Surgery is only used for severe cases of adhesive capsulitis in which all other treatments have failed. The aim of adhesive capsulitis surgery is to stretch or release the contracted, tight shoulder joint capsule. This can be accomplished through 2 methods – your surgeon will determine the best procedure for you.
Manipulation under Anesthesia (MUA) is a day procedure that involves the surgeon manipulating your shoulder (forcing your shoulder to move through full range of motion) to stretch and break up tight scar tissue around your shoulder joint while you are asleep. This is supposed to free the shoulder and increase range of motion. It is often performed in stage 1 or stage 2 of adhesive capsulitis. There are some complications with this procedure that include but are not limited to, stretching and possibly tearing of the soft tissues in your shoulder (rotator cuff muscles and tendons, ligaments, cartilage, joint capsule), increasing inflammation and scarring in the shoulder joint, dislocating or fracturing your arm bone, neurovascular injury to your brachial plexus or other nerves, and severe osteopenia (reduction in bone mass or density). This procedure requires aggressive rehabilitation.
Arthroscopic Capsular Release
Occasionally an arthroscopic exam or open surgical procedure is required to release a tight shoulder joint capsule, especially when you have a very adhesive capsulitis after an injury, trauma or fracture (often used with diabetics as well). Arthroscopic surgery involves making tiny incisions around your shoulder joint and inserting a pencil-thin, fiber optic camera with a small lens and lighting system in one hole, and small surgical instruments in the other holes. The surgeon will take a look inside your joint to investigate all the soft tissues and bones. These images will then be transmitted to a TV monitor, which allow the doctor to make a diagnosis and/or perform the adhesive capsulitis surgery under video control. At the end of surgery, your incisions are closed, and a dressing is applied.
Arthroscopic capsular release involves cutting the tight portions of your joint capsule, scar tissue and your coracohumeral ligament. This frees your joint which alleviates pain and returns your full range of motion. Results are seen faster with this surgery than with MUA, and this surgery can be repeated a few times if inflammation and scar tissue persist. However, if shoulder movement isn’t regained, open surgery may be required (a larger incision is made to have better access to the shoulder). Complications with this surgery involve persistent stiffness and pain.
Sometimes both surgeries will be used to get the best results. Generally recovery ranges from 6 weeks to a year after surgery. Your doctor will provide you with a rigorous, customized rehabilitation plan based on the treatments noted previously.
Keep in mind the longer you have your adhesive capsulitis symptoms prior to surgery, the longer it will take to recuperate. If you return to your activities too soon, you could cause permanent damage. You want to ensure the strength, flexibility and stability of your shoulder muscles before taking on too much.