Surgery to remove scar tissue and release contractures can lessen pain and improve function for stiff shoulders that have not responded to rehabilitation or physical therapy
|Last updated: Wednesday, January 26, 2005
This is the information which might be shared with patients as they consider a surgical release for shoulder stiffness. Before it can be applied to a specific clinical situation, however, it needs to be tailored to the patient, the problem, and the surgeon.
Home exercise program
Most patients with stiff shoulders can improve their comfort and function with a home exercise program. Your doctor may consider an open surgical release for the few stiff shoulders which do not improve with a persistent effort at the exercises.
The purpose of the surgical release is to cut through the adhesions, scar tissue, and other structures that may be interfering with the motion of your shoulder.
Alternatives to surgery
This procedure is purely elective. The alternatives are to continue with the exercises or to accept the current range of motion.
Open release is a surgical operation; as such it carries some risks. These include the risk of anesthesia, infection, nerve injury, blood vessel injury, excessive looseness and instability of the shoulder, persistent or increased shoulder stiffness, fracture, increased pain, or the need for repeat surgery.
After the surgery
After surgery, it is essential that you resume the stiff shoulder exercises so that adhesions will not have an opportunity to reform.
While an experienced surgeon can loosen the shoulder at surgery, you are the only person who can maintain the motion during the healing period. These exercises will need to be continued for up to a year after your surgery. If you have concerns about your ability to carry out this important aspect of your treatment, please discuss this with your doctor before you undertake surgery.
You are likely to be in the hospital until your exercise program is well launched. At the time of discharge your doctor will encourage you to be physically active and to avoid narcotic and sleeping medications. You will be unable to drive for at least two weeks after this procedure, so you should make appropriate provisions for getting around during this time.
Who should consider surgeryOpen surgical release is considered for informed, consenting patients if the manipulation is not indicated or successful in reestablishing motion in a stiff shoulder. The patient's role in the recovery process is emphasized.
After the surgery
Continuous passive motion and exercise
As soon as the procedure is completed, we place the arm in continuous passive motion. Early motion achieves several goals. It prevents formation of adhesions or scarring during the critical early healing period. It also demonstrates to the patient that the shoulder can and should be moved immediately. Finally, early movement seems to increase the comfort, speed, and completeness of motion recovery. The use of the continuous passive motion after surgery is greatly facilitated by a brachial plexus block for the surgical procedure. This type of anesthesia can give 12 to 18 hours of post-operative anesthesia, allowing the awake patient the opportunity to observe the increase in motion gained by the procedure without experiencing early post-operative pain.
On the first day after surgery, the patient resumes the stiff shoulder exercises. Each day the patient is in the hospital, we plot the range of elevation (overhead reach) and rotation on charts posted in the patient's hospital room. These charts (see figures) provide positive reinforcement for the patient's progress.
Ideally, before discharge the patient can demonstrate comfortable assisted motion to 140 degrees of elevation, 40 degrees of external rotation, internal rotation until able to reach T12 with the thumb, and cross body adduction comparable to the normal side. The wall charts reflect these discharge goals. With this program, the patient becomes the center of the treatment team and is motivated to continue the exercises after discharge.
The two-year follow-up data for twelve patients having open surgical release for refractory frozen shoulders are encouraging (see figure).