Arthroscopic Lysis of Adhesions

Q1. What is arthroscopic lysis of adhesions of the shoulder?

Arthroscopic lysis of adhesions is a minimally invasive surgery performed to remove scar tissue (adhesions) that has formed inside the shoulder joint. This scar tissue makes the joint stiff and painful, limiting your ability to move your arm. By using small incisions, a tiny camera (arthroscope), and specialized instruments, your surgeon can carefully cut away and release these tight bands of tissue, restoring your shoulder's mobility and reducing pain.

Q2. Why is lysis of adhesions performed, and what causes these shoulder adhesions?

Adhesions are bands of tough, fibrous scar tissue that can glue your shoulder joint capsule together, a condition often referred to as \"frozen shoulder\" (adhesive capsulitis) or joint contracture. This procedure is performed to restore normal joint motion when scar tissue blocks it. Adhesions are typically caused by:

• Prolonged immobilization after a shoulder injury, fracture, or surgery
• Inflammatory conditions inside the shoulder joint
• Severe trauma or repeated minor injuries to the shoulder
• Medical conditions such as diabetes, thyroid disorders, or cardiovascular disease

Q3. How do I know if I need arthroscopic lysis of adhesions?

You may be a candidate for this surgery if you suffer from severe shoulder stiffness and pain that prevents you from performing daily tasks. Symptoms include:

• A significant loss of active and passive shoulder movement (you cannot move your arm, and someone else cannot move it for you either)
• Constant, dull ache in the shoulder, which often worsens at night
• No improvement in pain or range of motion after several months of dedicated physical therapy, medications, or injections

Q4. What non-surgical alternatives are tried before recommending this procedure?

Surgery is typically considered a last resort. Before recommending arthroscopic lysis of adhesions, your doctor will usually try conservative treatments for at least 3 to 6 months:

• Physical Therapy: Structured stretching and range-of-motion exercises.
• Medications: Anti-inflammatory drugs (NSAIDs) to manage pain and swelling.
• Corticosteroid Injections: Targeted shots in the joint to reduce inflammation.
• Hydrodilatation: An injection of sterile fluid to stretch the joint capsule from the inside.

Q5. How should I prepare for the surgery in the days leading up to it?

Preparation helps ensure a safe procedure and a smooth recovery. You should:

• Follow all pre-operative instructions regarding eating, drinking, and taking medications.
• Arrange for a responsible adult to drive you home and stay with you for the first 24 hours.
• Prepare your home by putting frequently used items within easy reach (shoulder height or lower).
• Practice doing daily activities, like buttoning shirts or using the bathroom, with your non-operated arm.

Q6. What type of anesthesia is used during the procedure?

Arthroscopic lysis of adhesions is usually performed using a combination of two types of anesthesia:

• General Anesthesia: You will be asleep and comfortable throughout the entire procedure.
• Regional Nerve Block: An injection near the nerves in your neck or shoulder to numb your entire arm. This provides excellent pain relief for many hours after the surgery.

Q7. How is arthroscopic lysis of adhesions performed?

The procedure is done using minimally invasive techniques:

• The surgeon makes a few tiny incisions (about the size of a keyhole) around the shoulder.
• The arthroscope is inserted to display the inside of your joint on a monitor.
• Using specialized tools, the surgeon carefully cuts and removes the bands of scar tissue.
• The surgeon may also gently move the arm through its full range of motion to ensure all restrictions are freed.
• The incisions are closed with sutures and covered with a dressing.

Q8. What happens immediately after the surgery in the recovery room?

Immediately after the procedure:

• You will wake up in the recovery room, where nurses will monitor your vital signs.
• Your operated arm will likely feel numb and heavy due to the nerve block.
• A cold therapy pack or ice wrap may be applied to your shoulder to help reduce swelling.
• Once you are fully awake, pain is controlled, and you can tolerate fluids, you will be allowed to go home.

Q9. Do I need to wear a sling after arthroscopic lysis of adhesions, and for how long?

Unlike other shoulder surgeries where tissues are repaired and must be protected, the goal of this surgery is immediate movement. You will receive a sling for comfort, but:

• You should wear the sling only for a very short period (often just a few days) to protect the arm while the nerve block wears off.
• You are encouraged to discard the sling as soon as possible and begin moving your shoulder to prevent new scar tissue from forming.
• Your surgeon will give you specific guidelines based on your shoulder's condition.

Q10. How can I manage pain and swelling at home after the procedure?

Managing pain is key to starting your recovery exercises early. You can manage discomfort by:

• Taking prescribed pain medications exactly as directed by your surgeon.
• Applying ice packs or a cold therapy device for 15–20 minutes at a time, several times a day.
• Keeping the dressing clean and dry until your follow-up appointment.
• Performing gentle hand, wrist, and elbow movements to keep circulation active.

Q11. What is the best way to sleep and position my shoulder after surgery?

Sleeping can be challenging after shoulder surgery. To stay comfortable:

• Sleep in a semi-reclined position (using a recliner chair or propping yourself up with pillows in bed) for the first few weeks.
• Place a small pillow under your elbow or behind your shoulder on the operated side to keep it supported.
• Avoid sleeping directly on your operated shoulder or flat on your stomach.

Q12. When can I start physical therapy, and what does the rehabilitation look like?

Physical therapy is the most critical part of your recovery:

• Rehabilitation usually begins almost immediately—often the day after surgery.
• Early therapy focuses on passive stretching, where the therapist moves your arm to maintain the range of motion achieved during surgery.
• As healing progresses, you will transition to active stretching and gradual strengthening exercises.
• Commitment to a daily home exercise program is essential to prevent the joint from freezing up again.

Q13. What are the potential risks and complications of this surgery?

While arthroscopic lysis of adhesions is generally very safe, all surgeries carry some risks. These include:

• Infection or excessive bleeding
• Nerve or blood vessel damage around the shoulder
• Recurrent stiffness or return of the adhesions (often due to insufficient post-operative physical therapy)
• Temporary increase in shoulder pain

Q14. When can I return to normal daily activities, driving, and work?

Recovery timelines vary for every patient:

• Light daily activities: Feeding yourself or brushing teeth can usually be done within a few days using gentle movements.
• Driving: You should not drive while taking prescription pain medications or if you cannot safely control the steering wheel with both hands (typically 1 to 2 weeks).
• Work: You may return to desk work in 1 to 2 weeks, but heavy lifting or overhead physical labor may require 3 to 6 months.

Q15. What is the long-term outlook and success rate for arthroscopic lysis of adhesions?

The long-term success rate is highly dependent on your commitment to physical therapy:

• Most patients experience significant pain relief and a substantial improvement in shoulder mobility.
• Full recovery can take anywhere from 3 to 6 months of active rehabilitation.
• Maintaining a healthy lifestyle and continuing stretching exercises will help prevent future stiffness.

We encourage you to write down any specific questions you have and discuss them thoroughly with your surgeon, doctor, or physical therapist. They are your best resource for personalized advice and care.

Disclaimer: This brochure provides general information and is not a substitute for professional medical advice. Always consult your doctor or qualified healthcare provider with any questions you may have regarding your specific medical condition and treatment plan.