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

Immobilisation:

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

Precautions:

• No active shoulder elevation.

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

• Avoid sudden or uncontrolled movements.

Therapy:

• Hand, wrist, and elbow ROM exercises.

• Passive shoulder ROM as tolerated (flexion, abduction).

• Gentle pendulum exercises.

• Scapular setting and postural awareness.

Criteria to Progress:

• Pain and inflammation controlled.

• Tolerating passive shoulder motion without increased symptoms.

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

Immobilisation:

• Sling used as needed for comfort; gradually wean.

Precautions:

• No resisted shoulder movements.

• Avoid lifting or weight bearing through the arm.

Therapy:

• Progress passive and active-assisted shoulder ROM.

• Gradual introduction of active shoulder motion below shoulder height.

• Continue scapular control exercises.

• Gentle isometric activation of rotator cuff and deltoid.

From week 3 and following wound review hydrotherapy can be commenced.

Criteria to Progress:

• Improving active ROM without compensatory patterns.

• Minimal pain during daily activities.

Phase III: Strengthening Phase (6–12 Weeks)

Precautions:

• Avoid heavy lifting and sudden loading.

• Avoid repetitive overhead activity early in this phase.

Therapy:

• Progressive strengthening of rotator cuff and scapular stabilisers.

• Functional strengthening below and gradually above shoulder height.

• Continue to restore full shoulder ROM.

Criteria to Progress:

• Near full, pain-free ROM.

• Able to perform light daily and functional tasks without pain.

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

Precautions:

• Avoid contact or high-impact activities until cleared by surgeon.

Therapy:

• Advanced strengthening and endurance training.

• Progressive overhead and sport- or work-specific exercises.

• Gradual return to gym-based activities.

Criteria to Discharge:

• Full or near-full shoulder ROM.

• Strength adequate for work, sport, and daily activities.

• No pain with functional tasks.

• 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.