Phase I: Protection and Early Motion (0–2 Weeks)

Immobilisation:

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

Precautions:

• No resisted elbow flexion or forearm supination.

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

• Avoid sudden or forceful movements.

Therapy:

• Hand, wrist, and elbow range of motion exercises (no resistance).

• Passive and active-assisted shoulder range of motion as tolerated.

• Gentle pendulum exercises.

• Scapular setting and postural exercises.

Criteria to Progress:

• Pain controlled.

• Tolerating shoulder and elbow motion without increased symptoms.

Phase II: Controlled Motion Phase (2–6 Weeks)

Immobilisation:

• Sling used as needed for comfort; gradually wean.

Precautions:

• Continue to avoid resisted elbow flexion and supination.

• Avoid lifting heavier than light daily items.

Therapy:

• Progress to active shoulder range of motion.

• Active elbow flexion and forearm rotation without resistance.

• Continue scapular and postural exercises.

• Gentle isometric strengthening of shoulder musculature (excluding biceps).

Criteria to Progress:

• Full or near-full shoulder and elbow range of motion.

• Pain minimal during daily activities.

Phase III: Strengthening Phase (6–12 Weeks)

Precautions:

• Avoid heavy lifting and sudden loading of the biceps.

Therapy:

• Initiate resisted elbow flexion and forearm supination with light resistance.

• Progressive strengthening of rotator cuff and scapular stabilisers.

Criteria to Progress:

• Strength improving without pain.

• Able to perform functional tasks comfortably.

Phase IV: Advanced Strengthening & Functional Return (3–6 Months)

Precautions:

• Avoid maximal biceps loading early in this phase.

Therapy:

• Advanced strengthening of biceps, shoulder, and upper limb.

• Sport- and work-specific functional progression.

Criteria to Discharge:

• Range of motion and strength adequate for work, sport, and daily activities.

• No pain or cramping with resisted elbow flexion or supination.

• Cleared by treating surgeon or therapist.

General Recommendations

Work:

• Office/desk work may resume after 1–2 weeks if pain is well controlled

• Manual labour should be deferred until 4–6 weeks 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 activities may resume as comfort allows.

• Light shoulder activities (below shoulder height) from 4–6 weeks.

• Progressive return to gym and functional activities from 8–12 weeks.

• Resisted elbow flexion and heavy lifting from approximately 10–12 weeks.

• Overhead and higher-demand activities from 3–4 months as strength allows.

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.