayo Clinic), and non-surgical treatments are successful in up to 90% of patients. This includes treatments like medications, steroid injections, and physical therapy.

Comparing surgical and non-surgical treatments, a randomised controlled study revealed similar outcomes for both groups over a two-year period. Notably, patients treated with steroid-with-distension injections, a non-surgical approach, did not require additional surgical interventions (JAMA). This highlights the cost-effectiveness and efficacy of this non-surgical approach for primary frozen shoulder.

Surgical treatment is considered for resistant cases that do not respond to conservative treatment for 6-9 months. However, surgical options are not clinically superior to one another, and some, like manipulation under anaesthesia, could lead to complications such as fractures of the humerus or rotator cuff tears.

Risks and Complications

While frozen shoulder surgery can be successful in restoring shoulder motion and decreasing the duration of the disease, it's not without potential complications. These complications can be serious and, in rare cases, even life-threatening.

Most surgeries come with a low, inherent risk of:

• Infections
• Damage to nerves and blood vessels
• Blood clots
• Anesthetic risks

The complication risk for arthroscopic capsular release is considered fairly low, with axillary nerve damage being the most clinically relevant potential complication. While manipulation under anaesthesia can be effective, the procedure could lead to complications like fractures of the humerus or rotator cuff tears.

Therefore, before opting for surgery, it's essential to exhaust all non-surgical treatments and weigh the potential risks against the benefits. It's also crucial to discuss these factors with your healthcare provider, who can guide you in making an informed decision.

Treatment Options for Frozen Shoulder

When you're dealing with a frozen shoulder, you have several treatment options to consider. Choice of treatment often depends on the severity of your symptoms and the stage of the condition.

Alternatives to Surgery

If you're concerned about the potential risks and complications associated with surgery, there are several alternative treatments for frozen shoulder that you can consider.

• Pain Management: Usage of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are the standard pain management protocol that help reduce pain, decrease inflammation in the body, and help reduce immune system activity.
• Arthrographic Hydrodilatation: Also known as capsular distension, this procedure involves injecting fluid into the shoulder joint to stretch the capsule and improve range of motion. You can learn more about this treatment in our article on capsular distension.
• Adhesive capsulitis embolization (ACE): a minimally invasive procedure that uses a catheter and X-ray guidance to release microspheres into the blood vessels of a frozen shoulder, blocking blood flow to reduce inflammation and has shown excellent results in relieving shoulder pain.
• Seek RELIEF®: The RELIEF® procedure is a scientifically backed procedure that combines ultrasound guidance and hydrodissection, by specifically targeting damaged and dehydrated fascia in the shoulder joint, and may help address the underlying symptoms of adhesive capsulitis.^1,2,3,4

Ultimately, the best treatment option for your frozen shoulder will depend on your unique situation and needs. It's important to discuss all options with your healthcare provider to determine the most appropriate approach for you.

Recovery Process after Frozen Shoulder Surgery

Recovering from frozen shoulder surgery is a process that requires time, patience, and dedication to post-operative care and physical therapy. Understanding what to expect during recovery and the steps you can take towards rehabilitation can help you navigate this journey with greater confidence and efficacy.

Post-Surgery Care

After the surgery, comfort is a priority. Patients usually spend a week or two in a sling, which provides support and helps to minimize pain and discomfort. It's crucial to remember that each patient's recovery timeline may vary, with full recovery taking about six months to achieve a good range of movement (Healthdirect).

Pain management is a vital part of post-surgery care. Ensuring adequate pain control can make the recovery process more comfortable and help you engage more effectively in your physical therapy sessions. If you're a diabetic patient, be aware that clinical outcomes after arthroscopic capsular release (ACR) for frozen shoulder may be slightly inferior compared to non-diabetic patients.

During your recovery, it's also important to maintain a balanced diet that supports healing. For tips on what to include in your frozen shoulder diet, visit our dedicated article.

Physical Therapy Regimen

Physical therapy is crucial for recovery following frozen shoulder surgery. Aggressive range-of-motion physical therapy usually starts almost immediately post-surgery to prevent scar tissue from reforming.

Exercises prescribed by a physical therapist help maintain the range of motion gained during the surgery and restore shoulder motion. The total recovery of pain-free range of movement averages at around 2.8 months, with postoperative physiotherapy playing a crucial role in the rehabilitation process.

Engaging in frozen shoulder exercises as part of your physical therapy regimen can help you regain shoulder mobility and strength. Always remember to follow the advice and instructions of your physical therapist to ensure that you're doing these exercises safely and effectively.

Post-surgery recovery from frozen shoulder requires commitment to your physical therapy regimen and attention to your overall health. By understanding the recovery process and actively participating in your rehabilitation, you can work towards restoring your shoulder's full range of motion and return to your normal activities.

Conclusion

In conclusion, both surgical and non-surgical treatments have their merits, and the choice between the two should be based on individual patient factors, the severity of the condition, and personal preferences. It is crucial to consult with a healthcare professional before making a decision. For more information on this topic, read our articles about how to prevent frozen shoulder, frozen shoulder exercises, and adhesive capsulitis treatment.

For more information on how RELIEF® can help with adhesive capsulitis, without the need for steroids, surgery, anesthesia, or post-procedure immobilization, contact us today to schedule a free consultation.