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

Immobilisation:

• Sling worn continuously for comfort and protection, removed only for therapy and hygiene.

Precautions:

• No active shoulder adduction, internal rotation, or horizontal adduction.

• Avoid lifting, pushing, or pulling with the affected arm.

• Avoid end-range shoulder extension.

Therapy:

• Hand, wrist, and elbow range of motion exercises.

• Passive and active-assisted shoulder range of motion within comfort, avoiding stress on the repair.

• Gentle pendulum exercises.

• Scapular setting and postural exercises.

Criteria to Progress:

• Pain controlled.

• Tolerating protected shoulder motion without increased symptoms.

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

Immobilisation:

• Sling gradually weaned and discontinued as tolerated.

Precautions:

• Avoid resisted pectoralis activation.

• Avoid heavy lifting and sudden movements.

Therapy:

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

• Begin active shoulder motion within comfort.

• Continue scapular stabilisation exercises.

• Gentle isometric strengthening of rotator cuff and deltoid (excluding pectoralis major).

Criteria to Progress:

• Improving shoulder range of motion without pain.

• Good scapular control during active movement.

Phase III: Strengthening Phase (12–16 Weeks)

Precautions:

• Avoid heavy resisted adduction or bench press–type movements early in this phase.

Therapy:

• Initiate light, controlled strengthening of pectoralis major.

• Progressive strengthening of shoulder and scapular musculature.

• Functional strengthening below shoulder height.

Criteria to Progress:

• Near full, pain-free shoulder range of motion.

• Strength improving without pain or apprehension.

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

Precautions:

• Avoid maximal or explosive pectoralis loading early in this phase.

Therapy:

• Advanced strengthening of pectoralis major and shoulder girdle.

• Gradual return to gym-based and sport-specific activities.

Criteria to Discharge:

• Full shoulder range of motion.

• Strength sufficient for work, sport, and recreational activities.

• No pain with resisted adduction or pressing movements.

• Cleared by treating surgeon or therapist.

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:

• 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.