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

Immobilisation:

• Sling for 6 weeks

• Sling removed for hygiene and prescribed exercises

Precautions:

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

• Avoid active shoulder motion initially

• Avoid forceful rotation, extension, or overhead reaching

• Avoid sudden movements and supporting body weight through the arm

Therapy:

• Oedema management and postural education

• Active elbow, wrist and hand range of motion

• Pendular exercises

• Passive and active-assisted shoulder range of motion within comfort and fracture stability

Criteria to Progress:

• Pain controlled

• Minimal swelling

• Comfortable passive shoulder motion

• Maintaining elbow and hand mobility

Phase II: Restore Motion (6–12 Weeks)

Immobilisation:

• Wean from sling

Precautions:

• No lifting greater than approximately 1–2 kg

• Avoid heavy overhead activity

• Avoid sudden end-range loading

• Avoid impact activities

Therapy:

• Progress active-assisted shoulder range of motion

• Gradual progression to active shoulder motion

• Scapular control exercises

• Gentle stretching as tolerated

Criteria to Progress:

• Functional shoulder ROM

• Good scapular control

• Minimal pain with motion

• Tolerating daily activities

Phase III: Strength and Functional Recovery (12–16 Weeks)

Precautions:

• Gradually increase loading following clinical and radiographic healing

• Avoid heavy lifting initially

• Avoid repetitive overhead loading

Therapy:

• Restore full shoulder ROM

• Commence rotator cuff strengthening

• Scapular 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 (4–6 Months)

Precautions:

• Gradual return to unrestricted activity

• Avoid abrupt progression into heavy overhead loading

Therapy:

• Progressive strengthening

• Functional rehabilitation

• Occupation-specific rehabilitation

• Sport-specific rehabilitation as required

Criteria to Progress:

• Fracture union achieved

• Near full shoulder 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 affected upper limb may commence from approximately 6–8 weeks.

• Progressive return to functional and gym activities from approximately 3–4 months.

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