How is the procedure performed?
The procedure is performed under a combination of general and regional anaesthesia. An arthroscope is inserted into the joint after distending it with saline. The thickened capsule of the joint is divided circumferentially under direct vision. The shoulder may then be moved to confirm that the restriction of movements had been overcome. A subacromial decompression may be performed at the same time for persistent pain on the side of the arm or if there is a bone spur on the acromion.
The alternatives to surgery are to consider an injection and physiotherapy or a manipulation under anaesthesia (MUA). Whilst an MUA may be equally effective in restoring most movements, an arthroscopic release offers the opportunity to examine the inside of the joint, release the affected capsule under direct vision and treat any associated pathology.
The main benefit of the procedure is to improve the range of movements. This is often associated with an improvement in the function of the joint and ability to use the arm.
Pain - The shoulder may be painful for some days after surgery. This is usually managed by taking appropriate pain relieving medication and activity modification. If pain recurs then occasionally it may be necessary to inject the joint with steroid.
Swelling – During the procedure, the joint is distended with saline and this may lead to the shoulder remaining swollen for a day or two after surgery.
Bleeding – A small amount of bleeding from the arthroscopy portal sites is not unusual and will usually settle after a day or two.
Recurrence of stiffness – This may occasionally occur after surgery. Patients with diabetes are particularly at risk of recurrent stiffness. Prevention is the key and it is essential to follow the instructions provided, perform daily stretching at home and have regular physiotherapy to maintain the range of movements, which has been achieved at surgery. If stiffness cannot be overcome with physiotherapy over a number of weeks, then occasionally it may be necessary to perform a manipulation under anaesthesia.
Infection – Infection is a possibility but is rare after arthroscopic surgery.
Nerve injury – Injury to the axillary nerve is possible but extremely rare.
Following the procedure the arthroscopy portal sites (skin incisions) will be closed with tape or sutures and covered with shower-proof dressings. These dressings should be left undisturbed as far as possible for 5-7 days. If the dressings are removed for any reason they should be replaced with similar dressings or waterproof plasters. The shoulder may also be covered with an absorbent pad (or a nappy). This will usually be removed the day after surgery. A sling will be provided to support the arm, but may be removed as tolerated to move the arm and is usually discarded after 1-2 days. A physiotherapist will provide instructions about mobilising the shoulder prior to discharge from hospital. Outpatient physiotherapy is usually started no later than a week after surgery.
You may resume driving at approximately 4-5 days after surgery or when you have regained sufficient movements and control of the arm. Strenuous activities should be avoided for 6 weeks. Return to work will depend on your occupation. Office duties may be resumed within 2 weeks. Light manual activities may be started at 4 weeks but heavy manual work should be avoided for at least 3 months. Non-contact sports may be resumed at 3-4 months.
An appointment will be arranged for you in the outpatient clinic at 2-4 weeks after the procedure. Follow-up is required at monthly intervals for at least 3-4 months after surgery or until a satisfactory recovery is achieved.