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

Immobilisation:

• Sling for comfort only.

• Discontinue as tolerated.

Precautions:

• Avoid heavy lifting and repetitive overhead activity in the early postoperative period.

• Avoid sudden, uncontrolled shoulder movements.

Therapy:

• Immediate passive, active-assisted, and active shoulder range of motion as tolerated.

• Scapular setting and postural exercises.

• Early rotator cuff activation exercises as tolerated.

• Pain and oedema management.

Criteria to Progress:

• Pain and inflammation controlled.

• Near full active range of motion.

• Normalising shoulder mechanics.

Phase II: Strengthening Phase (6–12 Weeks)

Precautions:

• Avoid high-load overhead strengthening until pain-free.

Therapy:

• Progressive rotator cuff strengthening.

• Periscapular muscle strengthening.

• Functional strengthening for daily activities.

• Cardiovascular conditioning as tolerated.

Criteria to Progress:

• Full or near full pain-free range of motion.

• Good neuromuscular control.

Phase III: Advanced Strengthening (12–16 Weeks)

Precautions:

• Gradual progression of overhead and resisted activities.

Therapy:

• Advanced strengthening and endurance training.

• Dynamic shoulder stability exercises.

• Introduction of sport- or work-specific drills as appropriate.

Criteria to Progress:

• Pain-free functional movement.

• Symmetrical strength compared to contralateral side (where applicable).

Phase IV: Return to Activity (4–6 Months)

Therapy:

• Full return to recreational and sporting activities as tolerated.

• Maintenance strengthening program.

Criteria to Discharge:

• Full, pain-free shoulder range of motion.

• Strength and endurance appropriate for activity demands.

• Clearance by the treating surgeon.

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 from 4–6 weeks.

• Progressive return to gym and functional activities from 6–8 weeks.

• Overhead and higher-demand activities from 8–12 weeks as tolerated.

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.