Mga ehersisyo para sa inpatient — capsular release & subacromial decompression Impormasyon

Ito ang mga banayad na ehersisyo na sisimulan sa ospital pagkatapos ng isang capsular release o subacromial decompression. Para sa mga operasyong ito, ang prayoridad ay panatilihing malayang nakakagalaw ang balikat.

Iyong mga ehersisyo

Simulan ang mga banayad na ehersisyong ito sa ospital at ipagpatuloy ang mga ito sa bahay. Dapat itong komportable; bawasan ang tindi kung tumitindi ang sakit.

Pagsusuot ng iyong sling

Ang sling ay dapat isuot para lamang sa ginhawa, at dapat itong hubarin hangga't maaari. Hindi mo kailangang matulog nang nakasuot ng sling.
Igalaw at gamitin ang iyong braso hangga't maaari.
Ipinapayo ang pagsusuot ng sling kapag nasa labas ng bahay, upang maiwasan na mabangga ng ibang tao ang iyong braso.
Layunin ang mga physiotherapy session nang hindi bababa sa dalawang beses sa isang linggo para sa unang anim na linggo.
Gumamit ng ice para sa pagpapaginhawa ng sakit kung kinakailangan.
Kapag nakasuot ng sling, i-relax ang iyong balikat at hayaang dalhin ng sling ang bigat ng iyong braso.
Inumin ang iyong mga painkiller bago gawin ang iyong mga ehersisyo, at bago ang iyong mga physiotherapy appointment.
Maliban kung nag-ayos ka ng sarili mong physiotherapy, may nakatakda nang appointment para sa iyo at nakadetalye ito sa iyong discharge pack.
Kung mayroon kang anumang problema, makipag-ugnayan sa mga rooms o ipaalam ito sa iyong physiotherapist.

Pag-uwi ninyo sa bahay

Kapag nasa bahay na kayo, magpapatuloy ang inyong paggaling gamit ang buong rehabilitation protocol para sa inyong operasyon: capsular release; subacromial decompression.

Ang mga maagang ehersisyo sa loob ng ospital na ito ay hango sa mga nailathalang gabay para sa pasyente at mga rehabilitation protocol para sa mga pamamaraang ito, at ang mga saklaw ng linggo ay tipikal lamang at hindi permanente; gagabayan ng inyong physiotherapist ang inyong paggaling nang indibidwal base sa tugon ng inyong balikat. Ang ebidensya sa likod ng maagang yugtong ito (kung bakit ang prayoridad pagkatapos ng capsular release ay ang agarang paggalaw sa halip na ang pagprotekta sa balikat) ay nakabuod sa seksyon ng ebidensya, na available bilang PDF sa itaas ng pahinang ito.

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.

Topic scope: the early in-hospital phase of rehabilitation for patients who have just had an arthroscopic capsular release (for a stiff/frozen shoulder) and/or an arthroscopic subacromial decompression (acromioplasty). This page covers only the first day or two after surgery — getting the shoulder moving before the patient goes home. The full recovery course lives in the parent protocols: capsular release and subacromial decompression. Read those for the week-by-week plan, strengthening and return to work/sport.

Defining principle of this pathway (the inversion): unlike most shoulder operations — where a repair (cuff, labrum, instability) must be protected in a sling and range of motion is restricted to let the tissue heal — capsular release does the opposite. Nothing has been repaired, so there is no construct to protect. The shoulder was deliberately freed up in theatre, and the enemy now is re-stiffening. The in-hospital priority is therefore immediate, aggressive range of motion from day 0–1, usually with no protective sling (or a sling only for comfort, discarded quickly), to hold on to the range gained at surgery. A subacromial decompression is also a "make room / take pressure off" operation with no repair, so it follows the same early-movement logic. The single thing that changes this is if the surgeon also had to repair a rotator cuff tear at the same time — then the slower, protected cuff-repair pathway applies and the surgeon will say so.

The early in-hospital phase

The aim of the first day or two is simple: keep the shoulder moving and keep the patient comfortable enough to do so. In hospital, patients are started on gentle hand, wrist and elbow movements, pendulum (Codman) swings, and assisted elevation and external rotation — exactly the gentle exercises listed on the patient page. Adequate pain relief is the practical key, because a comfortable patient will move the arm, and a moving arm does not re-stiffen.

For capsular release in particular, surgeons commonly inject an intra-articular corticosteroid and perform a gentle controlled manipulation at the end of the operation to confirm the gained range and to damp down the post-operative inflammation that drives re-contracture [Smith 2017, PMC5137660]. The early motion exercises then begin straight away — often the same day or the first day after surgery.

Evidence by theme

Immediate-motion capsular-release protocols

Published arthroscopic capsular release (ACR) series describe starting motion immediately, not after a protected period. The largest cohort (Kanbe 2018, n = 255) commenced "passive, assisted-active and stooping (pendulum) exercises for forward flexion and external rotation 1 day after surgery," progressing to active strengthening at ~2 weeks and return to work by 4–6 weeks [Kanbe 2018]. Surgical-technique reviews echo this: active-assisted and passive range-of-motion exercises — pendulum/circumduction and pulley work — "can be started on the first postoperative day," and patients perceive the improvement in motion immediately, which reinforces their commitment to moving the arm [Essential Surgical Technique, PMC6221416]. Several ACR series pair the release with an intra-articular steroid + controlled manipulation at the index procedure to limit re-stiffening [Smith 2017, PMC5137660]. Evidence: large cohorts + expert/consensus.

Subacromial decompression — early motion, sling for comfort only

Arthroscopic subacromial decompression (acromioplasty) likewise has no repair to protect. Patient-guidance protocols start physiotherapy immediately after surgery, with a sling worn only 1–2 weeks for comfort and early active range of motion (forward elevation below shoulder height, gentle rotation) from the outset; strengthening follows at 4–6 weeks and unrestricted activity by 6–12 weeks [Boston Shoulder Institute SAD protocol; London Shoulder Partnership]. The important caveat, stated in every protocol, is that a concomitant rotator cuff repair (or biceps/SLAP repair) converts the recovery to the slower, protected pathway [PMC6145625].

Why immediate motion (and not protection)

A small number of patients develop stiffness after even simple arthroscopic shoulder procedures, which is the failure mode early movement is designed to prevent [Frozen shoulder after simple arthroscopic procedures, 10.1302/0301-620x.97b7.35387]. Conversely, the corpus also flags chondrolysis after shoulder arthroscopy as a rare but serious complication — a reminder that "aggressive" here means aggressive motion, on a comfortable, well-analgesed patient, not aggressive intra-articular intervention [10.1177/0363546503262176].

Phased timeline — early phase only

Phase	Window	Sling	ROM / use	Notes
0 — In hospital (this page)	Day 0–1	None, or comfort only — left off as much as possible, not worn to sleep	Gentle hand/wrist/elbow movement; pendulums; assisted forward flexion + external rotation begun day 1; HEP several times/day	Take painkillers before exercises and physio; ice for pain. Capsular release: intra-articular steroid ± gentle manipulation often given in theatre
1 — First weeks (see parent protocol)	Week 0–2+	Comfort only, discarded early	Continue assisted/active motion to hold the gained range; physio ≥ 2×/week early on	Full week-by-week plan, strengthening and return to function are in the capsular release and subacromial decompression protocols

Branch point — if a rotator cuff repair was also performed: the recovery converts to the protected rotator-cuff-repair pathway (sling ~6 weeks, restricted motion, delayed strengthening). The surgeon confirms which pathway applies before discharge — this is a surgeon-decided point, not a default.

Key controversies / evidence quality

The post-operative rehab protocol is consensus/expert, not RCT-derived. There is no high-level trial defining the optimal regimen after capsular release; published protocols are large cohorts and surgeon patient-guidance documents and vary in detail [Kanbe 2018; Willmore 2020 review]. What is consistent across them all is the immediate-motion, no-protective-sling principle.
Sling: comfort only vs none. Protocols differ on whether to use a comfort sling at all and for how long (days to ~2 weeks for decompression). All agree it must be left off as much as possible and is never a protective device here.
Steroid + manipulation at the index procedure. Common in ACR to limit re-stiffening, but the exact regimen (dose, whether to manipulate) is surgeon preference, not standardised by trial.

Evidence-strength flags

MODERATE (large cohorts): clinical outcomes of arthroscopic capsular release with day-1 motion (Kanbe 2018, n = 255); subacromial decompression outcomes.
WEAK / CONSENSUS: the early-phase rehab protocol itself — immediate motion, sling-for-comfort rules, intra-articular steroid + manipulation timing (surgeon patient-guidance and expert review; no defining rehab RCT).
Branch-point claim (cuff repair → protected pathway): STRONG rationale and uniformly stated across protocols.

Citations

RAG corpus (180,000+ Orthopaedic articles)

Arthroscopic capsular release for refractory shoulder stiffness: a critical analysis of effectiveness in specific etiologies. J Shoulder Elbow Surg. DOI: 10.1016/j.jse.2009.08.004
Arthroscopic release of postoperative capsular contracture of the shoulder. J Bone Joint Surg Am. 1997. DOI: 10.2106/00004623-199708000-00006
Arthroscopic release for chronic, refractory adhesive capsulitis of the shoulder. J Bone Joint Surg Am. 1996. DOI: 10.2106/00004623-199612000-00003
Clinical outcome of arthroscopic capsular release for frozen shoulder: essential technical points in 255 patients (Kanbe 2018; day-1 ROM, 4–6 wk return to work). J Orthop Surg Res. 2018. DOI: 10.1186/s13018-018-0758-5
Establishing the MCID and PASS thresholds following arthroscopic capsular release for idiopathic adhesive capsulitis. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.08.083
Frozen shoulder after simple arthroscopic shoulder procedures. Bone Joint J. 2015. DOI: 10.1302/0301-620x.97b7.35387
Glenohumeral chondrolysis after shoulder arthroscopy (rare serious complication; "aggressive" = motion, not intra-articular intervention). Am J Sports Med. 2004. DOI: 10.1177/0363546503262176
Effect of capsular release in the treatment of shoulder stiffness concomitant with rotator cuff repair. Am J Sports Med. 2014. DOI: 10.1177/0363546513519326

Literature & published protocols (URLs)

Kanbe K. Clinical outcome of arthroscopic capsular release for frozen shoulder (day-1 ROM protocol). PMC: https://pmc.ncbi.nlm.nih.gov/articles/PMC5857121/
Smith CD et al. Arthroscopic capsular release for idiopathic frozen shoulder with intra-articular injection and controlled manipulation. PMC5137660: https://pmc.ncbi.nlm.nih.gov/articles/PMC5137660/
Essential surgical technique for arthroscopic capsular release (active-assisted/passive ROM from first post-op day). PMC6221416: https://pmc.ncbi.nlm.nih.gov/articles/PMC6221416/
Arthroscopic subacromial decompression and acromioplasty — rehabilitation and concomitant-repair caveat. PMC6145625: https://pmc.ncbi.nlm.nih.gov/articles/PMC6145625/
Boston Shoulder Institute — Post-operative arthroscopic subacromial decompression protocol (sling 1–2 wk for comfort, immediate physio): https://bostonshoulderinstitute.com/wp-content/uploads/2014/07/Shoulder-Subacromial-Decompression-protocol2.pdf
The London Shoulder Partnership — Subacromial decompression (acromioplasty): http://thelondonshoulderpartnership.co.uk/shoulder/shoulder-surgery/subacromial-decompression-acromioplasty/
J Paget NHS — Patient information: arthroscopic capsular release following a frozen shoulder (sling for comfort, early movement): https://www.jpaget.nhs.uk/media/efmf3bab/arthroscopic-capsular-release-following-a-frozen-shoulder.pdf