Dr Alan Cheung
Senior Consultant Orthopaedic Surgeon in Singapore
MBBS (London), MRCS (England), FRCS (Trauma and Orthopaedics, England), Diploma in Sport and Exercise Medicine (UK), Fellow of the European Board of Orthopaedics and Traumatology, American Academy of Orthopaedic Surgeons (AAOS)
Frozen shoulder causes pain, stiffness and a gradual loss of movement that can make everyday activities difficult. It is usually managed initially without surgery, with treatment potentially including physiotherapy, exercises, medication or corticosteroid injections.
Surgery is therefore generally considered when symptoms remain significantly limiting despite appropriate non-surgical treatment. Keyhole surgery may be recommended when severe pain and stiffness persist despite an adequate course of conservative care or when restricted shoulder movement continues to interfere significantly with daily life. Understanding when surgery becomes appropriate can help patients make informed decisions about their treatment and recovery.
When Is Keyhole Surgery Considered for Frozen Shoulder?
Keyhole surgery for frozen shoulder, also known as arthroscopic capsular release, may be considered when persistent stiffness continues to substantially limit daily activities despite appropriate non-surgical treatment. The decision is based on the severity and duration of symptoms, response to previous treatment and the degree of movement restriction rather than a fixed timeframe.
Before recommending surgery, the doctor will confirm the diagnosis and assess whether another shoulder condition, such as a rotator cuff tear or arthritis, is contributing to the symptoms. The doctor will also consider the patient’s general health and ability to participate in post-operative rehabilitation. Physiotherapy after surgery is important for maintaining the movement gained during the procedure and reducing the risk of the shoulder becoming stiff again.
What Does Keyhole Surgery for Frozen Shoulder Involve?
Arthroscopic capsular release is a minimally invasive operation performed through several small incisions around the shoulder. The procedure aims to improve movement by releasing tight portions of the joint capsule that are restricting the shoulder.
During surgery, the patient is placed under anaesthesia and the surgeon inserts a small camera called an arthroscope into the shoulder joint. This allows the structures inside the joint to be viewed on a monitor. Fine instruments are then introduced through separate keyhole incisions.
Using specialised arthroscopic instruments, the surgeon carefully releases tight portions of the capsule to improve the shoulder’s range of movement.
Once the capsule has been released, the surgeon assesses the shoulder’s range of movement. Controlled manipulation under anaesthesia may also be performed to complete the release of any remaining tight tissue.
Physiotherapy generally begins soon after the operation. Regular guided movement is essential for maintaining the range gained during surgery while the released capsule heals, as stiffness can return without appropriate rehabilitation.
What Should Patients Expect After Keyhole Surgery?
Recovery after keyhole surgery for frozen shoulder focuses on controlling discomfort, protecting the small surgical wounds and maintaining the movement achieved during the capsular release. Timelines vary according to the extent of surgery, the severity of the original stiffness and the patient’s progress.
Pain and Numbness After Surgery
A regional nerve block may be administered during the operation to reduce pain. As a result, the shoulder and arm can feel numb, heavy or difficult to control for several hours afterwards. Patients should protect the arm from pressure, heat and accidental injury until normal sensation and control return.
As the nerve block wears off, the shoulder may become sore. Painkillers and anti-inflammatory medication may be prescribed in hospital and continued at home. Patients should take these medicines according to their doctor’s instructions rather than waiting until the pain becomes difficult to manage, particularly during the first few days.
Wearing a Sling
Patients usually return from the operating theatre wearing a sling, sometimes together with a cold-compression wrap. The sling is generally intended for comfort rather than to immobilise the shoulder. As the sling is generally used for comfort rather than prolonged immobilisation, patients should follow their surgeon’s advice on when it can be discontinued.
Sleeping Comfortably
Sleeping may remain uncomfortable during the early stages of recovery. Patients may find it more comfortable to sleep on their back or unaffected side with pillows supporting the operated arm, while avoiding direct pressure on the shoulder.
Starting Physiotherapy
Physiotherapy usually begins within a few days of surgery. Early rehabilitation focuses on preserving the range of motion obtained during the capsular release, managing pain and preventing the capsule from tightening again.
Rehabilitation usually begins with guided range-of-motion exercises before progressing according to the patient’s movement, comfort and recovery.
Patients will usually need to practise their exercises regularly at home in addition to attending therapy sessions. Some discomfort during stretching is common, but severe or worsening pain should be discussed with the physiotherapist or surgeon rather than pushed through.
Driving and Returning to Work
Driving should only resume once the patient is no longer using the sling, is not taking medication that affects alertness and can control the vehicle safely. The appropriate timing varies, so patients should follow their surgeon’s advice before returning to driving.
The timing of returning to work depends on the physical demands of the job. People in desk-based roles may be able to return sooner than those whose work involves lifting or repeated overhead activity. The timing should be guided by symptoms, recovery progress and the physical demands of the job.
Resuming Exercise and Leisure Activities
Light activities can usually be reintroduced gradually as comfort and shoulder control improve. More demanding exercise, particularly activities involving repeated or forceful overhead movement, may require a longer period of rehabilitation.
The timing of returning to sport varies according to the activity and the patient’s recovery. A surgeon or physiotherapist can advise when particular activities can be resumed safely based on movement, strength and functional progress.
Find the Right Treatment for Frozen Shoulder with Dr Alan Cheung
Surgery is not required for every frozen shoulder. When stiffness remains significantly limiting despite non-surgical treatment, further assessment can help determine whether continued conservative care or a procedure such as arthroscopic capsular release may be appropriate.
At the International Orthopaedic Clinic, patients receive personalised frozen shoulder care from assessment and non-surgical management through to surgery and rehabilitation. Dr Alan Cheung evaluates each patient’s symptoms, shoulder function and treatment history before recommending an appropriate approach. If frozen shoulder continues to limit your movement or daily activities, schedule an appointment to discuss your treatment options.
