Recovery after manipulation under anesthesia or an arthroscopic capsular release for frozen shoulder (adhesive capsulitis) usually starts with movement straight away, not rest. The first two weeks matter most, because movement gained during the procedure can tighten again if it is not used. Pain often settles over about 6 to 12 weeks, and most people keep gaining movement for 3 to 6 months.
Your surgeon’s protocol comes first. Some surgeons use a sling only for comfort for a day or two, some none at all, and physical therapy plans vary.
The two procedures work in different ways. In manipulation under anesthesia, the surgeon moves your arm firmly while you are asleep to stretch and tear the thickened, tight joint lining (capsule). In an arthroscopic capsular release, the surgeon cuts the tight parts of the capsule through small keyhole incisions. The two are often done together. Both aim to give back movement the shoulder has lost.
Key takeaways
- Movement starts early: exercises usually begin the same day or the day after.
- First two weeks: this is when movement gained during the procedure is most easily lost.
- Pain: often settles over about 6 to 12 weeks.
- Movement: often keeps improving for 3 to 6 months.
- Diabetes: people with diabetes may gain movement more slowly and have a higher chance of stiffness returning.
Where are you right now?
- The first 2 weeks: read days 0 to 14 and “Is this normal?”. Movement, several times a day, is the main job.
- Weeks 2 to 6: read weeks 2 to 6. Keeping the range and starting light strength.
- 6 to 12 weeks: read weeks 6 to 12 and “If it isn’t going to plan”.
- 3 months on: read months 3 to 6 and the “When can I” table.
Week by week, then month by month
- Days 0 to 3: the arm may be numb for some hours from a nerve block. Exercises often start once feeling returns. Many surgeons want you to move the arm through the range they achieved, with help from the other arm, a stick or a table, several times a day.
- Days 4 to 14: physical therapy is often frequent, sometimes several sessions a week. Home exercises usually run several times a day, in short sets. The aim is to keep the range open while the inside of the joint heals. Pain medicine taken before exercise, as your team advises, helps many people do the work.
- Weeks 2 to 6: range is kept and built. Light strengthening for the rotator cuff and shoulder blade muscles often starts. Night pain usually begins to ease.
- Weeks 6 to 12: strength builds and everyday reaching gets easier. Turning the arm out and reaching behind the back usually improve last.
- Months 3 to 6: movement and strength keep improving more slowly. Many people regain most of their movement, though some stiffness at the end of range is common.
Is this normal?
- Pain with the exercises: expected in the first two weeks. Pain that eases within an hour or two of exercising is usually acceptable. Pain that keeps rising day after day is worth reporting.
- Night pain: common for some weeks, often less than before the procedure. Sleeping propped up with a pillow under the arm helps many people.
- Swelling and bruising: bruising on the upper arm is common, especially after manipulation, and usually fades over two to three weeks.
- Stiffness each morning: common. It usually loosens after the first set of exercises.
- Clicking: painless clicking is common and not usually a concern.
- Numbness near the scars: small patches of numb skin around keyhole incisions are common and often shrink over months.
- Low mood: many people have lived with frozen shoulder for months before surgery. Feeling flat or impatient during recovery is common. Tell your doctor if it lasts.
The procedure opens the range; the next two weeks decide how much of it you keep.
If it isn’t going to plan
It is day nine. The exercises hurt, you are tired, and reaching for the seatbelt with that arm still catches. You skipped yesterday’s afternoon set, and the thought in your head is that the shoulder needs a few days of rest to calm down before you push on.
For most shoulder problems, a few quiet days are reasonable. After a release or manipulation, the inside of the joint is healing, and healing tissue tends to shorten. The range gained during the procedure is kept by using it, often and gently, through these weeks. A few days off can let some of it tighten again.
Get assessed by your surgeon or physical therapist if stiffness stops improving or is getting worse in the first few weeks, if pain is rising rather than settling after week 6, or if the arm is weak in ways that are not improving. Useful questions to ask:
- Range: what range did you achieve during the procedure, and what should I be reaching now?
- Pain: can we adjust my pain medicine so I can do the exercises?
- Dose: how many times a day, and how far into the stretch?
- Next steps: at what point would you consider an injection or a repeat procedure?
When can I…
| Activity | Typical range |
|---|---|
| Shower | Usually within a day or two, keeping any dressings as your surgeon advises |
| Sleep in bed | Usually from the first night, propped on pillows if that is more comfortable |
| Drive | Often 1 to 3 weeks, once you can control the car safely and are off medicine that causes drowsiness |
| Desk work | Often within 1 to 2 weeks, with time set aside for exercises |
| Lift | Light loads from about 2 to 4 weeks; heavier lifting often 6 to 12 weeks |
| Reach overhead | Encouraged early as part of the exercises; comfortable overhead use often 6 to 12 weeks |
| Manual work or sport | Often 6 to 12 weeks, sometimes longer for heavy or overhead work |
Your surgeon’s protocol comes first.
Call your local emergency number or go to the emergency department if
- Breathing or chest: you have sudden breathlessness or chest pain.
- Sudden change in the arm: the upper arm suddenly becomes very painful, swollen or out of shape, or you cannot move it at all.
- Hand circulation: the hand turns cold, pale or blue.
See a doctor today if
- Wound changes: a keyhole wound is red, hot, leaking or opening.
- Fever: you have a temperature of 100.4°F (38°C) or higher, or chills, or feel unwell.
- Calf swelling: one calf is swollen, warm or painful.
- Spreading numbness or weakness: numbness or weakness in the arm or hand that is spreading, or still present well after a nerve block should have worn off.
- Uncontrolled pain: pain stops you doing any of your exercises despite the medicine you were given.
Get it checked soon if
- Losing range: movement is getting less week to week despite the exercises.
- New weakness: you cannot lift the arm against gravity when you could after the procedure.
- Blood sugar: if you have diabetes, your readings stay higher than usual for more than a few days.
- Rising pain: pain is getting worse after week 6 rather than easing.
More on this area: surgery recovery guides.
After a frozen shoulder release, the movement you use is the movement you keep.
Written by Louise Yow, Neck & Shoulder Physio.