Phase I: Immediate Mobilisation (0–2 Weeks)

Immobilisation:

• Sling for comfort only; discontinue as soon as possible.

Precautions:

• Avoid prolonged immobilisation.

• Pain should guide activity levels.

Therapy:

• Immediate passive and active-assisted shoulder ROM in all planes.

• Frequent stretching exercises focusing on flexion, abduction, and rotation.

• Pendulum exercises.

• Scapular setting and postural exercises.

• Pain management including ice and appropriate analgesia.

Criteria to Progress:

• Tolerating frequent ROM exercises.

• Pain controlled sufficiently to allow active participation in therapy.

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

Precautions:

• Avoid excessive pain flare-ups following therapy.

• Avoid sudden or jerking movements.

Therapy:

• Progress to active shoulder ROM in all planes.

• Continued capsular stretching, including end-range mobilisation as tolerated.

• Initiate gentle isometric strengthening of rotator cuff and scapular muscles.

• Continue postural and scapular control exercises.

Criteria to Progress:

• Improving active ROM in all planes.

• Pain manageable during and after exercises.

Phase III: Strengthening Phase (6–12 Weeks)

Precautions:

• Avoid overloading the shoulder in the presence of persistent inflammation.

Therapy:

• Progressive strengthening of rotator cuff and scapular stabilisers.

• Continue aggressive but controlled stretching to maintain gains in motion.

• Functional strengthening below and above shoulder height as tolerated.

Criteria to Progress:

• Near full shoulder ROM.

• Strength improving without symptom exacerbation.

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

Precautions:

• Monitor for recurrent stiffness.

Therapy:

• Advanced strengthening and endurance training.

• Functional and work-specific exercises.

• Continued home stretching program to prevent recurrence.

Criteria to Discharge:

• Functional shoulder ROM achieved and maintained.

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

• Able to self-manage with a home exercise program.

• 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 6–12 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.