Frozen Shoulder Surgery Overview

Frozen shoulder can be a painful condition, also called adhesive capsulitis. Patients who have a frozen shoulder have difficulty with even simple movements of the joint. Typical symptoms of a frozen shoulder include pain when moving the arm, even with simple activities such as washing hair, buckling a seatbelt, or fastening a bra. The condition is caused by scarring of the shoulder capsule, the lining of the shoulder joint.

Treatment of a frozen shoulder is almost always successful with non-surgical treatments. Recovery from the condition can take months, or even years. In the rare cases of patients who have tried these methods to improve their shoulder mobility, and are still restricted by pain and stiffness, surgery may be considered for a frozen shoulder.

Frozen Shoulder Surgery

The usual surgical treatment of a frozen shoulder is called an arthroscopic capsular release. As is evident from the name, this is an arthroscopic shoulder surgery where a small camera is inserted into the shoulder joint. Through other small incisions, small instruments can also be inserted to treat the problem.

In the case of a frozen shoulder, the problem is the tight and thickened shoulder capsule, and therefore the treatment to address this is to cut the tight capsule to allow the joint more freedom of mobility. Instruments are inserted to release the capsule surrounding the shoulder socket.

The most important aspect of an arthroscopic release is ensuring any improvements in shoulder mobility are maintained after surgery. Sometimes patients will have their arm specially splinted to keep the capsule of the shoulder stretched. More commonly, ​physical therapy will begin immediately following the surgery to ensure that scar tissue does not begin to re-form around the joint.​​

Alternatives to Arthroscopic Release

• Nonsurgical Treatment: Most patients have tried nonsurgical treatment for their frozen shoulder before considering any invasive treatments. However, many patients don't realize the length of time that frozen shoulder can persist, and the fact that nonsurgical treatment may take 12 to 18 months before symptoms resolve. Therefore, most surgeons don't consider nonsurgical treatments to have failed unless they've been tried for many months.
• Manipulation Under Anesthesia: Performed less commonly since arthroscopic treatment options became common, a manipulation under anesthesia (MUA) is essentially the passive stretching of your shoulder while you're asleep. The advantage is getting a much better stretch of the joint capsule, but there are possible complications. Pain can occur after this procedure, and if pushed too forcefully, it is possible for bones to break or tear under excessive force. Often an MUA is performed in conjunction with an arthroscopic capsular release.
• Open Capsular Release: An open capsular release is a much less commonly performed surgical procedure, now that arthroscopic treatment is common. Much like the arthroscopic procedure, the shoulder capsule is divided, in this case by your surgeon creating an open incision in order to see inside the shoulder. Arthroscopic surgery is generally felt to be superior because it causes less pain, is less invasive and allows more complete access to the shoulder joint.

Recovery From Arthroscopic Capsular Release

While arthroscopic capsular release can be very helpful to gain shoulder mobility, the key is to ensure all treatments have been exhausted prior to undergoing surgery, and to maintain the improvement in motion after the surgery. Because of pain associated with surgery, it is tempting to limit shoulder movements after surgical release, but doing so can lead to a recurrence of the original problem. 

As mentioned, some surgeons specially splint the shoulder to keep it in a stretched position, and others will begin immediate movement and therapy after surgery in an effort to maintain improvements in shoulder motion.

There are possible complications of surgery, and before considering any surgery these should be discussed and understood. As mentioned, some surgeons specially splint the shoulder to keep it in a stretched position, and others will begin immediate movement and therapy after surgery in an effort to maintain improvements in shoulder motion.

The most common complication from any shoulder procedure for a frozen shoulder is the possibility of ongoing, or even worsening, symptoms. Surgery can cause scar tissue and may make the symptoms of frozen shoulder, including pain and stiffness, worse than before surgery. Having physical therapy commence immediately after the surgery can help to maintain, and ultimately improve, the mobility attained at the time of surgery. Other risks include infection and nerve or cartilage injury.

Injury to the cartilage and nerves can occur because the anatomy of a frozen shoulder can be altered. With the shoulder capsule being so tight from the frozen shoulder, getting good access and visualization during surgery can be difficult.

Total recovery following surgery can take three months or longer, and therapy to maintain motion of the shoulder during this process is critical. Most people who have this type of surgery will work with a physical therapist three or more times per week, especially in the early phases of recovery. In addition, doing therapy motion activities will need to be done several times per day. It is important to be ready to devote a significant amount of time to recovery so that your result is as good as possible!

A Word From Verywell

Surgery is infrequently used for the treatment of a frozen shoulder, as almost all cases can resolve without surgery. However, if prolonged nonsurgical treatment is not leading to relief of symptoms, surgery can be considered as an option.

The most critical aspect of any type of surgery used for treatment of frozen shoulder is to ensure you get the shoulder moving as soon as possible after surgery to protect any gains in mobility and prevent new scar tissue from forming in the shoulder joint.