Frozen Shoulder Treatment
in Rockhampton

What is going on

Frozen shoulder is a condition in which the capsule — the sleeve of tissue around the joint — becomes inflamed and then thickens and tightens, shrinking the space inside the shoulder. Despite the old name 'adhesive capsulitis', nothing is actually stuck together: the tissue has contracted, which is why the shoulder becomes both painful and genuinely stiff. Patients describe deep aching pain, often worst at night, and a marked loss of range — losing the ability to turn the hand outwards is the most characteristic sign. It's most common between 40 and 60, in women, and in people with diabetes or thyroid disease; with diabetes it also tends to take longer to settle. Most people improve a great deal — but the common reassurance that it 'always resolves on its own within a year or two' is more confident than the evidence supports: improvement tends to happen early and then plateau, and a proportion of patients keep some lasting ache or stiffness. That's why the practice treats the pain actively rather than asking patients to simply wait it out.

Not sure if this is the right diagnosis? The shoulder pain hub and shoulder injury hub triage the differential by anatomical location.

What the operation involves

**Arthroscopic capsular release** is a keyhole operation that divides the tightened capsule under direct vision — releasing the rotator interval anteriorly, and the inferior and posterior capsule as needed. Its main advantage is durability: recurrent stiffness after a release is uncommon, whereas after a **manipulation under anaesthesia** alone some shoulders tighten up again and need a repeat procedure, although studies comparing the two directly have not shown a clear difference. A less extensive release appears to do at least as well as dividing the whole capsule, so more isn't automatically better. It's usually done under regional block plus general anaesthesia, usually takes under an hour, and most patients stay one night in hospital. There is no repair to protect, so any sling is for comfort in the first day or two only — early movement from day one. Full clinical detail is on the capsular release education page, and the frozen shoulder education page covers the condition and the evidence in full.

For full clinical detail — incision, anaesthetic, post-operative instructions and the printable patient handout — see the frozen shoulder release education page or the shoulder surgery overview.

How this case is handled

The first consult focuses on confirming the diagnosis — frozen shoulder is over-diagnosed, and many stiff, painful shoulders have a different cause — and then on which is bothering the patient more, the pain or the stiffness. A steroid injection is the best-supported first step for pain; physiotherapy is worth doing but hasn't been shown to work better than an injection early on, and how hard the shoulder is pushed doesn't appear to matter, so exercise is kept within comfortable limits. Capsular release is offered early to patients who don't get adequate relief, rather than held back as a last resort. Physiotherapy is built into the post-operative pathway from week one.

Fees, Medicare rebates and the surgery-quote process are on the fees page. The case for seeing a fellowship-trained surgeon — and what fellowship training adds — is set out separately. GPs can find the referral pathway, urgency triage and what to include in the letter on the referrer page.

What this operation is billed under

The procedure is covered by the following Medicare Benefits Schedule items. Surgeon, anaesthetist, assistant, hospital and prosthesis fees are quoted separately and in writing before surgery — see the fees page for the practice's quote process and an explanation of why surgical fees follow the Australian Medical Association schedule. Surgery does not proceed without itemised written informed financial consent.

Item 48954 Shoulder arthroscopy with capsular release

The MBS item for arthroscopic capsular release of the frozen shoulder

Patient questions we hear most

• How long does frozen shoulder last on its own?

  Most people improve a great deal, but the familiar reassurance that it 'always resolves in one to two years' is more confident than the evidence supports. When researchers reviewed the studies, most improvement happened early and then slowed and plateaued, and a proportion of patients — by some measures a third to a half — still had some ache or stiffness several years later, though for most it's mild. People with diabetes tend to recover more slowly. Because 'just wait, it'll sort itself out' isn't a neutral piece of advice, the practice treats the pain actively rather than asking patients to endure it.

• What is hydrodilatation and how does it work?

  Hydrodilatation is an injection — performed by a radiologist under ultrasound or X-ray guidance — that fills the joint with local anaesthetic, corticosteroid and saline to stretch the capsule from the inside while the steroid settles the inflammation. It's a low-risk day procedure. The evidence for it is genuinely mixed — some studies show a benefit for pain, others for movement — so where it's appropriate Dr Hirpara refers patients to radiology for it, rather than treating it as a routine step. For pain specifically, a steroid injection into the joint has the strongest evidence.

• Will I need surgery?

  Many people settle with an injection and time and don't need surgery. But the practice doesn't treat surgery as a last resort reached only after months of struggling: if a steroid injection doesn't give adequate relief, arthroscopic capsular release is offered from that point. In the largest trial comparing the main treatments, all three landed within a few points of each other at a year. People who had a release were the least likely to need any further treatment, although serious complications, mostly general medical problems, were more common after a release than after a manipulation. The right path depends on the individual: how much the shoulder is affecting work and sleep, diabetes, and whether an injection has already been tried.

• How long is the recovery from arthroscopic capsular release?

  Movement starts the same day to prevent re-stiffening. There is no repair to protect, so any sling is for comfort in the first day or two only. Desk-based work usually resumes within two to six weeks. Driving is not allowed for at least six weeks after any shoulder operation, until your surgeon clears you at review. Physical work and overhead activities come back gradually, usually over two to three months. Most of the improvement comes over the first four months, with smaller gains for up to a year. People with diabetes tend to recover more slowly and may benefit from longer therapy support.

• Can frozen shoulder come back after surgery?

  Re-stiffening after capsular release is uncommon, and keeping up the exercises consistently in the first six weeks is the main thing you can do to prevent it. Stiffness is more likely to return in patients who can't tolerate the early movement programme (often because of pain) and where there is an underlying cause that wasn't addressed (a missed cuff tear, calcific deposit, or another inflammatory condition), and recovery tends to be slower in people with diabetes. The first review at two weeks specifically checks for early stiffening so it can be caught and corrected before scar tissue matures.

• Is shoulder bursitis the same as frozen shoulder?

  No. Shoulder bursitis (subacromial bursitis) is inflammation of the bursa under the acromion and gives pain on overhead reaching with relatively preserved range of motion when the pain is settled by injection. Frozen shoulder is a contracture of the joint capsule itself and gives loss of range that does NOT improve when pain is blocked. The two conditions are commonly confused and often co-exist; sorting out which is the dominant problem is part of the diagnostic consult, because the treatments are different.

• How much does frozen shoulder surgery cost? What does Medicare cover?

  Arthroscopic capsular release is performed under regional and general anaesthesia at Mater Private Hospital Rockhampton, so a separate anaesthetist gap applies on top of the surgeon and hospital fees. The practice quotes the surgical fee in writing before booking — Medicare item, rebate and out-of-pocket gap shown separately. Most major private health funds offer no-gap arrangements. The fees page covers the full process; surgery does not proceed without itemised written informed financial consent.

More general questions about appointments, fees and the practice on the FAQ page.