Shoulder Surgery — Melbourne

Arthroscopic Capsular Release

Capsular release is keyhole surgery to free a shoulder that has become stiff and painful from frozen shoulder (adhesive capsulitis). The tight, thickened capsule around the joint is divided from the inside, restoring movement in a single procedure.

It is reserved for shoulders that have not responded to time and good non-operative treatment.

Why the Shoulder Freezes

The shoulder joint is wrapped in a sleeve of connective tissue called the capsule. In frozen shoulder the capsule becomes inflamed, thickened and contracted, so the joint physically cannot move through its normal range — no amount of effort or stretching will push through it while the tissue remains tight.

That is why the stiffness feels different from ordinary muscle tightness, and why it limits movement in every direction, including when someone else moves your arm for you.

When Surgery Is Considered

Most frozen shoulders settle without an operation. More than nine in ten people improve with physiotherapy, anti-inflammatory medication, corticosteroid injection and hydrodilatation, though it can take many months.

We consider capsular release when:

  • Pain and stiffness have not meaningfully improved after around three to six months of well-directed non-operative treatment.
  • The restriction is limiting work, sleep or independence.
  • Stiffness is the dominant problem, rather than pain alone.

There is no fixed deadline. Some people prefer to wait it out; others cannot afford the time, particularly if the shoulder is affecting their livelihood. It is a decision about your circumstances as much as your shoulder.

What Is Released

The procedure is done arthroscopically under general anaesthetic. Working through small incisions, the surgeon divides the contracted capsule, usually in this order:

  • The rotator interval and coracohumeral ligament at the front — often the tightest structures, and the ones most responsible for loss of external rotation.
  • The anterior capsule, taking care to protect the subscapularis tendon.
  • The posterior capsule, where reaching across the body is restricted.
  • The inferior capsule is treated cautiously, because the axillary nerve runs close by.

A gentle manipulation may be performed once the capsule has been released. Releasing the tissue first, rather than relying on manipulation alone, avoids the tearing that manipulation under anaesthetic can cause.

How It Compares With the Alternatives

  • Hydrodilatation — fluid injected under image guidance to stretch the capsule from the inside. Non-surgical and worth trying first. Evidence is mixed, and it tends to work less well in people with diabetes.
  • Manipulation under anaesthetic — the capsule is stretched until it gives way while you are asleep. Quick, but it is an uncontrolled tear, with recognised risks including fracture of the upper arm, rotator cuff tears and nerve injury.
  • Arthroscopic capsular release — the release is deliberate and controlled, and the surgeon can see and treat anything else found in the joint.

Recovery

The physiotherapy is the operation. Surgery creates the movement; rehabilitation is what keeps it. Stiffness can return within days if the shoulder is not moved.

  • A nerve block is commonly used so you are comfortable enough to move the shoulder straight away.
  • Physiotherapy starts the same day or the next — not in a week or two.
  • A short course of anti-inflammatory or steroid medication may be used to limit inflammation while you work on range.
  • Desk work is often possible within 1–2 weeks.
  • Physiotherapy continues for several months, with strength returning after movement.

If you cannot commit to frequent rehabilitation in the weeks after surgery, this is worth discussing beforehand — the result depends on it more than on the operation itself.

Risks and Things to Weigh Up

  • Recurrent stiffness, particularly if rehabilitation is interrupted.
  • Nerve irritation, most relevant around the inferior capsule.
  • Infection, bleeding and the usual anaesthetic risks, all uncommon.
  • Incomplete relief where the shoulder has another problem alongside the stiffness.

Frozen Shoulder and Diabetes

Frozen shoulder is more common, often more severe and typically slower to settle in people with diabetes, and non-operative measures such as hydrodilatation are less reliable. Published series still report substantial gains in movement and pain after capsular release in patients with diabetes, but expectations and timelines should be set accordingly, and blood glucose control matters during recovery.

What the Results Look Like

Reported outcomes are good. Published series describe large improvements in forward elevation and external rotation and marked reductions in pain, with most patients satisfied at follow-up. Movement usually improves immediately; comfort and strength follow over the months afterwards.

Related Services & Information

Content reviewed by our shoulder surgery and physiotherapy teams. This information is general and does not replace personalised medical advice.