There is a gradual onset of pain around the shoulder, which gets progressively worse.  It may prevent the sufferer from being able to sleep on the affected shoulder.

There is also restricted movement or stiffness at the shoulder that may become severe enough to interfere with daily activities of living such as washing and dressing.

The exact reason for the disease is unknown and many cases occur spontaneously.  It may occur following an injury to the shoulder and patients who have diabetes or Dupuyten's disease are more susceptible to the disease.

If left untreated the condition may resolve eventually after a period of about two years.  This is not a guarantee of return to pain free normal movement.

The treatment options include:

• Physiotherapy to reduce pain and stiffness
• Steroid injections in the shoulder joint
• Manipulation under anaesthesia.  In the situation regional anaesthesia is used to prevent pain whilst the arm is moved to the limits of the normal range of motion.  By doing this, the capsule around the shoulder joint is torn thereby allowing the shoulder to move more freely
• Surgical release.  This may be done either as a keyhole or arthroscopic procedure where the tightened tissues are cut, again allowing the shoulder to move more freely.

Arthroscopy is a form of keyhole surgery used to diagnose and treat problems of the shoulder joint.  An arthroscope (which is an instrument for the examination of the inside of joints consisting of a steel tube arthroscope fibre optic system) is inserted into the cavity of the shoulder via a small incision.  The arthroscope is attached to a video camera that allows the surgeon to ‘see’ inside the joint to find out more clearly what needs to be done.

The surgeon then inserts small instruments through a number of additional small incisions.  Guided by the image on the TV monitor the shoulder joint is explored and any necessary procedures are carried out.

The operation will be done whilst you are under a general anaesthetic.  Sometimes a regional interscalene (at base of the neck) nerve block anaesthetic is used as well, which puts your arm to sleep.  This provides additional pain relief and reduces the amount of general anaesthetic required.

Reasons why it is done:

Diagnosis

• To confirm a diagnosis that is suggested by your physical problems and any special diagnostic tests that may have been carried out (e.g. x-ray, ultrasound, MRI scan)
• To investigate pain for which there is no apparent cause to try and find a cause.  If there is a cause found you might be offered treatment.  If no cause is found and no treatment is indicated you may have to continue to live with the discomfort you are experiencing

Procedures

Arthroscopic shoulder problems treated arthroscopically may include:

• Shoulder stabilisation: where the joint ligaments may be repaired and tightened to prevent dislocation
• Shoulder decompression (acromioplasty): where some bone is removed to allow more space for the rotator cuff tendons to move your shoulder
• Tendon repair: often combined with decompression
• In addition, a manipulation of the joint or a surgical release of the tightened ligaments to improve the movements in a stiff shoulder sometimes accompanies arthroscopy

Are there any risks?

As with any operation, there are risks associated with having general anaesthetic.  However, arthroscopy is generally a safe, reliable operation.

Specific to this operation there is an overall complication rate of about 1%.  The most common complications include:

• Failure of the operation to relieve pain, instability or weakness
• Stiffness of the shoulder sometimes called a 'frozen shoulder' (this is often temporary)
• Swelling (this is often temporary) and due to the salt water pumped into the shoulder during the operation
• Infection. If this does occur it will be managed with antibiotics
• Injury to nerves and blood vessels
• Bleeding (this is often temporary) and settles as swelling goes down

Your surgeon will discuss the risks with you prior to surgery.

What improvement am I likely to get?

This depends on the underlying problem but keyhole allows rapid relief of pain and recovery of function because the incisions are small and no muscles or tendons are divided to gain access to the joint.

Depending on the problem, in a small proportion of cases there may be no improvement.

Is there anything I should do to prepare for the operations?

If you are a smoker, it would benefit you greatly to stop smoking before you have the operation.  This will reduce the risk of chest troubles, as smoking makes your lungs sensitive to the anaesthetic.  If you stop smoking it improves your chance of a good result.  It will also improve wound healing.

• If you find it impossible to stop smoking altogether, try to reduce the number of cigarettes you smoke for at least 48 hours prior to surgery
• If you are overweight, it will help if you lose any excess weight
• All infections, including coughs and colds, must be cleared up before you have your operation
• Let your consultant know details of all drugs being taken particularly steroids
• Having a positive outlook before the operation will help you feel better overall and will assist in the speed of your recovery