U W H E A LT H S P O R T S R E H A B I L I T A T I O N

Rehabilitation Guidelines for

Arthroscopic Capsular Shift
The anatomic configuration of the Back View Front View
shoulder joint (glenohumeral joint) Supraspinatus
is often compared to a golf ball on
a tee. This is because the articular Infraspinatus
surface of the round humeral
head is approximately four times
Teres
greater than that of the relatively Minor Subscapularis
flat shoulder blade face (glenoid
fossa). The stability and movement
of the shoulder is controlled by
the rotator cuff muscles, ligaments,
and the capsulolabral complex
of the shoulder (Figure 1). The Figure 1Rotator cuff anatomy
labrum is a fibrocartilagenous ring, Image property of Primal Pictures, Ltd., primalpictures.com. Use of this image without authorization from Primal Pictures, Ltd. is prohibited.

which attaches to the bony rim

Shoulder dislocations often lead to For some athlete’s multi-
of the glenoid fossa. The labrum
recurrent dislocation or subluxation directional instability can be treated
doubles the depth of the glenoid
and posterior shoulder instability nonoperatively with rehabilitation.
fossa to help provide stability. An
occurs when the humeral head This often involves strengthening
analogy includes a parked car on
subluxes or dislocates in relationship the rotator cuff and scapular
a hillside with a chop block under
to the glenoid. Shoulder instability muscles, as well as improving the
the tire such that the round tire is
may involve the front of the body’s neuromuscular reaction
the humeral head, the road is the
shoulder and then is referred to as to sudden changes of position or
glenoid fossa and the chop block is
anterior instability. When it occurs in movement. When these approaches
the labrum.
the back of the shoulder it is referred are unsuccessful and instability
The anatomy of the shoulder allows to as posterior instability and when continues, the athlete may be
for great mobility, yet this anatomical it occurs toward the bottom of the left with the option of changing
structure also sacrifices stability. shoulder it is referred to as inferior sports or having surgery. Surgical
The shoulder is one of the most instability. correction for multi-directional
commonly dislocated joints in the instability consists of tightening the
Complete shoulder dislocations or
body. Shoulder dislocations can capsule and ligamentous tissue by
subluxations (also termed as a partial
occur from trauma, such as falling reducing the “looseness” or size of
dislocation of the joint) can also be
on an outstretched hand. When the capsule. This is usually done by
caused by “hyperlaxity” (genetic or
this happens it is common for the taking “tucks” in the capsule with
acquired looseness of the shoulder
capsule and ligaments to be torn, suture material.
capsule and ligaments). Hyperlaxity
which often includes a large tear
often affects the shoulder in more After surgery, rehabilitation plays
of the glenoid labrum. The type of
than one direction, which is referred a crucial role in maximizing the
labral tears in which a large piece of
to as multi-directional instability. This patient’s functional outcome. In
the labrum loses its connection to
often occurs without a true Bankart the early phases after surgery it is
the glenoid fossa are called Bankart
lesion. necessary to protect the surgical
lesions.
repair to allow healing. This is done

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 Rehabilitation Guidelines for Arthroscopic Capsular Shift

by only allowing the patient to move guidelines are presented in a criterion and injury severity. Specific time
the shoulder through certain ranges based progression. General time frames, restrictions and precautions
of motion and wear a sling most frames are given for reference to the may also be given to protect healing
of the time that they are not doing average, but individual patients will tissues and the surgical repair/
rehabilitation exercises. The range progress at different rates depending reconstruction.
of motion restrictions can be seen on their age, associated injuries, pre-
in Phase I below. The rehabilitation injury health status, rehab compliance

PHASE I (surgery to 6 weeks after surgery)

Appointments •  Rehabilitation appointments begin 7-14 days after surgery and occur
1-2 times per week

Rehabilitation Goals •  Protection of the post-surgical shoulder

•  Activation of the stabilizing muscles of the gleno-humeral and scapulo-thoracic
joints

Precautions •  Sling immobilization required for soft tissue healing for 6 weeks post-operatively.
Remove sling during post-operative week 6 in safe environments and wean totally
during post-operative week 7  
•  Hypersensitivity in axillary nerve distribution is a common occurrence
Range of Motion (ROM) guidelines
•  ROM should progress gradually to avoid stretching out the repaired tissues
•  No shoulder internal rotation (IR) past neutral for post-operative weeks 1-6 and no
shoulder internal rotation with abduction for post-operative weeks 1-8 to protect
repaired tissues
•  Week 1: No shoulder ROM; continuous use of sling except for elbow and wrist
active ROM; neck active ROM and ball squeeze  
•  Weeks 2 and 3: Shoulder flexion and abduction to 90° with shoulder external
rotation (ER) in neutral to 10°
•  Weeks 4 and 5: Shoulder flexion and abduction to 140° with shoulder ER in neutral
to 30°
•  Week 6: Shoulder flexion and abduction to 180° with shoulder ER in neutral to 50°
•  No shoulder ER with abduction for 6 weeks to protect repaired tissues

Suggested Therapeutic Exercise •  Begin at 10 days post-operatively: sub-maximal, pain free shoulder isometrics
at patient’s side for shoulder IR and ER, flexion and extension and abduction and
adduction
•  Passive ROM and active assistive ROM for shoulder flexion and extension, as well
as abduction and adduction with progression to active ROM at week 6
•  Hand gripping
•  Elbow, forearm and wrist active ROM
•  Cervical spine and scapular active ROM
•  Desensitization techniques for axillary nerve distribution  
•  Postural exercises

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 Rehabilitation Guidelines for Arthroscopic Capsular Shift

Cardiovascular Exercise •  Walking, stationary bike - sling on

•  Avoid running and jumping due to the distractive forces that can occur at landing
•  No treadmill

Progression Criteria •  Full active ROM for shoulder flexion and abduction
•  Normal (5/5) shoulder IR and ER strength at 0° abduction
•  Negative apprehension and impingement signs

PHASE II (begin after meeting Phase I criteria, usually 6 weeks after surgery)

Appointments •  Rehabilitation appointments occur once every 1-2 weeks

Rehabilitation Goals •  Full shoulder active ROM in all cardinal planes except ER in abducted positions –
this should stay limited to ~60° of shoulder abduction
•  Progress shoulder external rotation ROM in abduction to 60° gradually to prevent
overstressing the repaired anterior tissues of the shoulder
•  At 8 weeks post-operatively, begin normalizing shoulder IR to other side,
gradually and with appropriate end feel; keep in mind that if the initial problem
was posterior instability, regaining shoulder IR should be done gradually with an
emphasis on active ROM and with appropriate joint position and stability
•  Strengthen shoulder and scapular stabilizers in protected position
(0-45° abduction)
•  Begin proprioceptive and dynamic neuromuscular control retraining

Precautions •  Avoid passive and forceful movements into shoulder ER, extension and horizontal
abduction

Suggested Therapeutic Exercise •  Active assistive and active ROM in all cardinal planes while assessing scapular
rhythm
•  Rotator cuff strengthening in non-provocative positions with the shoulder in 0-45°
abduction
•  Scapular strengthening and dynamic neuromuscular control
•  Cervical spine and scapular active ROM
•  Postural exercises
•  Core strengthening

Cardiovascular Exercise •  Walking, stationary bike, Stairmaster are ok

•  No swimming or treadmill
•  Avoid running and jumping until the athlete has full rotator cuff strength in a
neutral position due to the distractive forces that can occur at landing

Progression Criteria •  Full active ROM in all cardinal planes except shoulder ER in abducted positions –
this should stay limited to ~60° shoulder abduction
•  Negative shoulder apprehension and impingement signs
•  Normal (5/5) shoulder IR and ER strength at 45° shoulder abduction

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 Rehabilitation Guidelines for Arthroscopic Capsular Shift

PHASE III (begin after meeting Phase II criteria, usually 12 weeks after surgery)

Appointments •  Rehabilitation appointments occur once every 2-3 weeks

Rehabilitation Goals •  Full active ROM in all cardinal planes with normal scapulo-humeral movement
•  Normal (5/5) rotator cuff strength at 90° shoulder abduction in the scapular plane
•  Normal (5/5) peri-scapular strength

Precautions •  All exercises and activities to remain non-provocative with low to medium velocity
•  Avoid activities where there is a higher risk for falling or outside forces to be
applied to the arm
•  No swimming, throwing or sports

Suggested Therapeutic Exercise Motion

•  Gradually progress shoulder ER ROM with shoulder abduction to 90°, focusing
primarily on active motion
Strength and Stabilization
•  Shoulder flexion in prone; shoulder horizontal abduction in prone; full can exercise
and D1 and D2 diagonals in standing
•  Resistive tubing, cable column and dumbbell exercise with light resistance and
high repetitions with shoulder IR and ER in 90° shoulder abduction; rowing is ok
too
•  Balance board in push-up position (with RS); prone Swiss ball walk-outs; rapid
alternating movements in supine D2 diagonal and closed kinetic chain stabilization
with narrow base of support

Cardiovascular Exercise •  Walking, biking, StairMaster and running are ok if the patient has met Phase II
criteria
•  No swimming

Progression Criteria •  Patient may progress to Phase IV if they have met the above stated goals and have
no shoulder apprehension or impingement signs

PHASE IV (begin after meeting Phase III criteria, usually 15 weeks after surgery)

Appointments •  Rehabilitation appointments occur once every 2-4 weeks

Rehabilitation Goals •  Patient to demonstrate shoulder stability with higher velocity movements and
change of direction movements
•  Normal (5/5) rotator cuff strength with multiple repetition testing at 90° shoulder
abduction in the scapular plane
•  Full multi-plane active ROM

Precautions •  Progress gradually into provocative exercises by beginning with low velocity and
known movement patterns

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 Rehabilitation Guidelines for Arthroscopic Capsular Shift

Suggested Therapeutic Exercise Motion

•  Active ROM exercises to regain full functional shoulder ROM
Strength and Stabilization
•  Dumbbell and medicine ball exercises that incorporate trunk rotation and control
with rotator cuff strengthening at 90° shoulder abduction; begin working towards
more functional activities by emphasizing core and hip strength and control with
shoulder exercises
•  Resistive tubing, cable column, and dumbbell exercises with shoulder IR and ER in
90° shoulder abduction; rowing is ok too  
•  Higher velocity strengthening and control, such as inertial, plyometrics and rapid
resistive tubing drills; plyometrics should start with 2 hands below shoulder height
and progress to overhead, then back to below shoulder with one hand, progressing
again to overhead

Cardiovascular Exercise •  Walking, biking, StairMaster and running are ok if the patient has met Phase II
criteria
•  No swimming

Progression Criteria •  Patient may progress to Phase V if they have met the above stated goals and have
no shoulder apprehension or impingement signs

PHASE V (begin after meeting Phase IV criteria, usually 20 weeks after surgery)

Appointments •  Rehabilitation appointments occur once every 2-4 weeks

Rehabilitation Goals •  Patient to demonstrate shoulder stability with higher velocity movements and
change of direction movements that replicate sport specific patterns, including
swimming, throwing, etc.
•  No shoulder apprehension or instability with high velocity overhead movements
•  Improve core and hip strength and mobility to eliminate any compensatory
stresses to the shoulder
•  Work capacity cardiovascular endurance for specific work/sport demands

Precautions •  Progress gradually into sport specific movement patterns

Suggested Therapeutic Exercise Motion

•  Assess the whole upper quarter to assess for muscle imbalances that could lead to
compensatory or abnormal motion at the shoulder
Strength and Stabilization
•  Dumbbell and medicine ball exercises that incorporate trunk rotation and control
with rotator cuff strengthening at 90° shoulder abduction and higher velocities;
begin working towards more sport specific activities
•  Initiate throwing, swimming or overhead racquet program depending on the
athlete’s sport
•  High velocity strengthening and dynamic control, such as inertial, plyometrics and
rapid resistive tubing drills

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 Rehabilitation Guidelines for Arthroscopic Capsular Shift

Cardiovascular Exercise •  Design to use sport specific energy systems

Progression Criteria •  Patient may return to sport after receiving clearance from the Orthopedic Surgeon
and Rehabilitation Therapist

These rehabilitation guidelines were developed collaboratively by UW Health Sports Rehabilitation and the
UW Health Sports Medicine Physician group.
Updated 2/2018

REFERENCES
1. Bell JE. Arthroscopic management of 2. Bigliani LU, Kurzweil PR, Schwartzbach 3. Duncan R, Savoie FH 3rd. Arthroscopic
multidirectional instability. Orthop Clin CC, Wolfe IN, Flatow EL. Inferior capsular inferior capsular shift for multidirectional
North Am. 2010 Jul;41(3):357-65. shift procedure for anterior-inferior instability of the shoulder: a preliminary
shoulder instability in athletes. Am J report. Arthroscopy. 1993;9(1):24-7.
Sports Med. 1994 Sep-Oct;22(5):578-84.

At UW Health, patients may have advanced diagnostic and /or treatment options, or may receive educational materials that vary from this information. Please be aware that this information is not intended to replace
the care or advice given by your physician or health care provider. It is neither intended nor implied to be a substitute for professional advice. Call your health provider immediately if you think you may have a medical
emergency. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any question you may have regarding a medical condition.

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