Patients › Shoulder
Capsular Release for Frozen Shoulder
Arthroscopic capsular release frees a stiff shoulder (frozen shoulder) when physiotherapy and injections fail.
Why this operation has been suggested¶
In our clinic, Dr Kieran Hirpara approaches this procedure by carefully reviewing your history and imaging. The operation is for adhesive capsulitis, also known as frozen shoulder, where the joint capsule has become tight and stiff.
You will not be asked to endure it for a set number of months first. Dr Hirpara is happy to offer a capsular release as soon as frozen shoulder is diagnosed. In practice he will often suggest a steroid injection first, because for many people that settles the pain well enough to get on with things — but if the injection does not give you adequate pain relief, he will offer the release rather than ask you to wait it out. The reason for that approach is simple: the older advice that frozen shoulder reliably resolves on its own within a year or two is not as well supported by the evidence as it is often made to sound, and there is no good reason to spend months in pain waiting to find out.
We perform this as an arthroscopic procedure using two or three small incisions and a small camera inside the joint. This allows us to release the tight capsule to restore movement. In the short term, you can expect almost immediate relief of pain and symptoms. You will also see dramatic improvements in your range of motion, which is often not seen with injections or physiotherapy alone. The main benefit this operation aims to deliver is significant pain relief and improved shoulder function.
Before the operation¶
Your surgeon will arrange X-rays, MRI scans, blood tests, and an anaesthetic review to confirm your suitability for this arthroscopic procedure. This keyhole surgery uses two or three small incisions and a tiny camera inside the joint. Please fast before your operation and stop certain medications as advised by your surgeon, who will provide specific instructions. Bring a complete list of your current medications. Wear comfortable clothing to the hospital. You must arrange a lift home, as you cannot drive immediately after the procedure.
On the day¶
You will arrive at the hospital and be admitted to the ward. Your surgeon will meet you to confirm your details and answer any final questions. You will then be taken to the operating theatre. This operation is done under general anaesthetic combined with a regional nerve block. You will be fully asleep for the operation, and the block — an injection that numbs the nerves supplying the arm before you wake up — provides pain relief for the first 12 to 24 hours after surgery. The anaesthetist will meet you before the operation and talk you through both parts.
We perform this procedure using an arthroscopic approach. This means we use two or three small incisions, or keyhole cuts, rather than one large opening. A small camera is inserted inside the joint to guide the surgery. After the procedure, you will wake up in the recovery area where our team will monitor your comfort and ensure the pain relief from the nerve block is working effectively. You will stay in hospital for observation before going home with your care instructions.
What the operation involves¶
Your surgeon performs this procedure using an arthroscopic, or keyhole, approach. This means we make two or three small incisions, each about 1 cm long, over the shoulder. Through these tiny cuts, we insert a small camera and specialized instruments directly into the joint space. This allows us to see inside clearly while keeping the damage to your skin and muscles minimal.
Inside the joint, we identify the tight, thickened capsule—the fibrous tissue that surrounds your shoulder like a stiff sleeve. In cases of frozen shoulder, this tissue becomes scarred and shrinks, trapping the joint and stopping it from moving. We carefully release this tight tissue in a full circle around the joint. This circumferential release is necessary because each part of the capsule affects movement in different directions. By loosening the entire sleeve, we restore the space needed for your shoulder to move freely again.
We do not typically close these small keyhole incisions with stitches. Instead, we use a special glue to seal the skin and apply a simple dressing. The entire procedure is designed to be reliable and cause minimum discomfort to your tissues. Because we are working through small portals rather than making one large cut, the focus is on releasing the stiffness without adding new trauma to your shoulder.
After the operation¶
You will wake up in the recovery ward. We manage your pain with standard medication. Your shoulder will be in a sling, and dressings will cover the small incisions. This surgeon performs the procedure arthroscically, using two or three small cuts and a tiny camera inside the joint. Most patients stay one night in hospital after this operation, though some are able to go home the same day. You must have someone stay with you for the first 24 hours. Do not drive for at least six weeks after any shoulder operation, regardless of which arm was operated on. Once your surgeon clears you, typically at the six-week review, you may resume driving. See Driving after upper-limb surgery.
Recovery¶
You will likely feel significant pain and swelling in the first few days after your arthroscopic capsular release. This is normal as your body responds to the surgery. We use small incisions and a camera to access the joint, which helps keep trauma to the surrounding tissue low. You can manage this discomfort with prescribed pain relief and by keeping your arm elevated. Ice packs applied to the area around the shoulder (not directly on skin) can also help reduce swelling.
Your arm will be in a sling to protect the joint while the initial healing begins. You will not be able to drive for at least six weeks after any shoulder operation, regardless of which arm was operated on. You cannot drive until your surgeon clears you, typically at the six-week review. For more details, see our guide on Driving after upper-limb surgery.
Once the acute pain settles, you will begin a stepwise rehabilitation program guided by your physiotherapist. This is mandatory to restore motion. You will start with gentle movements to prevent the capsule from stiffening again. As your range of motion returns, you will gradually increase the intensity of your exercises. You will learn specific stretches to improve flexibility and strength.
Your daily activities will change temporarily. You may need help with tasks like dressing or cooking in the early days. Sleep may be difficult at first; propping yourself up with pillows often helps. Milestones are based on your progress, not a fixed calendar. You will advance your exercises as movement improves and pain decreases. Your timeline may differ; your surgeon and physio will guide you through each stage of your recovery.
What can go wrong¶
Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.
If your shoulder feels stiff or tight again, it may mean the joint capsule has thickened or tightened once more. This is known as adhesive capsulitis or frozen shoulder. You might notice a return of pain and a loss of movement that makes daily tasks difficult. If you feel this stiffness returning, let us know at your next review so we can adjust your care plan.
Sometimes, the pain does not improve as expected after the procedure. While most people find their pain eases quickly, some may continue to feel discomfort. You might notice a deep ache that does not go away with simple painkillers. If your symptoms persist or worsen instead of improving, please contact the clinic. We can check if further treatment is needed.
In rare cases, the joint may become unstable or feel loose. You might experience a clicking, grinding, or slipping sensation when moving your arm. This could indicate that the structures supporting the joint are not holding together as intended. If you notice sudden instability or a feeling that the shoulder is giving way, seek medical advice promptly.
If you experience any signs of infection, such as redness spreading from the small incisions, warmth, or pus draining from the wounds, contact the clinic immediately. These are signs that your body is fighting an infection. Early treatment is important to keep your recovery on track.
The complications table on this page lists typical rates if you want the specifics.
When to call us¶
Call us if you have a fever, increasing wound redness or discharge, or sudden severe pain. Go to emergency if you notice calf swelling, shortness of breath, loss of sensation, or cannot move the limb. These signs need urgent assessment. We are here to help you stay safe during your recovery. Please contact our clinic immediately if any of these symptoms occur.