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

Immobilisation:

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

Precautions:

• No active internal rotation.

• Avoid passive external rotation beyond neutral.

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

Therapy:

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

• Passive and active-assisted shoulder flexion and abduction within comfort.

• Gentle pendulum exercises.

• Scapular setting and postural exercises.

Criteria to Progress:

• Pain controlled.

• Tolerating protected shoulder motion without increased symptoms.

Phase II: Controlled Motion Phase (Weeks 6–12)

Immobilisation:

• Sling gradually weaned and discontinued as tolerated.

Precautions:

• Avoid resisted internal rotation.

• Gradually increase external rotation within comfort.

Therapy:

• Progress passive and active-assisted shoulder range of motion in all planes.

• Begin active shoulder motion within comfort.

• Gentle isometric strengthening of rotator cuff (excluding internal rotation).

• Continue scapular stabilisation exercises.

Criteria to Progress:

• Improving shoulder range of motion without pain or apprehension.

• Good scapular control during active movement.

Phase III: Strengthening Phase (Weeks 12–16)

Precautions:

• Avoid forceful or resisted internal rotation early in this phase.

Therapy:

• Initiate light resisted internal rotation exercises.

• Progressive strengthening of rotator cuff and scapular stabilisers.

• Functional strengthening below and gradually above shoulder height.

Criteria to Progress:

• Near full, pain-free shoulder range of motion.

• Strength improving without symptoms.

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

Precautions:

• Avoid heavy internal rotation loading early in this phase.

Therapy:

• Advanced strengthening of subscapularis and shoulder girdle.

• Progressive return to gym-based and sport-specific activities.

Criteria to Discharge:

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

• Cleared by treating surgeon or therapist.

General Recommendations

Work:

• Office/desk work may resume after 4–6 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.