Shoulder Manipulation Under Anesthesia
and Scope/Lysis of Adhesions
Shoulder manipulation under anesthesia and scope/lysis of adhesions may be performed on patients with frozen shoulder (adhesive capsulitis). While asleep, the shoulder is manipulated in several directions to break up the scar tissue. A few small incisions are made around the joint to allow a camera and various instruments to pass through. These instruments are used to visualize the anatomic structures as well as to release the tight capsule and scar tissue that has formed in the shoulder.
- A manipulation under anesthesia is performed after the patient has been put to sleep. It involves moving the arm in certain positions to break up the scar tissue that is causing the shoulder to be stiff. A shoulder arthroscopy is then usually performed. This involves making 2-3 incisions (approximately 0.5 inch long) around the shoulder joint for a camera and various other instruments, such as a shaver tool. A shaver is used to clean up any residual scar tissue bands (known as adhesions) that could restrict shoulder motion. The incisions are closed and dressings applied.
- This surgery is most often performed under general anesthesia with a nerve block, but can be performed with a nerve block and sedation.
- This surgery is usually outpatient, which means the patient will be able to go home the same day.
- Surgery typically lasts about 1 hour.
- Patient are usually set up with a continuous passive motion (CPM) device to use after surgery to prevent recurrent scarring and stiffness.
- It is critical to start physical therapy within a few days of surgery to preserve the range of motion obtained from the surgery.
- The incisions are closed with absorbable sutures and are covered with dressings that can usually be removed 2-3 days after surgery.
- Patients who are not progressing with more conservative treatments, such as physical therapy, steroid injection, or anti-inflammatories
- Patients that want to return to activity, sport, and work as soon as possible
- Patients who develop a frozen shoulder after a shoulder surgery that have failed to progress with physical therapy
Patients will be allowed to move their arms once the nerve block has worn off. Physical therapy should start within a couple of days of surgery. Physical therapists follow a protocol outlined by Dr. Faulkner to help regain shoulder motion and function. Physical therapy and home exercises are a critical part to a patient’s outcomes and quality of life after surgery.
A sling is only used for comfort. Patients are encouraged to start moving their arms as soon as the nerve block has worn off. There are typically no restrictions on range of motion after this procedure.
No. Driving with a sling is considered driving impaired and could be subject to a citation.
The CPM should be used for at least 4 hours a day. Use of the CPM should be accompanied by a daily home exercise program that involves actively moving and stretching the shoulder. This home exercise program will be explained to you before surgery.
Physical therapy typically starts within a couple of days of surgery.
2 days after surgery. Once you remove the bandages, you will see 3 sticky white strips covering the wounds. These are called steri-strips and should be left in place until your first postoperative appointment.
The ice machine should be used for about 30 minutes at least 3 times a day until your first postop. You may ice more frequently if desired.
An anesthetic injection performed by the anesthesiologist to turn off pain signals that go to a targeted region.
This will be discussed at your preop appointment. If a narcotic is prescribed, the risks and side effects will be reviewed with you. We encourage you to try and discontinue these by your first postop appointment. Depending on your health history, you may be encouraged to take anti-inflammatories and Tylenol instead of the narcotics.
The overall risk of a complication is less than 1%. The most common risk is shoulder stiffness from scarring. Other more rare risks include infection, bleeding, and persistent pain.