Arthroscopic Arthrolysis

What does the procedure involve?

This is a keyhole operation that allows a controlled removal and release of excess scar tissue within the shoulder that develops as a result of a frozen shoulder. It is done under general anaesthetic (with you asleep) with a supplementary nerve block that provides good pain relief for the first 12-24 hours. The tight joint lining is released using a radiofrequency device with minimal risk of damaging other structures.  Normally three keyholes are used (one front, one back and one at the side).  Once the lining of the joint is fully released, a gentle manipulation of the shoulder is carried out to achieve a full range of movement.

What is the success rate?

90% of patients can expect a good or excellent result.  One in ten patients may have early recurrence of the stiffness.  It is unclear why this happens. To reduce this risk an injection of anti-inflammatory steroid (Depo-Medrone) is generally given into the joint under direct vision at the end of the procedure, particularly if there are signs of inflammation within the joint.

What happens after the procedure?

Physiotherapy as well as home exercises begin almost immediately after surgery (as soon as the nerve block has worn off) and are essential for a good outcome.

Potential Complications of Arthroscopic Arthrolysis Procedure

Scars:

There will usually be 2 scars which heal well and rarely cause any problems.

Fine stitches are removed between 10 to 14 days.

Bleeding:

There is minimal blood loss.  The dressings may be blood stained however most of this is the fluid used to wash through the joint during the operation.

Infection:

This is a very rare although serious risk.  It is estimated that 1 in 500 patients may get an infection.  The real risk for this operation may well be less.

Swelling:

The shoulder may get quite swollen during the operation.  The fluid used to wash/ expand the space during surgery will leak into the surrounding tissues however most of this drains into the dressings or gets absorbed by the body.  Usually the shoulder is of normal size by the next day.

Stiffness:

Most patients will have a successful operation.

A minimum of 50% of movements is expected at 2 weeks from surgery and 80% at 6 weeks.

Internal rotation (ability to reach hand up behind back to shoulder blades) is the last movement to return and may take a few weeks to do so.  One in ten patients may fail to improve.

Variable recovery:

Some patients never take a painkiller after the operation and others have to for 6 weeks or so.  Most will fall between these two extremes.

Office work and driving should be possible at about 1 to 2 weeks, below shoulder height gardening may take 3 to 4 weeks and overhead activities 6 weeks +.

 

Very rare complications 

Nerve/Blood vessel injury: 

The axillary nerve crosses below the shoulder joint therefore is at theoretical risk of injury, however the risk of this is very low (less than 1 in 100).

Deep Vein Thrombosis and Pulmonary Embolus:

The overall risk for such a complication is estimated 1 in 2000, i.e. very rare.

A thrombosis is a clot that can form in the veins due to immobility. When it travels to the lungs it is called an embolus.

You will be given special stockings that compress your calf and compression cuffs whilst on the theatre table.  There is usually no need for medication/ injections to thin the blood unless you have significant risk factors.  This will be discussed with you before your operation.

Fracture:

Theoretically this gentle manipulation could lead to breaking the bone.  We have never encountered this complication for manipulation after a controlled capsular release.