What does surgery involve?

On the day of surgery you will be admitted to the ward or surgical admission area. You will once again meet Mr Moverley who will ensure you are still happy to proceed and that you understand the risks and benefits of the procedure. This is a good opportunity for you to ask any further questions. You will be asked to sign a consent form if you have not already done so.

You will meet your anaesthetist who will explain the type of anaesthetic you will receive. Arthroscopic shoulder surgery usually requires a general anaesthetic (you will be asleep) and a nerve block so that the arm will be numb for approximately 12 hours post operatively.

An arthroscopic capsular release is performed as a ‘key-hole’ procedure through two or three 1cm incisions at the front and back of your shoulder. Mr Moverley will be able to assess the inside of your shoulder in great detail using a high-resolution camera. Mr Moverley will then release any inflamed and contracted tissue that may be causing your symptoms. Your surgeon will usually assess the subacromial bursa (which is a pocket of tissue and fluid just above the ball and socket joint) and remove any inflamed tissue from here if necessary. At the end of the procedure Mr Moverley will gently stretch the shoulder in all directions to ensure a full range of motion can be achieved.

The procedure is usually done as a day case meaning you can go home on the same day as your surgery.

The wounds are repaired with stitches and covered with a splash proof dressing. The wounds should be kept dry for 10-14 days.

What happens post operatively?

Immediately after surgery your arm will be in a sling and will usually feel heavy and numb as a result of the nerve block. You will be given painkillers if you are in any pain, and these will also be provided upon discharge.

A physiotherapist will assess you to make sure that you can remove and apply the sling safely. They will provide some early exercises to help prevent stiffness of the hand, wrist and shoulder.

How long is the rehabilitation process?

A sling will be provided to rest the shoulder but this should only be used for the first 1-2 days after the surgery. To use it any longer increases the risk of stiffness.

An early physiotherapy stretching exercise programme is crucial to the long-term success of the procedure. This will maximise the benefit of your operation and will need to be continued at home. In the early post-operative stage the physiotherapy may be painful, if this is the case then you should take pain-killers, but the stretching exercises must be continued.

Physiotherapy is individualised to your specific needs and will progress with the following goals:

• Early (1-2 weeks): Minimize post-operative stiffness with active finger, wrist and elbow movements. Wean off the sling after 2 days. Shoulder pendulum exercised progressing to full active range of movement as pain allows.

• Middle (2-6 weeks): Continue to achieve full active range of movement

• Late (6 weeks and beyond): Strengthening program, once full range has been achieved. Graded return to all previous functional and recreation activities.

Approximately how long will it be before I can…?

• Drive 2 weeks

• Desk job 2 weeks

• Manual work 8-12 weeks

• Golf 12 weeks

• Racket sport 12 weeks

• Contact sport 12 weeks

• Repetitive overhead activity/sport 12 weeks

Pain can persist for 6 months post surgery

What are the potential risks and complications?

As with any operation, a small number of people may have problems after an arthroscopic capsular release. Most of these problems are quite minor and can be treated easily but occasionally further surgery is needed.

The main risks are:

• Infection – less than 1 % of cases

• Nerve injury – Extremely rare (less than 1 in a 10,000). One of the main nerves of the shoulder (the axillary nerve) is very close to the socket of the shoulder and a can be damaged during surgery. If permanently damaged this can lead to pain and weakness.

• Stiffness - Mild stiffness is quite common but occasionally a full frozen shoulder can re-occur (5% of cases) which can prolong your recovery by a few months, it usually responds well to a steroid injection.

• Fracture - Extremely rare (less than 1 in a 10,000) - This may occur during manipulation of your shoulder if the capsule contracture is very severe.

Is arthroscopic capsular release always successful?

Approximately 80% of patients will make a good or excellent recovery. 15% will have a degree of discomfort but will be satisfied with their outcome. 5% of patients will have on-going problems, such as pain and stiffness, and some of these require further surgery.

The results of arthroscopic capsular release are therefore not guaranteed which is why Mr Moverley will want to ensure that all non-operative measures have been exhausted first.