Phase I: Protection and Immobilisation (Weeks 0–4)

Immobilisation:

• Standard sling to be worn at all times (including sleep) for 6 weeks.

• Removed only for hygiene and exercises.

Precautions:

• No shoulder flexion beyond 90°.

• No horizontal adduction across midline.

• No lifting, pushing, pulling, or weight-bearing.

• Avoid any movement that may provoke pain or discomfort in the AC joint area.

Therapy:

• Passive ROM for shoulder flexion (up to 90°) and abduction (up to 45°).

• Elbow, wrist, and hand active ROM exercises.

• Scapular retraction and stabilisation exercises.

• Rest, ice, compress and elevate (RICE) for pain and inflammation.

Criteria to Progress:

• Pain well-controlled and stable.

• Passive ROM to 90° flexion and 45° abduction without signs of discomfort.

• No increased symptoms in the AC joint.

Phase II: Early Motion and Muscle Activation (Weeks 4–8)

Immobilisation:

• Discontinue sling use by Week 6.

Precautions:

• No active horizontal adduction or internal rotation beyond neutral.

• External rotation to be limited to 30° until Week 8.

• Avoid overhead or lifting activities.

Therapy:

• Begin active-assisted ROM for flexion, abduction, and external rotation (limited to 30°).

• Isometric strengthening for rotator cuff and deltoid muscles.

• Scapular exercises for improved stability.

• Postural control exercises and stretching for posterior capsule.

Criteria to Progress:

• Active ROM to 120° in flexion without pain.

• External rotation to 30° or more without symptoms.

• Stable shoulder with minimal discomfort.

Phase III: Strengthening and Functional Movement (Weeks 8–12)

Precautions:

• No resisted horizontal adduction or excessive internal rotation.

• Avoid high-impact activities or overhead lifting.

• Progress slowly with resistance training.

Therapy:

• Full active ROM achieved.

• Begin strengthening exercises for the rotator cuff and scapular stabilisers using bands or light weights.

• Proprioception training with closed-chain exercises.

• Continue with functional movement drills and controlled strengthening exercises.

• Introduce functional tasks with gradual overhead and reaching activities.

Criteria to Progress:

• Full active ROM without pain or stiffness.

• Stable shoulder function with dynamic movement patterns.

• No signs of instability or discomfort during functional tasks.

Phase IV: Return to Sport and Full Activity (Months 3–6)

Precautions:

• Avoid contact or collision activities until cleared.

Therapy:

• High-level strengthening exercises with progressive load.

• Advanced proprioception and dynamic stability drills.

• Plyometric training, sport-specific exercises, and neuromuscular control drills.

• Preparation for sport-specific functional tasks and drills.

Discharge Criteria:

• Full and pain-free ROM and strength.

• Pain-free shoulder function during daily activities and sports.

• Surgeon's clearance for return to unrestricted activity.

General Recommendations

Work:

• Office/desk work may resume after 2–4 weeks if pain is well controlled

• Manual labour should be deferred until 3–6 months 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 (below shoulder height) from 8–12 weeks.

• Progressive return to gym and functional activities from 3–4 months.

• Overhead and higher-demand activities from 4–6 months as strength allows.

• Contact sport typically from 6 months or longer with full recovery.

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.