Phase I: Protection and Early Motion (0–6 Weeks)

Immobilisation:

• Sling worn continuously for comfort and protection, removed only for therapy and hygiene.

Precautions:

• Protect subscapularis repair.

• Avoid active internal rotation.

• Avoid external rotation beyond neutral.

• Avoid lifting, pushing, pulling, or weight bearing through the operated arm.

Therapy:

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

• Passive and active-assisted shoulder flexion and abduction within comfort.

• Gentle pendulum exercises.

• Scapular setting and postural exercises.

Criteria to Progress:

• Pain controlled.

• Wound healing satisfactory.

• Tolerating protected shoulder motion without increased symptoms.

Phase II: Controlled Motion Phase (6–12 Weeks)

Immobilisation:

• Sling weaned and discontinued as tolerated.

Precautions:

• Avoid resisted internal rotation.

• Gradually increase external rotation within comfort.

• Avoid lifting heavier than light household items.

Therapy:

• Progress passive and active-assisted shoulder range of motion in all planes.

• Begin active shoulder motion within comfort.

• Gentle isometric strengthening of rotator cuff (excluding internal rotation).

• Continue scapular stabilisation exercises.

Criteria to Progress:

• Improving shoulder range of motion.

• Minimal pain with daily activities.

Phase III: Strengthening Phase (12–16 Weeks)

Precautions:

• Avoid forceful internal rotation early in this phase.

• Avoid heavy lifting.

Therapy:

• Initiate light resisted internal rotation exercises.

• Progressive strengthening of rotator cuff and scapular stabilisers.

• Functional strengthening below and gradually above shoulder height.

Criteria to Progress:

• Near full, pain-free shoulder range of motion.

• Improving strength without pain.

Phase IV: Advanced Strengthening & Functional Return (4–6 Months)

Precautions:

• Avoid heavy lifting and repetitive overhead loading.

Therapy:

• Advanced strengthening and endurance training.

• Gradual return to functional and recreational activities.

Criteria to Discharge:

• Full or near-full shoulder range of motion.

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

• No pain or instability.

• Cleared by treating surgeon.

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:

• Gentle lower-limb and non–shoulder loading activities (e.g. walking, stationary cycling) may resume as comfort allows.

• Light recreational activities involving the shoulder (e.g. swimming, golf, light gym work) may resume from approximately 8–12 weeks, depending on strength and control.

• Higher-demand activities, heavy lifting, and repetitive overhead use should be approached with caution and only resumed after discussion with the treating surgeon.

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.