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

Immobilisation:

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

Precautions:

• Protect tuberosity repair and fracture healing.

• Avoid active shoulder elevation.

• Avoid shoulder extension past neutral.

• Avoid combined adduction and internal rotation (hand behind back).

• Avoid lifting, pushing, pulling, or weight bearing through the operated arm.

Therapy:

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

• Passive shoulder flexion and abduction within comfort.

• Gentle pendulum exercises if tolerated.

• Scapular setting and postural exercises.

Criteria to Progress:

• Pain controlled.

• Wound healing satisfactory.

• Tolerating passive shoulder motion without increased pain.

Phase II: Active-Assisted Motion Phase (6–12 Weeks)

Immobilisation:

• Sling weaned and discontinued as tolerated.

Precautions:

• Continue to protect tuberosity healing.

• Avoid forceful internal rotation or extension behind the back.

• Avoid lifting heavier than light household items.

Therapy:

• Progress passive shoulder range of motion.

• Begin active-assisted shoulder elevation and rotation.

• Gentle scapular stabilisation exercises.

• Continue elbow, wrist, and hand exercises.

Criteria to Progress:

• Improving shoulder range of motion.

• Minimal pain at rest and with exercise.

Phase III: Active Motion & Early Strengthening Phase (12–16 Weeks)

Precautions:

• Avoid sudden or heavy lifting.

• Avoid high-load internal rotation behind the back.

Therapy:

• Initiate active shoulder elevation.

• Begin gentle strengthening of deltoid and periscapular muscles.

• Functional range of motion for activities of daily living.

Criteria to Progress:

• Functional active shoulder range of motion.

• Improving strength without pain or instability.

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

Precautions:

• Avoid heavy lifting and repetitive overhead loading.

Therapy:

• Progressive strengthening and endurance training.

• Gradual return to functional and recreational activities.

Criteria to Discharge:

• Stable, pain-free shoulder function.

• Strength adequate for independence and daily activities.

• Radiographic evidence of fracture healing.

• Cleared by treating surgeon.

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 (e.g. swimming, golf, light gym work) may resume from approximately 8–12 weeks, depending on strength and control.

• Higher-demand activities, heavy lifting, and repetitive overhead use should be approached with caution and only resumed after discussion with the treating surgeon.

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.