| Time | Day 0 | 0–2 weeks | 2–4 weeks | 4–6 weeks | 6–12 weeks | 12+ weeks |
| Immobilisation & Protection | Shoulder immobiliser sling continuously (often up to 6 weeks)[15]. | Sling worn at all times; prevent tension on repair (e.g. support arm when sitting). | Begin to wean from sling (often around 3 weeks) as comfort allows. | Discontinue sling completely. Avoid any sudden stretching of pec. | No sling. Resume normal posture. Continue protecting end-range extension/abduction. | Full freedom of shoulder; avoid extreme horizontal abduction. |
| Mobilisation/Exercises | Hand/wrist/elbow and scapular setting exercises. No shoulder movement except gentle hand-to-mouth activities. | Passive/active-assisted shoulder flexion and abduction in safe zones (forward flex <90°). No pulley/overhead. | Active-assisted range in all planes as tolerated. Begin very gentle isometrics in neutral. | Gradually progress active ROM; start light rotator-cuff and deltoid isometrics (avoid heavy pectoralis loading). | Begin light resistive exercises for other shoulder muscles (rhomboids, deltoid); avoid bench-press or push-ups until 12 weeks. | Progressive resistive strengthening of pec, deltoid, cuff (8–12 reps). Avoid heavy weight lifts abruptly. |
| Activity | Use hand for hygiene/feeding only. Sling on except for exercises. | Light ADLs within sling (feeding, typing) at waist level. No lifting. | Increase ADLs; gentle grooming without pain. | Daily tasks with arm (brushing hair, light chores); no heavy lifting. | Swimming (breaststroke) at ~6 weeks; light lifting <2–3 kg by 6–8 weeks. | Return to most activities by ~3 months; gradual return to sports (e.g. golf at 3 months) as strength returns. |
Key clinical points: The arm is kept immobilised in a sling up to ~6 weeks post-op. Early rehab focuses on passive and assisted ROM within a “safe” range (no forced shoulder extension or horizontal abduction). No resisted shoulder adduction or internal rotation (pec function) before 12 weeks. At 6 weeks, start gentle active ROM; strengthen the rotator cuff and scapula first, then gradually load the pec muscle. Return to function is comparatively rapid, suggest driving ~6–8 weeks, light gym work ~3 months, and full sports (including swimming breaststroke at 6w, freestyle at 12w).
Movement restrictions: Avoid any stretching into hyperextension or forced horizontal abduction for 6 weeks. No push-ups, bench press, heavy pushing. Initially limit lifting to ~0–2 kg (e.g. no more than a full kettle).
Return to function: Sedentary work immediately or within 2 weeks. Manual labour or heavy lifting by ~3 months. Driving at ~6–8 weeks. Contact sports and heavy resistance (weightlifting) are deferred until 3–6 months when full strength returns.
