Phase I: Protection and Early Recovery (0–2 Weeks)

Immobilisation:

• Sling for comfort for 2 weeks

• Sling removed for hygiene and prescribed exercises

Precautions:

• No lifting, carrying, pushing, pulling, or weight bearing through the operated upper limb

• Avoid forceful shoulder or elbow motion

• Avoid resisted elbow extension

• Avoid supporting body weight through the arm

Therapy:

• Oedema management and postural education

• Active wrist and hand range of motion

• Active elbow flexion and extension

• Gentle active-assisted shoulder range of motion

Criteria to Progress:

• Wound healed

• Pain controlled

• Minimal swelling

• Comfortable shoulder and elbow motion

Phase II: Restore Motion (2–6 Weeks)

Immobilisation:

• Wean from sling as comfort allows

Precautions:

• No lifting greater than approximately 1–2 kg

• Avoid repetitive overhead loading

• Avoid forceful rotational or pushing activities

• Avoid impact activities

Therapy:

• Progress active and active-assisted shoulder range of motion

• Restore elbow range of motion

• Commence forearm pronation and supination

• Scapular control exercises

Criteria to Progress:

• Functional shoulder ROM

• Functional elbow ROM

• Minimal pain with movement

• Tolerating light upper limb use

Phase III: Strength and Functional Recovery (6–12 Weeks)

Precautions:

• Gradually increase loading following evidence of fracture healing

• Avoid heavy lifting initially

• Avoid repetitive overhead or loaded elbow activities

Therapy:

• Restore full shoulder and elbow ROM

• Commence rotator cuff and shoulder girdle strengthening

• Progressive elbow strengthening

• Functional upper limb strengthening

Criteria to Progress:

• Clinical and radiographic progression toward union

• Functional ROM restored

• Improved strength

• Minimal pain with strengthening

Phase IV: Return to Function and Endurance (3–6 Months)

Precautions:

• Gradual return to unrestricted activity

• Avoid abrupt progression into heavy loading

Therapy:

• Progressive strengthening

• Functional rehabilitation

• Occupation-specific rehabilitation

• Sport-specific rehabilitation as required

Criteria to Progress:

• Radiographic union achieved

• Near full shoulder and elbow ROM

• Functional strength restored

• Return to unrestricted activity

General Recommendations

Work:

• Office and sedentary work may resume after approximately 2–4 weeks depending on comfort

• Manual labour is commonly delayed until approximately 3–6 months depending on fracture healing and occupational demands

Driving:

• It is important that you are medically fit to return to driving and liaise with your insurance provider to confirm liability requirements.

• Driving should only resume once you are no longer requiring a sling and can safely control the vehicle and perform emergency manoeuvres.

Sports and Leisure:

• Lower-limb activities may resume as comfort allows.

• Light use of the operated upper limb may commence from approximately 6–8 weeks.

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

• Contact sport, overhead sport, racquet sports, or impact activities typically from 4–6 months or longer with full recovery and 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.