Are you still on the fence about frozen shoulder surgery? If that’s the case, then let this article help you decide.
You might have worsening symptoms or have exhausted other nonsurgical treatments with no luck. These are instances when even surgery can sound appealing.
Here are the topics we’ll cover – click on any of these bullets to quickly navigate this article:
- Surgical options
- What to expect after surgery
- Treatments to try before surgery
- 3 Tips to prevent another episode
Surgical options for frozen shoulder
Before starting, please keep in mind that surgery is far from a quick-fix solution. You’ll still have to do more treatment for your shoulder joint capsule to heal after surgery.
With that said, here are the best surgical techniques for frozen shoulder:
Manipulation under anesthesia
Manipulation under anesthesia (MUA) is a non-invasive procedure. This means that the surgeon won’t open your shoulder or use surgical tools.
It consists of putting you under general anesthesia. That way, an orthopedic specialist will move your affected arm through each possible shoulder motion.
The goal here is to tear off the adhesions and scar tissue that restrict your shoulder motion. This means an improved range of motion and less shoulder pain. (1)
Studies show that 85% of those who underwent MUA are satisfied with their results. (1)
When should you consider manipulation under anesthesia?
Here are the following criteria that make you a candidate for MUA (1):
- If you are unable to adjust to your daily life having both shoulder pain and stiffness.
- Your shoulder external rotation (turning your arm outward) is < 50% compared to your good arm.
- The duration of your symptoms is at least 3 months.
- You didn’t get satisfying results after a cortisone injection.
Is manipulation under anesthesia safe?
Although very rare, about 0.4% of MUA operations lead to complications. Some of them include (3):
- Upper arm fracture.
- Rotator cuff tear.
- Nerve injury.
- Shoulder dislocation.
Arthroscopic capsular release
Arthroscopic surgery for frozen shoulder is a minimally-invasive procedure. It won’t lead to much collateral damage to nearby muscles, at least compared to traditional surgery.
To perform this surgery, your surgeon will use a small set of surgical tools and an arthroscopic camera. Both will be inserted through small incisions to access your shoulder joint.
Once inside, your surgeon will check for and cut out stiffened sections and scar tissue surrounding your shoulder capsule.
Overall, around 83% of patients have a normal functional shoulder even after 22 months from their surgery. (2)
How to tell if arthroscopic surgery is for you?
If you fall into one of the following benchmarks, then you should consider arthroscopic capsular release (4):
- Tried and failed at least 6 months of physical therapy.
- Tried and failed 3 or more steroid injections, each with a 6-month interval.
- Tried and failed to see promising results from other treatments, like MUA.
- If you have diabetes and a steroid injection isn’t good for your health.
- If you want all possible options to quickly recover.
Is shoulder arthroscopic release safe?
Same as MUA, this procedure also has a low chance (0.6%) of causing potential complications – like a nerve injury on your affected arm. (5)
What to expect after frozen shoulder surgery
The following is what your frozen shoulder surgery recovery plan can look like in the coming months:
Icing your upper arm bone and taking pain medications
Both ice packs and nonsteroidal drugs(NSAIDs) are helpful to control pain until 2-3 weeks after your surgical treatment. (3)
If you don’t have an ice pack, you may also use a bag of frozen peas/vegetables as a substitute. Meanwhile, your doctor will give you strict orders on when and how many NSAIDs you should take in a day.
Follow-up appointments with your doctor
As your body continues to get better, your doctor also needs to be updated on your health.
This can help your physician decide, among other things, changes on your medications and guidelines for physical therapy.
Physical therapy can start immediately after the procedure and may last for 4 to 6 months. (3) You’ll likely go through three phases of recovery:
Phase 1: Maintaining your strength and shoulder joint mobility
This phase may last for 1 to 2 weeks post-surgery. (6) Your physical therapist may start your rehabilitation with some light exercises and shoulder mobilizations.
This targets your arm muscles and shoulder blade to prevent loss of muscle strength, size, and joint motion.
Phase 2: Building your foundation
After a few weeks, your PT may then progress to strengthening exercises that involve more joint movement.
Your therapist will likely include stretching exercises to keep or improve your post-operative range of motion.
Phase 3: Transitioning from rehab to real-life
In this last phase, your therapist will progress your exercises that may mimic your daily activities.
The goal here is to achieve a shoulder function that is as close as possible to what you had before dealing with a frozen shoulder.
Treatments to do before considering frozen shoulder surgery
Corticosteroid injection and physical therapy are two usual treatments for your condition. If both have failed to deliver promising results, then here are a few more things you should try:
Heat therapy and massage can both help temporarily improve blood flow, and reduce pain and stiffness.
Using a transcutaneous electrical nerve stimulation (TENS) device could also block pain signals, but you should ask your PT first how to use it safely.
Another option is taking NSAIDs, either by mouth or ointments. They can lower your pain sensitivity temporarily.
Also, there are specific yet simple shoulder exercises that you can do at home for pain relief. They don’t need a lot of equipment, and you can supplement them with any of the prior home remedies.
This will help: 6 home treatments for frozen shoulder
You may need to consult a medical professional for the following treatment options:
An injection-based method that distends the capsule to break adhesions, leading to more range of motion. (3)
Extracorporeal shockwave therapy
This therapy uses a machine that generates low-energy impulses. These can improve blood flow and flexibility on collagen fibers around your shoulder. (7) Thus, increasing range of motion and reducing pain.
This ancient technique targets key points in your shoulder to release your body’s natural opioids to control pain.
Learn more: Benefits of acupuncture for adhesive capsulitis
This therapy lowers your pain sensitivity by injecting pain-numbing agents into the nerves that provide sensation to your shoulder region. (8)
3 tips to prevent another frozen shoulder
The truth is that there is a 15% chance that you might have another frozen shoulder on your opposite arm. (9)
I know that it’s just a small number. But it’s better to be proactive now, especially with what you’ve been through. To avoid another frozen shoulder, here’s what you should do:
1) Be mindful of what you eat
Keep them at bay by choosing fresh produce and home-cooked meals over fried, processed foods. As for the beverage, water is still better than soda and bubble tea.
Check this out: Top diets for frozen shoulder management.
2) Go for daily walks
Choose the stairs over the escalator/elevator. Or go for a walk break every hour.
They may not seem much, but the continuous movement of your arms and better blood flow is good for shoulder joint health.
This will help: 12 exercises to avoid adhesive capsulitis.
3) Consult a menopause specialist
If you are a woman in your 40s or early 50s, there might be a chance that your hormonal shifts might be related to you having a frozen shoulder.
A menopause specialist will help you navigate those changes so they affect you as little as possible.
Further reading: Why does menopause increase the risk of frozen shoulder?
What happens if a frozen shoulder is left untreated?
Frozen shoulder occurs due to gradual build-up of shoulder joint inflammation. Without treatment, it may take 2 to 3 years for this to subside and for you to recover. (12)
How does surgery work for a frozen shoulder?
A developing frozen shoulder can lead to joint capsule stiffness in the long run. Surgery frees up these tight spots to improve your shoulder motion.
What are the possible complications of frozen shoulder surgery?
On very rare occasions, complications may include nerve damage, bone fracture, and joint dislocation. (5)
Conclusion: When to have surgery for frozen shoulder?
The length of recovery and past failures of other treatments can make you consider if surgery is for you. That’s understandable as nobody wants to be in pain for so long.
However, keep in mind that surgery is a personal decision. Consult with your physical therapist and doctor to learn all your options.
- Kraal, Tim et al. “Manipulation under anesthesia for frozen shoulders: outdated technique or well-established quick fix?.” EFORT open reviews vol. 4,3 98-109. 19 Mar. 2019, doi: 10.1302/2058-5241.4.180044
- Kanbe, K. Clinical outcome of arthroscopic capsular release for frozen shoulder: essential technical points in 255 patients. J Orthop Surg Res 13, 56 (2018). https://doi.org/10.1186/s13018-018-0758-5
- Pandey, Vivek, and Sandesh Madi. “Clinical Guidelines in the Management of Frozen Shoulder: An Update!.” Indian journal of orthopaedics vol. 55,2 299-309. 1 Feb. 2021, doi: 10.1007/s43465-021-00351-3
- Arce, Guillermo. “Primary Frozen Shoulder Syndrome: Arthroscopic Capsular Release.” Arthroscopy techniques vol. 4,6 e717-20. 19 Nov. 2015, doi: 10.1016/j.eats.2015.06.004
- Kraal, Tim et al. “What Is the Right Timing for Arthroscopic Capsular Release of a Frozen Shoulder? Letter to the Editor.” Orthopaedic journal of sports medicine vol. 8,2 2325967120903710. 28 Feb. 2020, doi: 10.1177/2325967120903710
- Sharma, Sunil. “Management of frozen shoulder – conservative vs surgical?.” Annals of the Royal College of Surgeons of England vol. 93,5 (2011): 343-4; discussion 345-6. doi: 10.1308/147870811X582080
- Vahdatpour, Babak et al. “Efficacy of extracorporeal shockwave therapy in frozen shoulder.” International journal of preventive medicine vol. 5,7 (2014): 875-81.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4124565/
- Lee, Sang Hoon et al. “Effectiveness of new nerve blocks method on the articular branches of the suprascapular and subscapular nerves to treat shoulder pain.” Medicine vol. 99,35 (2020): e22050. doi: 10.1097/MD.0000000000022050
- Mezian K, Coffey R, Chang KV. Frozen Shoulder. [Updated 2021 Sep 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482162/
- Wang, Jr-Yi et al. “Hyperlipidemia Is a Risk Factor of Adhesive Capsulitis: Real-World Evidence Using the Taiwanese National Health Insurance Research Database.” Orthopaedic journal of sports medicine vol. 9,4 2325967120986808. 5 Apr. 2021, https://pubmed.ncbi.nlm.nih.gov/33869642/
- Dyer, Brett P et al. “Diabetes as a Prognostic Factor in Frozen Shoulder: A Systematic Review.” Archives of rehabilitation research and clinical translation vol. 3,3 100141. 14 Jul. 2021, DOI: 10.1016/j.arrct.2021.100141
- Kwaees, Tariq A, and Charalambos P Charalambous. “Rates of surgery for frozen shoulder: an experience in England.” Muscles, ligaments and tendons journal vol. 5,4 276-9. 13 Feb. 2016, doi: 10.11138/mltj/2015.5.4.276