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Education · shoulder

Capsular Release for Frozen Shoulder Info Evidence Consent

Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed

Related shoulder topics. Frozen shoulder .

Why this operation has been suggested

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. At your appointment we take a history, examine your shoulder, and arrange imaging if it is needed to confirm the diagnosis.

Frozen shoulder causes pain and stiffness because the capsule, the stretchy lining around the joint, becomes inflamed and tight. We usually begin with non-operative care such as physiotherapy, stretching and injections. Surgery is considered when that has not given enough improvement. Capsular release means cutting the tight parts of that lining so the shoulder can move freely again. We suggest it when a steroid injection has not given you enough relief, rather than making you wait a fixed number of months, and it is done as a keyhole operation through small incisions around the shoulder. Most people notice less pain and freer movement soon after surgery, and the operation aims to restore movement, ease pain and return your shoulder to everyday use.

Before the operation

Your surgeon will give you clear instructions in the weeks before surgery. You will need to stop eating and drinking for seven hours beforehand. We ask for seven rather than six so that your operation can be brought forward if the theatre list runs early. Tell your surgeon about all the medicines you take, including blood thinners, because some may need to be paused. Bring a written list of them on the day. Arrange for someone to drive you home afterwards, and wear loose, comfortable clothing that is easy to change out of. Imaging such as X-rays, an ultrasound or an MRI scan helps plan the operation and shows the condition of your shoulder. If you have other medical conditions, you may need blood tests or a review with the anaesthetist.

On the day

You arrive at the hospital's surgical admissions unit, where you are checked in and prepared for theatre. You then meet the anaesthetist, the doctor who looks after your anaesthetic and pain relief. This operation is done under general anaesthetic combined with a regional nerve block. You will be fully asleep for the operation, and the block (an injection that numbs the nerves supplying the arm before you wake up) provides pain relief for the first 12 to 24 hours after surgery. The anaesthetist will meet you before the operation and talk you through both parts.

You are then taken into the operating theatre, where the operation is performed. When it is finished, you wake up in the recovery area, where nurses monitor you while the anaesthetic wears off. Once you are stable, you either go to the ward or go home, depending on the procedure and your recovery.

What the operation involves

Your surgeon does this operation as a keyhole procedure. A few small cuts are made around your shoulder, including one at the back. A thin tube with a small camera goes inside the joint so the surgeon can see the capsule, the tight lining around the joint, on a screen.

The tight bands of tissue are then cut to free the shoulder. The surgeon releases the tight parts of the lining, usually starting at the front and top of the shoulder and working down and around as far as the stiffness needs. Cutting one part of the capsule only frees movement in one direction, so the release goes as far as is needed; a less extensive release appears to do at least as well as dividing the whole capsule. Inflamed tissue inside the joint can also be cleaned away. Care is taken near nerves that run close to the bottom of the joint, and the release is done in layers to protect them.

Once the tight tissue has been released, your shoulder is gently moved to check the new range of motion. The small cuts are then closed with stitches, and a dressing is placed over them.

The aim is simple: cut what is tight so the joint can move freely again.

After the operation

Most patients stay one night in hospital after this operation, though some are able to go home the same day. You wake up in the recovery area, then move to the ward. You may have a simple sling for comfort for the first day or two; there is no repair to protect, so you can use the arm freely. A physiotherapist will show you the movements to start straight away, and you keep doing them through the day. Pain relief is planned before you wake up, so most people find the first day or two manageable. Someone should stay with you for the first 24 hours. We leave the dressing on for about 10 days; please do not take it off before then unless we tell you to. We change or remove it when we see you.

Recovery

Most people notice a change straight away. The tight, catching pain that made sleep and dressing difficult is often much less from the first days. Your arm will still be sore, and the shoulder may feel bruised and swollen where the work was done. This settles over the first couple of weeks. Keeping up your movements, using the pain relief you have been given, and using the arm freely between exercise times all help.

Your days will centre on simple, frequent exercise. A physiotherapist will show you the first movements before you leave hospital, and you repeat them through the day to keep the new motion from stiffening up again. Your physiotherapist then guides your program, building from gentle assisted stretches to movements you do yourself. Any sling is for comfort only, in the first day or two. You can move around the house freely, but wait until your surgeon clears you before driving, typically at the six-week review. Our guide to driving after upper-limb surgery explains this in more detail.

As movement returns, everyday tasks come back in stages: reaching behind you, lifting your arm overhead, then returning to work and the activities you enjoy. Recovery varies from person to person, and your timeline may differ. Your surgeon and physiotherapist will guide you at each review.

What can go wrong

Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.

The small cuts around your shoulder can become infected. Watch for redness that spreads out from a wound, swelling that gets worse, or fluid leaking from the site. A deep, throbbing pain that does not ease with simple painkillers is another warning sign. If you notice any of these, call the clinic rather than waiting for your next visit. Infection caught early usually settles with drainage and a course of antibiotic tablets.

Nerves run close to the shoulder, and surgery near them can cause temporary irritation. You might notice tingling, pins and needles, or patches of numbness in the arm. Some people find part of the arm feels weak or slow to respond. These changes are usually temporary and settle on their own over days to months. Mention any new numbness or tingling at your review, or call the clinic if it appears suddenly.

The bone and the smooth lining of the joint can be injured during the operation. You would notice this as pain that is different from the usual post-operative soreness, or a clicking or grinding feeling when you move. Bring this up at your next review so it can be checked.

The rotator cuff, the group of tendons that help you lift and rotate your arm, can also be affected. This feels like a deep ache at the side of the shoulder, with weakness when lifting your arm or reaching overhead. Simple tasks like getting dressed may feel harder than expected. Tell your surgeon or physiotherapist if this does not improve as expected, so they can examine it and adjust your program.

If anything worries you between reviews, call the clinic. The complications table on this page lists typical rates if you want the specifics.

When to call us

Call the clinic straight away if you have a fever, or if redness, swelling or fluid leaking from a wound gets worse. Call us if you notice sudden severe pain, new numbness or tingling, or if you cannot move your arm. Go to emergency if you have calf swelling or pain, or shortness of breath, as these can signal a blood clot. If anything worries you and you are not sure, call us. We would rather hear about it early.

Where to read more about the condition

This page is about the operation itself. The condition it treats, including what the evidence shows about when surgery helps and when it does not, is covered in more detail on the Frozen Shoulder page.

Reviewed by Dr Kieran Hirpara · 7 August 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Anatomy & Pathophysiology

Bony Anatomy

  • The proximal humerus comprises four main parts: the humeral head, greater tuberosity, lesser tuberosity, and humeral shaft [3].
  • The articular head of the humerus is spherical with a diameter of 37 to 57 mm [3].
  • The most superior portion of the articular surface of the humeral head averages 8 mm above the greater tuberosity [3].
  • Humeral version averages 29.8 degrees, with a range of 10 to 55 degrees [3].
  • The humeral head is inclined approximately 130 degrees with respect to the humeral shaft [3].
  • The neck-shaft angle measures an average of 135 degrees [4].
  • The humeral head is retroverted an average of 30 degrees [4].
  • The glenoid is a convex structure of shallow depth shaped like an inverted pear [3].
  • The glenoid cavity is a shallow socket, approximately one third the size of the humeral head [4].
  • The subchondral bone of the glenoid is relatively flat, with the articular concavity augmented by cartilage and a circumferential labrum [6].
  • The glenoid averages 5° of retroversion in relation to the axis of the scapular body [6].
  • The acromion, coracoacromial ligament, and coracoid process form the coracoacromial arch, a rigid bony-ligamentous structure that imparts stability to the shoulder girdle [3].
  • The scapula is attached to the axial skeleton by the acromioclavicular and sternoclavicular joints [5].
  • The scapula is separated from the chest wall by thin gliding fibro-fatty tissue, allowing its smooth excursion over the chest wall [5].
  • The lateral pillar connects the inferior border of the glenoid with the inferior angle of the scapula [5].
  • The spinal pillar arises from the central part of the glenoid and continues medially to become part of the base of the scapular spine [5].
  • The two bony pillars connected by a markedly thinner medial border form the basic load-bearing structure of the scapular body, known as the biomechanical body of the scapula [5].
  • The weakest bone in the scapula is located primarily in the central part of the biomechanical body, specifically in the infraspinous fossa [5].
  • The weakest area of the circumference of the biomechanical body of the scapula is the spinomedial angle, which is the connection of the scapular spine and the medial border of the scapula [5].

Soft Tissue Anatomy

  • The greater tuberosity serves as the attachment site for the supraspinatus, infraspinatus, and teres minor tendons of the rotator cuff [3].
  • The lesser tuberosity serves as the attachment site for the subscapularis tendon [3].
  • The bicipital groove lies between the greater and lesser tuberosities and serves as a pathway for the long head of the biceps [3].
  • The rotator cuff consists of four muscles: the subscapularis, supraspinatus, infraspinatus, and teres minor [4].
  • The infraspinatus and teres minor are external rotators, while the subscapularis is an internal rotator of the humerus [4].
  • The rotator cuff muscles serve as depressors of the humeral head to allow the deltoid to efficiently abduct the humerus [4].
  • The subscapular bursa lies between the subscapularis tendon and the neck of the scapula and communicates with the joint cavity between the superior and middle glenohumeral ligaments [7].
  • The rotator interval is defined medially by the base of the coracoid, superiorly by the supraspinatus tendon, and inferiorly by the subscapularis tendon [6].
  • The rotator interval contains the coracohumeral ligament, the superior glenohumeral ligament, and the intra-articular portion of the long head of the biceps tendon [6].
  • The coracohumeral ligament restricts external rotation in adduction and is a static restraint to inferior and posterior translation in adduction and external rotation [6].
  • The superior glenohumeral ligament is a primary static restraint against anterior translation with the arm at the side [6].
  • The middle glenohumeral ligament is a primary static restraint against anterior translation with the arm in external rotation and 45° of abduction [6].
  • The anterior band of the inferior glenohumeral ligament is a primary static restraint against anterior-inferior dislocation of the glenohumeral joint in 90° of abduction and external rotation [6].
  • The posterior band of the inferior glenohumeral ligament is a primary static restraint against posterior-inferior translation in internal rotation and adduction [6].
  • The glenoid labrum provides concavity and up to 50% of marginal glenoid socket depth [6].

Vascular Anatomy

  • The proximal humerus receives its blood supply from the anterior and posterior humeral circumflex branches from the third division of the axillary artery [3].
  • The anterior humeral circumflex artery provides vascular inflow to the humeral head by way of its terminal anterolateral branch known as the artery of Laing, also known as the arcuate artery [3].
  • The ascending branch of the anterior humeral circumflex artery courses parallel to the lateral aspect of the long head biceps tendon and enters the humeral head at the interface of the bicipital groove and greater tuberosity [3].
  • The anterolateral ascending branch of the anterior humeral circumflex artery provides the primary blood supply to the humeral head [6].
  • Injury to the arcuate artery may result in osteonecrosis of the humeral head [3].
  • Additional extraosseous collateral branches can permit humeral head perfusion despite complete ligation of the arcuate artery [3].

Pathophysiology of Frozen Shoulder

  • Frozen shoulder, also known as adhesive capsulitis, is characterized by pain and restricted glenohumeral joint motion, especially external rotation [15].
  • The essential lesion in frozen shoulder involves the coracohumeral ligament and the rotator interval capsule [15].
  • Histologically, frozen shoulder shows evidence of inflammation and fibrosis with a dense matrix of type III collagen containing fibroblasts and myofibroblasts [15].
  • The histological findings in frozen shoulder appear similar to findings in Dupuytren disease [15].
  • Laxity of the rotator interval results in inferior laxity, while contracture of the interval is seen with adhesive capsulitis [6].
  • Posttraumatic or postsurgical stiffness results from excessive scar formation [15].
  • Motion loss in posttraumatic or postsurgical stiffness may involve the humeroscapular motion interface between the proximal humerus and overlying deltoid and conjoined tendon, as well as contracture of the rotator cuff and capsule [15].
  • The pathogenesis of a stiff shoulder is still elusive, though ongoing basic science research has provided insight into cellular and biochemical pathways resulting in shoulder stiffness [1].

Investigations

General Principles

  • The diagnosis of a stiff shoulder depends on awareness of the problem, with history and physical examination being paramount [1].
  • Ancillary studies may be helpful in certain circumstances for the diagnosis of a stiff shoulder [1].
  • The purpose of imaging the shoulder is to help establish the diagnosis, determine the severity of the pathoanatomy, assist in surgical planning, and enable the surgeon to illustrate the condition to the patient [2].
  • Unless a specific research protocol is in place, the temptation to "overimage" should be resisted by obtaining only the scans or reconstructions necessary for patient care [2].
  • Proper radiographic technique is as important as proper surgical technique to achieve the desired outcome [2].
  • A robust approach to imaging the shoulder must recognize that the shoulder is a three-dimensional structure that cannot be represented by a single planar view [13].
  • Critical relationships, such as the degree of centering of the humeral head, change with the position of the arm [13].
  • Shoulder pathology may be found in a large number of different bones and soft tissues [13].
  • Overlying and superimposed structures as well as metallic implants may complicate imaging the structures of interest [13].
  • Surgeons need to develop a judicious approach to imaging that yields necessary information while avoiding the tendency to "over-image" [13].

Radiographic Evaluation

  • Standardized plain films are almost always sufficient to garner the information needed for shoulder care [2].
  • CT scans may offer a few degrees of increased precision in the measurement of glenoid version, but this precision does not improve the quality of the surgery or the clinical outcome [2].
  • There is information that can be gathered from properly taken plain films that cannot be obtained from CT scans [2].
  • The first key radiographic view is the anteroposterior (AP) view in the plane of the scapula taken so that the x-ray beam passes through the glenohumeral joint [2].
  • The AP view in the plane of the scapula shows the superoinferior position of the humeral head relative to the glenoid [2].
  • The AP view in the plane of the scapula shows the presence of osteophytes on the humeral head and glenoid [2].
  • The AP view in the plane of the scapula shows narrowing of the joint space [2].
  • The AP view in the plane of the scapula shows the degree of medial displacement of the humerus in relation to the lateral acromial line [2].
  • The AP view in the plane of the scapula shows the quality of the humeral and glenoid bone [2].
  • The AP view in the plane of the scapula shows the presence of loose bodies [2].
  • The AP view in the plane of the scapula shows whether there is humeral head collapse or deformity [2].
  • The second key radiographic view is the axillary view taken with the arm in the functional position of elevation in the plane of the scapula [2].
  • The axillary view is oriented so that both the spinoglenoid notch and the scapular neck are visible [2].
  • The axillary view shows a different perspective of the humeral anatomy [2].
  • The axillary view shows the amount of glenoid bone [2].
  • The axillary view shows the shape of the glenoid [2].
  • The axillary view shows the version of the glenoid in relation to the plane of the scapula [2].
  • The axillary view shows the relationship of the humeral head to the glenoid fossa [2].
  • The standardized axillary view is referred to as the "truth view" because it demonstrates glenohumeral relationships in the functional position of elevation [2].
  • CT scans have the disadvantage of being taken with the arm in the adducted position [2].
  • Many "axillary views" sent for consultation are taken without standardization, making it impossible to determine important features of the glenohumeral joint [2].
  • When taken properly, standardized anteroposterior and axillary views indicate the thickness of the cartilage space between the humerus and the glenoid [2].
  • When taken properly, standardized anteroposterior and axillary views indicate relative positions of the humeral head and the glenoid [2].
  • When taken properly, standardized anteroposterior and axillary views indicate the presence of osteophytes [2].
  • When taken properly, standardized anteroposterior and axillary views indicate the degree of osteopenia [2].
  • When taken properly, standardized anteroposterior and axillary views indicate the extent of bony deformity and erosion [2].
  • Joint space narrowing is most evident on the axillary truth view as opposed to images made with the arm at the side [2].
  • The axillary truth view can show posterior subluxation or "functional decentering" that is not evident in images taken with the arm at the side [2].
  • The degree of posterior subluxation can be measured as the position of the center of the humeral head in relation to the plane of the scapula [2].
  • The degree of posterior subluxation can be measured as the position of the center of the humeral head in relation to the glenoid face [2].
  • The degree of posterior subluxation can be measured as the point of contact of the humeral articular surface on the glenoid articular surface [2].
  • The point of contact of the humeral articular surface on the glenoid articular surface reflects the degree of centering of the net humeral joint reaction force on the glenoid [2].
  • Malcentering of the joint reaction force leads to posterior instability, posterior glenoid wear, and "rocking horse" loosening of prosthetic glenoid components [2].
  • At least two X-ray views should be obtained: an anteroposterior in the plane of the glenoid and an axillary projection with the arm in abduction [11].
  • The axillary projection with the arm in abduction shows the relationship of the humeral head to the glenoid [11].

Magnetic Resonance Imaging

  • Magnetic resonance imaging (MRI) is useful to identify osteonecrosis of the humeral head [11].
  • Magnetic resonance imaging (MRI) is useful to identify a bone tumour [11].
  • Magnetic resonance imaging (MRI) can identify labral tears [11].
  • Magnetic resonance imaging (MRI) can identify rotator cuff tears [11].
  • The accuracy of MRI for identifying labral tears and rotator cuff tears is enhanced by combining the scan with arthrography [11].
  • Findings of adhesive capsulitis and an intact labrum on magnetic resonance arthrography were independent predictors for pain relief after glenohumeral corticosteroid injections [14].

Computed Tomography

  • Computed tomography (CT) is helpful for planning fracture surgery [11].
  • Computed tomography (CT) is helpful for planning shoulder joint replacement [11].

Ultrasonography

  • Ultrasonography is a simple and accurate test for identifying rotator cuff tears [11].
  • Ultrasonography is a simple and accurate test for identifying calcific tendinitis [11].
  • Ultrasonography can be useful in guiding injections [11].
  • Ultrasonography can be useful in guiding barbotage, which involves aspirating calcific deposits in the rotator cuff [11].
  • The most commonly performed joint examination using ultrasonography is the shoulder examination [9].
  • The accuracy of shoulder ultrasonography depends on the skill of the scanner operator and an awareness of pitfalls that are encountered [9].

References

[1] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > SUMMARY.

[2] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > Radiographic Evaluation.

[3] Rockwood And Matsen S The Shoulder. Shoulder and Elbow Specialty Clinic Workers’ Survey > ANATOMY.

[4] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 2Musculoskeletal Trauma Surgery > SHOULDER AND ARM INJURIES.

[5] Rockwood And Green S Fractures In Adults. 29: Principles of Nonunion and Bone Defect Treatment > Applied Anatomy Related to Scapular Fractures.

[6] Aaos Comprehensive Orthopaedic Review 3. Anatomy of the Shoulder, Arm, and Elbow > I. Shoulder.

[7] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > Bursae.

[9] Orthopaedic Knowledge Update Sports Medicine 6. Diagnostic Ultrasonography and Ultrasonography-­Guided Procedures > Annotated References.

[11] Apley And Solomon S Concise System Of Orthopaedics And Trauma. INVESTIGATION.

[13] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > SENIOR EDITOR COMMENTARY.

[14] Orthopaedic Knowledge Update Sports Medicine 6. Magnetic Resonance Imaging of the Glenohumeral Joint > Annotated References.

[15] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > SHOULDER STIFFNESS > 1. A stiff shoulder may be posttraumatic, postsurgical, or the result of adhesive capsulitis.

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