Phase I: Protection and Immobilisation (Weeks 0–4)

Immobilisation:

• Standard sling to be worn at all times (including sleep) for 6 weeks.

• Removed only for hygiene and exercises.

Precautions:

• No shoulder flexion beyond 90°.

• No horizontal adduction across midline.

• Avoid combined flexion, adduction, and internal rotation.

• No lifting, pushing, pulling, or weight-bearing.

Therapy:

• Passive ROM for shoulder flexion (up to 90°), abduction (up to 45°).

• Elbow, wrist, and hand active ROM.

• Pendulum exercises for shoulder motion.

• Scapular retraction exercises to maintain mobility.

• Rest, ice, compress and elevate (RICE) for pain and inflammation.

Criteria to Progress:

• Pain controlled and well-managed.

• Passive ROM to 90° in flexion and 45° in abduction.

• No signs of posterior instability.

• Minimal discomfort during passive motion.

Phase II: Early Mobilisation and Muscle Activation (Weeks 4–8)

Immobilisation:

• Discontinue sling use by Week 6.

Precautions:

• No active horizontal adduction or internal rotation past neutral.

• External rotation to be kept below 30° until Week 8.

• Avoid pushing or lifting motions.

Therapy:

• Active-assisted ROM for shoulder flexion, abduction, and external rotation (limit to 30°).

• Scapular strengthening and mobility exercises.

• Begin isometric strengthening of rotator cuff and deltoid.

• Begin gentle stretching of the posterior capsule to restore mobility.

• Postural control exercises to stabilise shoulder position.

Criteria to Progress:

• Active forward flexion to 120° without pain or discomfort.

• External rotation to 30° or more.

• Full scapular control during upper limb motion.

• Stable shoulder without signs of instability.

Phase III: Strengthening and Advanced Motion (Weeks 8–12)

Precautions:

• Avoid extreme horizontal adduction or heavy lifting.

• No contact activities or high-demand sports yet.

• No forceful internal rotation.

Therapy:

• Achieve full active ROM (flexion, abduction, external rotation).

• Begin progressive rotator cuff strengthening with light weights or bands.

• Begin functional movement patterns and stabilisation drills.

• Proprioceptive exercises using closed-chain techniques.

• Gradual introduction of sports-specific drills (if appropriate).

Criteria to Progress:

• Full active ROM without discomfort.

• No signs of instability or apprehension with dynamic movements.

• Minimal pain with functional motions.

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

Precautions:

• Avoid contact or collision activities until cleared.

Therapy:

• High-level resistance training for rotator cuff, deltoid, and scapular stabilisers.

• Plyometric exercises for shoulder stability (e.g., medicine ball throws, push-up progressions).

• Sport-specific movements and drills.

• Advanced proprioception and functional control exercises.

Discharge Criteria:

• Full and symmetric ROM and strength.

• Pain-free shoulder function in daily and sport-specific tasks.

• Negative relocation and apprehension tests.

• Surgeon clearance for return to unrestricted activity.

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.