Phase I: Protection and Early Mobilisation (Weeks 0–4)

Immobilisation:

• Worn full-time, including during sleep, for 6 weeks.

• Removed only for hygiene and exercises.

Precautions:

• No external rotation beyond neutral.

• No abduction or extension past neutral.

• No lifting, pushing, pulling, or weight-bearing with the operative arm.

• Avoid combined abduction and external rotation.

• Maintain mobility of elbow, wrist, and hand.

Therapy:

• Passive shoulder flexion to 90° and abduction to 45° as tolerated.

• Pendulum exercises (small circles only).

• Elbow, wrist, and hand active ROM.

• Scapular stabilisation and postural training.

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

Criteria to Progress:

• Minimal pain at rest and during passive motion.

• Passive forward flexion to 90°.

• No signs of instability.

• Compliance with sling use and precautions.

Phase II: Active-Assisted ROM and Muscle Activation (Weeks 4–8)

Immobilisation:

• Discontinue sling use by Week 6.

Precautions:

• External rotation limited to 30° in 0° abduction.

• Avoid internal rotation behind the back.

• No resisted biceps activity.

• No overhead lifting or pushing.

Therapy:

• Begin active-assisted ROM in all planes.

• Gentle active ROM as tolerated.

• Initiate isometric exercises (excluding internal rotation).

• Scapular re-education and rhythmic stabilisation.

Criteria to Progress:

• Active forward flexion to ≥120°.

• ER to at least 30° with no pain or apprehension.

• Restoration of scapulothoracic control.

• No subjective instability with daily activities.

Phase III: Full Active ROM and Strengthening (Weeks 8–12)

Precautions:

• Avoid end-range ER in abduction.

• Avoid forceful or ballistic shoulder activity.

• No heavy lifting or sports-specific movements yet.

Therapy:

• Progress to full active ROM.

• Resistance band or light dumbbell strengthening (rotator cuff, deltoid, scapular stabilisers).

• Closed-chain proprioceptive drills (wall slides, ball stabilisation).

• Neuromuscular control exercises.

Criteria to Progress:

• Full pain-free ROM.

• Stable shoulder with mid-range activity.

• Symmetrical scapular mechanics.

Phase IV: Advanced Strengthening and Return to Activity (Months 3–6)

Precautions:

• No overhead sports or contact activities until cleared.

Therapy:

• Advanced resistance training.

• Sport- or work-specific functional drills.

• Plyometrics if applicable (e.g. two-handed wall throws).

• Endurance and overhead stability exercises.

Discharge Criteria:

• Symmetric ROM and strength.

• Pain-free functional use.

• Negative apprehension and relocation tests.

• Surgeon and physiotherapy clearance for full return.

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 and non–shoulder loading activities may resume as comfort allows.

• Light recreational activities involving the shoulder (below shoulder height) may resume from approximately 8–12 weeks, depending on strength and control.

• Running may commence from approximately 8–12 weeks if comfortable.

• Non-contact sports and progressive return to functional shoulder use are typically allowed from 3–4 months.

• Contact sports, collision sports, and overhead or high-demand activities are usually delayed until 5–6 months or longer with surgeon clearance.

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.