Capsular Release

What is a Capsular Release?

Arthroscopic capsular release is keyhole surgery involving the release of the tight capsule seen in 'frozen shoulder'. The capsule is released using a special probe.

Frozen Shoulder is an extremely painful condition in which the shoulder is completely or partially unmovable. Frozen shoulder often starts out of the blue, but may be triggered by a mild injury to the shoulder. The condition goes through three phases, starting with pain, then stiffness and finally a stage of resolution as the pain eases and most of the movement returns. This process may take an awfully long time, sometimes as long as two or more years.

Frozen shoulder may be associated with diabetes and is also seen in patients with scar tissue in their hands, a condition called Dupuytren's contracture.

Surgery may be required to restore motion for some patients, as most people never regain full shoulder motion. It is also used in patients where their pain fails to respond to physiotherapy treatment.

What are the benefits of having a Capsular Release?

Surgery has been shown to be of benefit in both the early and later stages of a Frozen Shoulder. It is excellent for both pain relief and restoring movement, although intensive physiotherapy is essential after the surgery. This procedure is successful in over 80% of patients.

What are the risks of having a Capsular Release?

All operations involve an element of risk, these are very small but you need to be aware of them and can discuss them with your doctor at any time. The risks are (less than 1%)

Complications relating to the anaesthetic
Infection
Recurrence of shoulder stiffness
Damage to nerves or blood vessels around the shoulder

What sort of anaesthetic will be given to me?

You will be given a general anaesthetic. General anaesthesia is drug-induced unconsciousness: it is always provided by an anaesthetist, who is a doctor with specialist training. Your anaesthetic will probably be supplemented by a local anaesthetic block to provide improved pain relief in the immediate post-operative period.

Unfortunately, general anaesthesia can cause side effects and complications. Side effects are common, but are usually short-lived: they include nausea, confusion and pain. Complications are very rare, but can cause lasting injury: they include awareness, paralysis and death.

The risks of anaesthesia and surgery are lower for those who are undergoing minor surgery, and who are young, fit, active and well.
You will be given an opportunity to discuss anaesthetic options and risks with your anaesthetist before your surgery.

If you are worried about any of these risks, please speak to your Consultant or a member of their team.

The day of your operation

You will come into hospital on the day of your operation.

If you are on regular medication, you will be told to take this if necessary.

You will be asked to take a shower and put on a gown and disposable underwear.

A bracelet with your personal details will be attached to your wrist.

You may be prescribed some medication to take before your operation by the anaesthetist. A member of the nursing staff will give this to you.

A nurse and porters will take you to the operating theatre.

Your dentures, glasses or hearing aid can stay with you on your journey to the operating theatre.

When you arrive in the waiting area, a theatre nurse will check your details with you. You will then be asked to put on a disposable hat. The ward nurse will then leave you and you will then be taken to the anaesthetic room.

What should I expect after my operation?

After your operation you will be kept in the theatre recovery room before being transferred to the ward.

A nurse will check your pulse, blood pressure, and breathing rate regularly. It is important that if you feel any pain you must tell the nursing staff, who can give you painkillers to help.

The nursing staff will also advise you when you can start taking sips of water. Anaesthetics can make some people sick. If you feel sick we advise you not to drink until this feeling has passed. The nursing staff may offer an injection to help this sick feeling go away.

A nerve block is used during the procedure, which means that immediately after the operation the shoulder and arm may feel numb. This may last a few hours. The shoulder will be sore when this wears off and this may last for the first few weeks. It is important that you continue to take the painkillers prescribed from the hospital. A cold pack or ice packs may also help reduce pain. Wrap frozen peas/crushed ice in a damp, cold towel and place on the shoulder for up to 15minutes.

The ward physiotherapist will see you before you are discharged home to:
- Assess your shoulder
- Teach you the exercises you need to do immediately. It is of the utmost importance that you begin moving and exercising the arm on the day of the procedure. Adequate pain relief will enable you to perform the exercises demonstrated by the physiotherapist. Try to use the arm for normal daytime activities where possible

Going Home

Your doctor will normally discharge you the day after surgery if your pain is well controlled, and the physiotherapists are happy with your progress.

Your exercises will be supervised by outpatient physiotherapy appointments, which will be arranged for you before you leave hospital.

Discharge Information

Pain relief & medication

The nursing staff will advise you about painkillers before you leave the hospital. Please tell the nurses what painkilling tablets you have at home.

Your wound

Your wounds must remain covered with dressings until your outpatient appointment, where your sutures will be removed.

Getting back to normal

Remember that you have just had an operation. It is normal to feel more tired than usual for a few days after having an operation.

Your shoulder is likely to be uncomfortable in the first few days post-surgery. This is normal but can be helped by;

Using ice on your shoulder for 15 minutes, 2 times per day or after exercise and therapy. Gel packs, frozen peas or a plastic pack of ice can be used. These must be wrapped in a moist towel as direct contact with the skin can cause burns (cover your dressings with cling film or a plastic bag to prevent them getting wet).
Sleeping can be uncomfortable if you try and lie on your operated arm. We would recommend that initially you lie on your back or on the opposite side. If you lie on your back support the operated arm with a folded pillow under your lower arm. Make sure that your elbow is above your shoulder. If you are on your side then a folded pillow supports your operated arm from your elbow to your wrist.

Your sling is for comfort only and should be discarded as soon as possible -usually within the first 2-4 days. You may find it useful to continue to wear the sling at night for a little longer if the shoulder feels uncomfortable. In the first few days post-op it is generally recommended to wear the sling if you are going out to protect your arm.
Posture can make a significant difference to your pain post surgery. Avoid 'hitching' your shoulder or holding it in an elevated position. Also try to avoid slumping or standing/sitting with round shoulders.

In the first few days after surgery you will find it helps to support your arm on pillows with your elbow in front of your shoulder and slightly out to the side when you are sitting down (see picture).

Exercises
It is essential that you carry out the exercises regularly following your procedure, ideally four to five times per day increasing as able. It is quite normal for you to experience aching, discomfort and stretching when doing the exercises but you can decrease the exercises if you experience intense or lasting pain

Returning to work

You can self-certify for the first seven days of sickness. Before you are discharged, a medical certificate (sick note) may be issued by your hospital doctor to cover the expected time off you will need. The time that you can return to work will depend on the nature of your work. If you are in a relatively sedentary job you may be able to return as early as 1 week after surgery. If your job involves heavy lifting or sustained overhead positions it may take 6 to12 weeks before you can return. Your doctor and physiotherapist will discuss this with you and advise you accordingly.

Driving - If you feel comfortable and have good range of movement you can begin driving 1 week after your operation. It is advisable to check this with your Doctor or Physiotherapist if you are unsure. It is important to advise your Insurance Company that you have had Shoulder Surgery.

Further Appointments

You will be seen in outpatient's clinic approximately 1- 2 weeks after your surgery. This appointment will be made and given to you before you are discharged from hospital.

Physiotherapy Appointments

It is important that physiotherapy is commenced immediately after surgery. An appointment will be arranged within two days of your surgery.

The amount of physiotherapy you require will depend on your individual progress.