Phase I: Protection and Early Mobilisation (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 shoulder flexion to 90°, abduction to 45°.

• Elbow, wrist, and hand active ROM.

• Gentle pendulum exercises.

• Scapular retraction and posture work.

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

Criteria to Progress:

• Pain well-controlled.

• Passive flexion to 90° and abduction to 45° without signs of instability.

• No excessive tightness or capsular restriction.

Phase II: Controlled Motion and Early Activation (Weeks 4–8)

Immobilisation:

• Discontinue sling use by Week 6.

Precautions:

• Limit shoulder flexion to 120°.

• No active horizontal adduction or internal rotation past neutral.

• Avoid pushing or pressing motions.

Therapy:

• Begin active-assisted ROM in flexion and abduction.

• Gradually initiate active ROM once scapular control improves.

• Isometric strengthening of deltoid and rotator cuff (no IR).

• Rhythmic stabilisation drills for scapulothoracic control.

• Wall slides, isometrics, and scapular retraining.

Criteria to Progress:

• Active forward flexion to ≥120° without pain.

• Stable scapular movement.

• No signs of posterior instability or apprehension.

Phase III: Full ROM and Strength Development (Weeks 8–12)

Precautions:

• Avoid aggressive cross-body stretches or heavy horizontal adduction.

• No contact activity or high-demand resistance work yet.

Therapy:

• Achieve full, pain-free active ROM in all planes.

• Begin rotator cuff and scapular strengthening with bands or light weights.

• Proprioceptive training: ball on wall, body blade, closed-chain stability.

• Initiate gentle functional reaching patterns.

Criteria to Progress:

• Full active ROM.

• No symptoms of instability with functional use.

Phase IV: Advanced Strengthening and Return to Sport (Months 3–6)

Precautions:

• Avoid contact or collision activities until cleared.

Therapy:

• High-level resistance and scapular endurance work.

• Introduce overhead stability and perturbation training.

• Progress to sport-specific or work-specific activities.

• Plyometric drills (e.g., chest passes, push-ups) if appropriate.

Discharge Criteria:

• Symmetric ROM and strength.

• No posterior pain or apprehension.

• High-level shoulder control and endurance.

• Surgeon clearance for 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.