Rehabilitation after arthroscopic capsular release

An arthroscopic capsular release is performed to treat a stiff shoulder that has not responded to non-surgical treatment. Following the procedure, a near-normal range of movements is usually achieved. The main risk of surgery is recurrence of stiffness. The focus of rehabilitation is to maintain the range of movements achieved at surgery and prevent recurrence of stiffness. Whilst maintaining the range of movements is not particularly challenging during the first months after surgery, this becomes more challenging during the second month and regular hands-on physiotherapy is critical during this phase. Physiotherapy should ideally continue for at least 12 weeks or until such time as the patient is able to maintain the range of movements without assistance.

PHASE I  (0-4 weeks):

Wear sling for 2-3 days and then as needed for the first week.

Movements will feel relatively easy but it is important to perform daily stretches to maintain the range achieved at surgery.

0-2 weeks: Initiate outpatient physiotherapy as per postop instructions

Regular passive ROM and capsular stretching in all directions including – 

  • Supine external rotation
  • Supine elevation
  • Cross body stretches lying on affected side
  • Sleeper stretches
  • Internal rotation behind the back (towel stretch)

Active movements as tolerated.

Periscapular muscle exercises

2-4 weeks: Continue capsular stretching: Passive ROM, joint mobilisation to maximum tolerance. 

Deltoid, cuff isometrics, begin scapular protraction/retraction.

Avoid heavy lifting.

 

PHASE II (4-8 weeks):

During this phase some pain is expected. It is important to control pain with medication if necessary to facilitate stretching.

Continue capsular stretching and passive ROM including (in addition to phase I stretches) – 

  • Standing external rotation
  • Standing elevation
  • Wall climbing and door frame stretch
  • Corner stretches

Active movements as tolerated.

Advance isometrics, rotator cuff and deltoid* 

 

PHASE III (8-16 weeks): 

Continue passive stretching and active assisted ROM.

Advance to therabands as tolerated. 

Advance strengthening as tolerated begin eccentrically resisted motions and closed chain activities 

Advance to sports and fully activity as tolerated after 12 weeks.