Phase I: Early Mobilisation (0–2 Weeks)

Immobilisation:

• Sling for comfort only; discontinue as tolerated.

Precautions:

• Avoid heavy lifting or sudden movements.

• Pain should guide activity levels.

Therapy:

• Immediate active and passive shoulder range of motion as tolerated.

• Pendulum exercises.

• Scapular setting and postural exercises.

• Hand, wrist, and elbow range of motion exercises.

Criteria to Progress:

• Pain controlled.

• Tolerating shoulder motion without symptom flare.

Phase II: Functional Motion Phase (2–6 Weeks)

Precautions:

• Avoid repetitive heavy lifting.

• Avoid activities that reproduce AC joint pain.

Therapy:

• Progress to full active shoulder range of motion.

• Begin gentle strengthening of rotator cuff and scapular stabilisers.

• Postural and scapular control exercises.

Criteria to Progress:

• Full or near-full range of motion.

• Minimal pain with daily activities.

Phase III: Strengthening Phase (6–12 Weeks)

Precautions:

• Avoid heavy lifting early in this phase.

Therapy:

• Progressive strengthening of shoulder and scapular musculature.

• Functional strengthening including overhead activities as tolerated.

Criteria to Progress:

• Strength improving without pain.

• Able to perform functional tasks comfortably.

Phase IV: Advanced Strengthening & Functional Return (3–6 Months)

Precautions:

• Avoid high-impact or contact activities.

Therapy:

• Advanced strengthening and endurance training.

• Sport- and work-specific exercises.

Criteria to Discharge:

• Full, pain-free shoulder range of motion.

• Strength sufficient for work, sport, and daily activities.

• No AC joint pain with functional or overhead tasks.

• Cleared by treating surgeon or therapist.

General Recommendations

Work:

• Office/desk work may resume after 1–2 weeks if pain is well controlled

• Manual labour should be deferred until 4–6 weeks depending on job demands

Driving:

• It is important that you are medically fit to return to driving and you feel safe to control the vehicle and take evasive action if needed.

Sports and Leisure:

• Lower-limb activities may resume as comfort allows.

• Light shoulder activities from 4–6 weeks.

• Progressive return to gym and functional activities from 6–8 weeks.

• Overhead and higher-demand activities from 8–12 weeks as tolerated.

Disclaimer: This protocol is intended as a general rehabilitation guide only. Rehabilitation progression should always be individualised and may be modified by A/Prof Ernstbrunner and the treating rehabilitation team based on the patient’s clinical progress, surgical findings, and individual circumstances.