Surgical intervention is indicated if symptoms worsen despite intensive physiotherapy or fail to improve. Usually, arthroscopic arthrolysis (minimally invasive circular opening of the shoulder joint capsule) is then performed. The aim of the measures is to eliminate the irritation or adhesions in the periarticular tissue of the shoulder and to restore the active and passive mobility of the shoulder joint.
This is achieved by surgical measures such as arthroscopic subacromial decompression (ASD; the area below the acromion (shoulder roof) is widened, allowing normal gliding of the underlying rotator cuff). If a calcific deposit is present, it is removed.
Rotator cuff surgery is followed by four to six weeks of immobilization of the arm using an arm sling. In a small study with a relatively short follow-up period, it was shown six months later that if an arm sling was not used postoperatively (= sling-free rehab), mobility was greater and pain was somewhat less.
In patients with small to moderate rotator cuff rupture, 10-year outcomes were significantly better for patients undergoing primary surgery than for patients undergoing physical therapy alone.
Additional notes
- Capsular release surgery for frozen shoulder in idiopathic frozen shoulder does not appear to be significantly superior to physical therapy alone. It should also be noted that there were serious complications mainly in the release group. A randomized trial was able to determine the following advantages and disadvantages:
- Capsule release surgery: slightly more effective and fewer follow-up treatments, but higher risk of complications.
- Physiotherapy group: more often required further interventions.