Arthroscopic Capsular Release: Minimally invasive division of the anterior and posterior capsule to restore ROM

Q1. What is arthroscopic capsular release?

Arthroscopic capsular release is a minimally invasive surgery performed to treat a very stiff elbow. During this procedure, the surgeon makes a few tiny cuts (incisions) around the elbow and inserts a small camera, called an arthroscope, to see inside the joint. Specialized tools are then used to carefully cut and release the tight, scarred joint capsule, which allows the elbow to move freely again.

Q2. Why does the elbow joint capsule become tight and stiff?

The joint capsule is a strong, flexible sleeve of tissue that surrounds and protects the elbow joint. When you experience an injury (like a fracture or dislocation), undergo surgery, or keep your arm still in a cast for a long time, the body can produce too much scar tissue. This causes the flexible capsule to become thick, scarred, and tight, which physically blocks the elbow from bending or straightening.

Q3. When is arthroscopic capsular release recommended?

This procedure is recommended when:

• You have severe elbow stiffness that makes daily tasks difficult.
• You have completed several months of dedicated physical therapy and stretching, but your movement has stopped improving.
• Dynamic or static progressive bracing has not successfully restored your range of motion.
• There are no bony blockages inside the joint that would prevent movement.

Q4. How does arthroscopic surgery compare to open surgery for capsular release?

Arthroscopic surgery offers several important benefits over traditional open surgery, including:

• Smaller incisions, which leave very minor scars.
• Less disruption to the healthy muscles and ligaments around the elbow.
• Lower levels of post-operative pain and swelling.
• A faster start to physical therapy, which is critical for preventing stiffness from returning.

Q5. How should I prepare for my upcoming surgery?

To prepare for surgery, you should:

• Stop eating and drinking (fast) before midnight on the night before your procedure, or as instructed by your surgical team.
• Review your current medications with Dr. Veillette, especially blood thinners that may need to be stopped.
• Arrange for a family member or friend to drive you home after the surgery and stay with you for the first day.
• Set up your home space with easy-to-reach items and plenty of pillows to help elevate your arm.

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

Most patients receive general anesthesia, which means you will be asleep and feel no pain during the surgery. In addition, the anesthesiologist will often perform a regional nerve block, injecting numbing medicine near the nerves in your shoulder or neck. This block numbs your entire arm and provides excellent pain relief for 12 to 24 hours after the operation.

Q7. What happens during the actual arthroscopic capsular release procedure?

During the procedure, the surgical team will:

• Make two or three tiny portals (incisions) around the elbow joint.
• Insert the arthroscope to inspect the joint surfaces and locate the tight areas of the capsule.
• Use tiny instruments to divide (release) the tight capsule at the front (anterior) and back (posterior) of the joint.
• Remove any loose bone fragments or scar tissue that might be blocking movement.
• Gently move the elbow through its full range of motion to confirm the release is successful before closing the incisions.

Q8. Will I need to wear a splint or brace after the surgery?

Yes. A specialized brace or splint is typically used after surgery to hold the elbow in its new, fully stretched position (either bent or straight). You may also use a Continuous Passive Motion (CPM) machine, which slowly moves your elbow for you while you rest. The brace is worn between physical therapy sessions and at night to prevent the joint capsule from scarring down in a stiff position again.

Q9. How is post-operative pain managed?

Pain is managed using a combination of methods:

• The regional nerve block provides numbing relief immediately after surgery.
• Prescription pain medications may be prescribed for the first few days.
• Over-the-counter pain relievers, such as acetaminophen or anti-inflammatories, can be used as you transition off prescription drugs.
• Applying ice packs and keeping your arm elevated above your heart are highly effective ways to reduce swelling and throbbing pain.

Q10. What is the best position for sleeping after elbow surgery?

The best position is sleeping on your back or on your unoperated side. You should place several pillows under your operated arm to keep it elevated above the level of your heart. This elevation uses gravity to drain fluid away from the elbow, significantly reducing swelling, stiffness, and pain during the night. Avoid sleeping directly on your operated arm.

Q11. How soon after surgery will I start physical therapy?

You will begin physical therapy and gentle elbow movements almost immediately—often the very same day or the day after surgery. Starting movement early is the most important factor in your recovery. If the elbow is kept still, the body will quickly form new scar tissue, and the stiffness will return.

Q12. What are the key phases of rehabilitation following a capsular release?

Rehabilitation typically progresses through three phases:

• Phase 1 (Weeks 1-2): Focuses on managing pain, reducing swelling, and performing frequent passive stretching to maintain the range of motion achieved in surgery.
• Phase 2 (Weeks 2-6): Focuses on active movement, where you use your own muscles to bend and straighten the elbow, and beginning light daily activities.
• Phase 3 (Weeks 6 and beyond): Focuses on strengthening the muscles around the elbow, forearm, and shoulder, and gradually returning to full activities.

Q13. How long does the complete recovery take, and when can I return to normal activities?

Complete recovery typically takes about 3 to 6 months. However, you can return to light tasks, like typing or eating, within 1 to 2 weeks. You can usually drive within 2 to 3 weeks once you are off prescription pain medications and have sufficient control of your arm. Return to heavy lifting, manual labor, or sports will be guided by Dr. Veillette and your physical therapist, usually around 3 to 4 months.

Q14. What are the potential risks and complications of this procedure?

While arthroscopic capsular release is very safe, potential risks include:

• Temporary or permanent nerve irritation (especially the ulnar nerve), which can cause numbness or tingling in the hand.
• Return of elbow stiffness if rehabilitation is not followed closely.
• Joint infection or delayed healing of the incisions.
• Bleeding into the joint or reaction to anesthesia.

Q15. What are the signs of a problem that mean I should call my doctor's office?

You should contact Dr. Veillette's clinic immediately if you experience:

• A fever of 38°C (100.4°F) or higher.
• Worsening pain that is not helped by your pain medications.
• Increased redness, warmth, swelling, or yellow fluid draining from the incisions.
• Sudden numbness, tingling, or weakness in your hand or fingers that does not go away.

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.