Frozen Shoulder Release

Frozen shoulder, also known as adhesive capsulitis, is a painful condition marked by stiffness and restricted motion of the shoulder joint. Initially described by Codman, it affects 2–5% of the population, with peak incidence between ages 40 and 60. Patients often experience chronic shoulder pain and significant limitations in daily activities such as dressing, driving, or lifting. While most cases improve with non-surgical treatment, some persist despite physical therapy and medications. For these stubborn cases, arthroscopic capsular release offers a promising surgical solution.

How Common It Is and Who Gets It? (Epidemiology)

Frozen shoulder is more common in adults between the ages of 40 and 60, with a higher incidence in females. It is particularly prevalent in individuals with diabetes, thyroid disorders, or a history of shoulder injuries or surgeries. The condition affects 2-5% of the population, and it can occur either without a clear cause (idiopathic) or as a result of previous surgery or trauma.

Why It Happens – Causes (Etiology and Pathophysiology)

Frozen shoulder develops when the shoulder capsule, which surrounds the joint, thickens and tightens, leading to restricted movement. The exact cause is unclear in many cases, but it is thought to result from inflammation in the joint capsule. This can be triggered by injury, surgery, or systemic conditions such as diabetes. In idiopathic cases, no underlying condition is identified, while post-operative or post-traumatic cases are caused by prior shoulder injury or surgery.

How the Body Part Normally Works? (Relevant Anatomy)

The shoulder is a ball-and-socket joint, where the humeral head fits into the glenoid of the scapula. The joint is surrounded by a capsule made of connective tissue, which helps stabilize the joint. In frozen shoulder, this capsule becomes thickened and tight, restricting the shoulder’s ability to move freely and causing pain. The rotator cuff muscles also play a key role in shoulder stability and motion, and they are often intact in frozen shoulder cases.

What You Might Feel – Symptoms (Clinical Presentation)

Patients with frozen shoulder often experience pain and stiffness, particularly with overhead or reaching motions. The pain is typically dull and aching, and it worsens with movement. Over time, the stiffness increases, and patients may have difficulty performing daily activities like dressing, reaching, or driving. The condition progresses through three stages: freezing (pain and limited movement), frozen (significant stiffness), and thawing (gradual improvement of mobility).

How Doctors Find the Problem? (Diagnosis and Imaging)

Frozen shoulder is diagnosed through a combination of physical examination and imaging. The doctor will assess the range of motion and may identify characteristic pain during movement. X-rays are typically used to rule out other conditions, like arthritis or fractures, while MRI or ultrasound may be used to confirm the diagnosis and evaluate the extent of capsule thickening and inflammation.

Classification

Frozen shoulder can be classified into three types:

• Idiopathic: No known cause, often occurring without a preceding event.
• Post-operative: Occurs after shoulder surgery, such as rotator cuff repair.
• Post-traumatic: Develops after a shoulder injury or trauma.

Other Problems That Can Feel Similar (Differential Diagnosis)
Other conditions that can cause shoulder pain and limited motion include rotator cuff tears, labral tears, shoulder impingement, and arthritis. A detailed clinical examination and imaging studies are needed to distinguish between these conditions and frozen shoulder.

Treatment Options

Non-Surgical Care

• Physical therapy to improve range of motion and reduce stiffness
• Anti-inflammatory medications or corticosteroid injections to manage pain and inflammation
• Activity modification to avoid exacerbating the condition

Surgical Care

• Arthroscopic capsular release, where the tight portions of the joint capsule are cut and released using small instruments and a camera
• Manipulation under anesthesia may be used in some cases, though it is less common than arthroscopic surgery

Recovery and What to Expect After Treatment

Post-surgery recovery begins immediately with passive range-of-motion exercises to prevent stiffness. After the first few weeks, patients progress to active exercises to restore strength and mobility. Full recovery, including a return to overhead activities, may take 3 to 6 months, depending on individual progress.

Possible Risks or Side Effects (Complications)

As with any surgery, risks include infection, nerve injury, or stiffness. There is also a small risk of re-tearing the capsule or experiencing persistent pain. In rare cases, patients may require further surgery to fully resolve the condition.

Long-Term Outlook (Prognosis)

Arthroscopic capsular release has a high success rate, with most patients experiencing significant pain relief and improved range of motion. Most patients can return to normal activities, including sports, within 3 to 6 months. However, the long-term prognosis depends on the patient’s adherence to rehabilitation and the underlying cause of their frozen shoulder.

Out-of-Pocket Costs

Medicare

CPT Code 29825 – Arthroscopic Capsular Release (Shoulder Surgery for Frozen Shoulder or Adhesive Capsulitis): $140.04

CPT Code 23030 – Adhesive Capsulitis Release (Open or Arthroscopic Release for Frozen Shoulder): $102.46

Medicare Part B typically covers 80% of the approved cost for these procedures once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield generally cover the remaining 20%, minimizing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans work alongside Medicare to fill the coverage gap and reduce financial responsibility.

If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans generally cover any remaining coinsurance or small deductibles, which typically range between $100 and $300, depending on your plan and provider network.

Workers’ Compensation

If your capsular release surgery (either arthroscopic or open) is required due to a work-related injury or condition, Workers’ Compensation will cover all associated medical expenses, including surgery, rehabilitation, and follow-up care. You will not have any out-of-pocket expenses, as the employer’s insurance carrier directly covers all approved treatments.

No-Fault Insurance

If your shoulder condition requiring capsular release is related to an automobile accident, No-Fault Insurance will typically cover the full cost of treatment, including surgery and recovery. The only potential out-of-pocket cost may be a small deductible or co-payment, depending on your insurance policy.

Example

Laura Stevens required arthroscopic capsular release (CPT 29825) for her frozen shoulder. Her estimated Medicare out-of-pocket cost was $140.04. She also needed adhesive capsulitis release (CPT 23030), which had an estimated out-of-pocket cost of $102.46. Since Laura had supplemental insurance through AARP Medigap, both remaining balances were fully covered, leaving her with no out-of-pocket expenses for the surgeries.

Frequently Asked Questions (FAQ)

Q. What is frozen shoulder release surgery?
A. Frozen shoulder release surgery is a procedure to treat adhesive capsulitis by releasing the tight and thickened shoulder capsule to improve range of motion and reduce pain.

Q. When is frozen shoulder release surgery recommended?
A. It is recommended when non-surgical treatments such as physical therapy and medications have not improved shoulder mobility or pain after several months.

Q. How is frozen shoulder release surgery performed?
A. The surgery is usually done arthroscopically by inserting a small camera and instruments through tiny incisions to release the contracted capsule and scar tissue.

Q. What are the benefits of frozen shoulder release surgery?
A. Benefits include improved shoulder movement, decreased pain, and faster recovery compared to traditional open surgery.

Q. What should I expect during recovery after frozen shoulder release surgery?
A. Early physical therapy is crucial to maintain motion gains. Most patients regain significant shoulder mobility within weeks to months after surgery.

Q. Are there any risks associated with frozen shoulder release surgery?
A. Risks include infection, bleeding, nerve injury, stiffness recurrence, and complications related to anesthesia.

Q. How long does the surgery take?
A. The procedure usually takes about 30 to 60 minutes.

Q. Is frozen shoulder release surgery done under general anesthesia?
A. Yes, it is typically performed under general anesthesia, sometimes combined with a regional nerve block for pain control.

Q. Will I need physical therapy after surgery?
A. Yes, physical therapy is essential after surgery to regain and maintain shoulder motion and strength.

Q. How soon can I return to normal activities after frozen shoulder release surgery?
A. Most patients can resume daily activities within a few weeks but should avoid heavy lifting or overhead activities until cleared by their surgeon.

Q. Can frozen shoulder release surgery completely cure frozen shoulder?
A. While it greatly improves motion and reduces pain, some patients may still have residual stiffness and require ongoing therapy.

Q. What are alternative treatments to frozen shoulder release surgery?
A. Alternatives include physical therapy, corticosteroid injections, manipulation under anesthesia, and oral medications.

Q. How effective is arthroscopic frozen shoulder release compared to other treatments?
A. Arthroscopic release often provides quicker and more lasting improvement in range of motion compared to manipulation or conservative therapy alone.

Q. Will frozen shoulder release surgery affect my shoulder strength?
A. Strength typically improves as pain decreases and mobility returns with rehabilitation after surgery.

Q. What should I do to prepare for frozen shoulder release surgery?
A. Follow your surgeon’s instructions, which may include medical evaluations, stopping certain medications, and arranging post-surgery physical therapy.

Q. How soon after surgery will I feel pain relief?
A. Pain usually begins to improve within days after surgery, although some soreness is expected during recovery.

Q. Can frozen shoulder release surgery be repeated if stiffness returns?
A. Repeat surgery is rare but may be considered if stiffness recurs and limits function despite therapy.

Q. Are there any specific complications unique to frozen shoulder release surgery?
A. Possible complications include damage to nearby nerves or blood vessels and failure to achieve full motion restoration.

Q. Is frozen shoulder release surgery suitable for all patients with frozen shoulder?
A. It is generally reserved for patients who do not respond to conservative treatment and who have persistent pain and motion loss.

Q. How long is the typical hospital stay after frozen shoulder release surgery?
A. The surgery is usually outpatient, and patients go home the same day.

Summary and Takeaway

Arthroscopic capsular release is an effective surgical solution for patients with frozen shoulder who have not responded to conservative treatments. This minimally invasive procedure offers pain relief, improved shoulder function, and faster recovery compared to traditional open surgery. With high patient satisfaction and excellent outcomes, it provides a valuable treatment option for those with persistent shoulder stiffness and pain.

Clinical Insight & Recent Findings

A recent study evaluated the impact of preoperative anxiety and depression on postoperative pain and range of motion in patients undergoing arthroscopic frozen shoulder release.

The study found that while all patients experienced significant improvements in pain and function, those with psychological distress (HADS scores ≥8) had higher pain levels both preoperatively and at one-year follow-up, despite similar improvements in their visual analogue scale (VAS) scores compared to patients without psychological distress.

The findings suggest that addressing psychological distress may be crucial in optimizing recovery outcomes for patients undergoing shoulder surgery. (“Study on frozen shoulder and psychological distress – see PubMed.“)

Who Performs This Treatment? (Specialists and Team Involved)

Orthopedic surgeons specializing in shoulder disorders typically perform arthroscopic capsular release. A rehabilitation team, including physical therapists, plays an important role in helping patients regain motion and strength after surgery.

When to See a Specialist?

If you have shoulder pain or stiffness that has not improved with conservative treatments, or if you are unable to perform daily activities due to limited shoulder motion, you should consult a specialist to discuss surgical options like arthroscopic capsular release.

When to Go to the Emergency Room?

Seek emergency care if you experience severe shoulder pain following an injury or if you notice signs of infection, such as fever or redness at the surgical site.

What Recovery Really Looks Like?

Recovery after arthroscopic capsular release involves wearing a sling for a short period, followed by rehabilitation to restore motion and strength. Most patients can return to daily activities within a few weeks, and full recovery typically takes 3 to 6 months.

What Happens If You Ignore It?

If left untreated, frozen shoulder can lead to persistent pain, loss of shoulder function, and increased difficulty in performing daily tasks. Over time, the condition may become more debilitating, potentially requiring more invasive surgery.

How to Prevent It?

To prevent frozen shoulder, maintain shoulder mobility through regular stretching and strengthening exercises. Avoid prolonged periods of immobility following shoulder injuries or surgeries, as this can contribute to the development of frozen shoulder.

Nutrition and Bone or Joint Health

A diet rich in calcium, vitamin D, and omega-3 fatty acids can support joint health and reduce inflammation, helping to prevent or manage frozen shoulder symptoms.

Activity and Lifestyle Modifications

Regular physical activity and strengthening exercises for the shoulder muscles can help prevent stiffness and maintain joint mobility. Avoiding excessive overhead movements or repetitive strain on the shoulder joint can also reduce the risk of developing frozen shoulder.