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

Immobilisation:

• Sling to be worn at all times for 6 weeks (including sleeping).

• Removed only for hygiene and guided physiotherapy sessions.

Precautions:

• Strictly no active shoulder motion.

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

• Avoid positions that stretch the repair.

• No reaching behind the back or across the midline.

Therapy:

• Immediate initiation of wrist, hand, and elbow active ROM.

• Passive shoulder forward flexion to 60–90°, within pain-free range.

• Gentle pendulum exercises (avoid shoulder muscle activation).

• Initiate scapular setting and postural awareness early.

Criteria to Progress:

• Surgical site well healed with no signs of inflammation.

• Passive motion progressing safely within target ranges.

• Patient demonstrates good Immobilisation compliance and pain control.

Phase II: Assisted Mobility and Early Muscle Recruitment (Weeks 6–10)

Immobilisation:

• Begin gradual weaning after Week 6 under physiotherapy guidance.

• Discontinue sling completely by Week 8–10.

Precautions:

• No lifting heavier than cup of tea (<500 g).

• Avoid combined internal rotation and extension.

• Limit active elevation to below shoulder height initially.

• No resisted shoulder exercises.

Therapy:

• Begin active-assisted ROM (pulleys, wand exercises).

• Gradually progress to active motion as tolerated, avoiding compensatory patterns.

• Introduce gentle submaximal isometrics for deltoid, rotator cuff, and scapular stabilizers.

• Continue passive ROM to prevent stiffness.

Criteria to Progress:

• Active ROM initiated with minimal pain and proper control.

• No substitution or shrugging patterns with elevation.

• Passive range approaching full motion within comfort.

Phase III: Strengthening and Functional Mobility (Weeks 10–16)

Precautions:

• No overhead resistance training in early part of this phase.

• Avoid repetitive heavy use or fast motions.

• Continue to avoid combined IR/adduction/extension beyond midline.

Therapy:

• Progress to full active ROM in all planes.

• Introduce light resistance (Theraband or light weights under 1kg).

• Emphasize quality of movement and muscle activation sequencing.

• Scapular control exercises, kinetic chain involvement, and proprioceptive drills.

• Increase endurance with low-resistance, high-repetition tasks.

Criteria to Progress:

• Full active ROM or nearing pre-injury levels.

• Demonstrates improved strength in ER, IR, and elevation.

• Shoulder control during functional tasks without pain or fatigue.

Phase IV: Advanced Strengthening and Return to Activity (Months 4–6)

Precautions:

• Gradual return to lifting up to 5 kg by the end of Month 6.

• No overhead heavy lifting until cleared by surgeon.

Therapy:

• Progressive resistance strengthening, including eccentric and closed-chain work.

• Introduce functional tasks relevant to occupation or sport.

• Plyometric drills, core integration, and scapulothoracic coordination.

• Simulate high-level movements in a controlled setting (e.g., reaching, lifting, or throwing).

Criteria for Discharge:

• Strength at least 80–90% of contralateral side.

• Pain-free ROM and strength in all functional activities.

• Cleared by surgeon and physiotherapist for return to full work/sport.

• No instability, weakness, or compensatory movements noted.

General Recommendations

Work:

• Office/desk work may resume after 4–6 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 may resume after 3–4 months.

• Overhead sports, heavy lifting, and high-demand or contact activities should only resume after full clearance by the treating surgeon, typically after 5–6 months.

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.