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 coracoid graft and subscapularis split.

• No resisted elbow flexion or forearm supination.

• Avoid external rotation beyond neutral.

• Avoid combined abduction and external rotation.

• 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 apprehension.

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

Immobilisation:

• Sling weaned and discontinued as tolerated.

Precautions:

• Gradually increase external rotation within comfort.

• Continue to avoid combined abduction–external rotation early in this phase.

• Avoid heavy lifting.

Therapy:

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

• Begin active shoulder motion below shoulder height.

• Initiate gentle scapular and rotator cuff strengthening.

Criteria to Progress:

• Improving shoulder range of motion.

• No instability or apprehension.

Phase III: Strengthening Phase (12–16 Weeks)

Precautions:

• Avoid high-risk positions for instability early in this phase.

Therapy:

• 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.

• Good dynamic shoulder control.

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

Precautions:

• Avoid contact or collision activities until cleared.

Therapy:

• Advanced strengthening and endurance training.

• Sport- and work-specific rehabilitation.

Criteria to Discharge:

• Full or near-full shoulder range of motion.

• Strength and stability adequate for work and sport.

• No apprehension or instability symptoms.

• 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:

• 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.