• Adhesive Capsulitis—Arthroscopic Surgery

    (Frozen Shoulder—Arthroscopic Surgery)

    Definition

    Adhesive capsulitis is a tightening in the shoulder joint. It decreases the range of motion in the shoulder and causes pain. This condition is also known as frozen shoulder . It is caused by tightening of the soft tissue and formation of scar tissue.
    During this arthroscopic surgery, the doctor cuts and removes scar tissue around the shoulder. The goal of the procedure is to improve range-of-motion by breaking up scar tissue
    Frozen Shoulder
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    Reasons for Procedure

    This procedure is done to:
    • Relieve pain
    • Restore range of motion in the shoulder joint
    • Break up scar tissue

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have arthroscopic shoulder surgery, your doctor will review a list of possible complications which may include:
    • Bleeding
    • Infection
    • Pain
    • Nerve injury
    • Damage to soft tissue
    • Instability or stiffness in joint
    • Fracture
    • Reaction to anesthesia used
    Some factors that may increase the risk of complications include:
    • Recent or chronic illness
    • Certain medicines—especially those that increase bleeding (eg, aspirin )
    • Smoking or alcohol use
    • Previous shoulder surgery (may cause damage)
    Some factors that may increase the risk of complications include:
    • Recent or chronic illness
    • Certain medicines—especially those that increase bleeding (eg, aspirin )
    • Smoking or alcohol use
    • Previous shoulder surgery (may cause damage)

    What to Expect

    Prior to Procedure

    Your doctor may do the following:
    • Physical exam
    • Blood and urine tests
    • X-ray —a test that uses radiation to take a picture of structures inside the body, especially bones
    • MRI scan —a test that uses magnetic waves to make pictures of structures inside the body
    Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Aspirin or other anti-inflammatory drugs
    • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
    Leading up to the procedure:
    • Arrange for a ride to and from the hospital. Also, arrange for help at home after the surgery.
    • The night before, eat a light meal. Do not eat or drink anything after midnight. If you have diabetes, you may need to adjust your medicines. Talk to your doctor about this.
    • If told to do so by your doctor, on the day of the surgery, shower using a special antibacterial soap. Do not use deodorant.

    Anesthesia

    General anesthesia is often used for this surgery. You will be asleep.

    Description of the Procedure

    Three small incisions will be made in your shoulder. A special tool called an arthroscope will be inserted. An arthroscope is a flexible tube with a light at the end and a camera attached. This will allow the doctor to view the inside of the shoulder on a screen. Tiny instruments will be inserted into the other incisions. The doctor will then cut and remove scar tissue. The incisions will be closed with stitches.

    Immediately After Procedure

    You will be taken to a recovery room after surgery. You will be monitored for any adverse reactions to surgery or anesthesia.

    How Long Will It Take

    About 1-½ to 2 hours

    How Much Will It Hurt?

    Anesthesia will block pain during the procedure. In some cases, the doctor implants a pain pump into the shoulder. This pump slowly delivers pain medicine. It may be used for the first couple of days and then removed. Afterwards, you will have medicine to help manage the pain.

    Average Hospital Stay

    If there are no complications, it may be possible to leave the hospital on the same day. Talk to your doctor to see if this is an option in your case.

    Post-procedure Care

    Your shoulder will be sore for a few weeks. It can take 3-6 months to fully recover.
    When you return home, you may be asked to do the following to help ensure a smooth recovery:
    • Ice the swollen area for the first 24-48 hours. Do this for 20-30 minutes at a time.
    • Sleep sitting up or in a recliner. Place a pillow behind your elbow.
    • Change the dressing.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Take pain medicine. If you have a pain pump, this will be removed in 1-2 days.
    • Return to the doctor in 7-14 days to have your stitches removed.
    • Resume your regular diet when you are ready. You may need to start with a clear liquid diet .
    • Use a sling if told to do so by your doctor. You may not need to use one, because it can cause stiffness.
    • Work with a physical therapist at home to focus on range-of-motion exercises .
    • Be sure to follow your doctor’s instructions.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Signs of infections, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision sites
    • Cough, trouble breathing, or chest pain
    • Severe nausea or vomiting
    • Pain becomes worse or swelling increases
    • Tingling or numbness that will not go away, especially in arms and hands
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Academy of Orthopaedic Surgeons http://www.aaos.org/

    American Orthopaedic Society for Sports Medicine http://www.aossm.org/tabs/Index.aspx/

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org/

    Canadian Orthopaedic Foundation http://www.canorth.org/

    References

    Adhesive capsulitis. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/20030315/1323ph.html . Accessed December 14, 2011.

    Adhesive capsulitis. EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated September 2008. Accessed December 3, 2008.

    Adhesive capsulitis (frozen shoulder). Palo Alto Medical Foundation website. Available at: http://www.pamf.org/sports/king/adhesive%5Fcaps.html . Accessed December 3, 2008.

    Adhesive capsulitis: physical therapy. EBSCO Publishing Nursing Reference Center website. Available at: http://www.ebscohost.com/pointOfCare/nrc-about . Updated June 2007. Accessed November 18, 2008.

    Arthroscopy. EBSCO Publishing Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 2008. Accessed December 3, 2008.

    Carson-DeWitt R. Frozen shoulder. EBSCO Publishing Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 2008. Accessed December 3, 2008.

    Emper WD, Eremus JL, Freedman KB, Good RP, Lorei MP, Walsh KM. Patient guide to shoulder arthroscopy. Orthopaedic Specialists website. Available at: http://www.orthspec.com/PDFs/Shoulder-Arthroscopy.pdf . Accessed December 4, 2008.

    Examination under anesthesia. University of Washington Orthopaedics and Sports Medicine website. Available at: http://www.orthop.washington.edu/uw/examination/tabID%5F%5F3376/ItemID%5F%5F207/PageID%5F%5F425/Articles/Default.aspx . Accessed November 21, 2008.

    Frozen Shoulder. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00071 . Accessed December 14, 2011.

    Frozen shoulder. EBSCO Publishing Patient Education Reference Center website. Available at: http://www.ebscohost.com/pointOfCare/perc-about . Updated March 2008. Accessed November 19, 2008.

    Geier C, orthopedic surgeon. Surgery times. E-mail communication. December 9, 2008.

    Iannotti JP, Williams GR. Disorders of the Shoulder: Diagnosis and Management . Philadelphia, PA: Lippincott Williams & Wilkins; 2007: 556.

    Kellicker P. General anesthesia. EBSCO Publishing Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 2008. Accessed December 3, 2008.

    Outpatient surgery. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/florida/weston/hospital/outpatient%5Fsurgery.aspx . Accessed November 21, 2008.

    Patient information guide: frozen shoulder syndrome. American Academy of Orthopaedic Surgeons website. Available at: http://orthodoc.aaos.org/mobyparsons/Pat%20Guide%20Frozen %20 Shoulder.doc . Accessed December 4, 2008.

    Role of massage in scar therapy. EBSCO Publishing Consumer Health Complete website. Available at: http://www.ebscohost.com/thisMarket.php?marketID=14 . Updated March 2002. Accessed November 18, 2008.

    Rouzier P. Frozen shoulder (adhesive capsulitis). EBSCO Publishing Consumer Health Complete website. Available at: http://www.ebscohost.com/thisMarket.php?marketID=14 . Published July 2006. Accessed November 18, 2008.

    Shoulder Arthroscopy. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00589 . Accessed December 14, 2011.

    Solomon D, director of Sports Medicine and Shoulder Service at Naval Medical Center, San Diego, CA. Surgery times. E-mail communication. December 5, 2008.

    Warner JP. Frozen shoulder: diagnosis and management. J Am Acad Orthop Surg . 1997;5:130-140.

    What treatments work best for shoulder pain? Best Health website. Available at: http://besthealth.bmj.com/btuk/conditions/1000096758.html . Updated September 2008. Accessed December 3, 2008.

    Your shoulder surgery. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00066 . Updated August 2009. Accessed December 14, 2011.

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