| Phase | Timeline | Goals & Interventions | Avoid |
|---|---|---|---|
| Phase 1: Protection Phase | 0–2 weeks | – Sling full-time – Pendulums – Elbow/wrist/hand AROM – Patient education |
– ER beyond neutral – Resisted elbow flexion – Any biceps loading |
| Phase 2: Early Passive Motion | 2–4 weeks | – Wean sling during day – Passive flexion <120° (e.g., table slides) – ER to neutral only – Begin scapular setting |
– ABD/ER combo – Biceps activation (including supination) |
| Phase 3: Active ROM + Stability | 4–6 weeks | – Light activities in short lever positions – Active-assisted to AROM – ER to 45° – Begin proprioception drills |
– Overhead work – Carrying/lifting |
| Phase 4: Strength & CKC Training | 6–12 weeks | – Begin isometric and light resistance for RC – Introduce CKC scapular work – Progress ER range – Avoid resisted elbow flexion |
– ABD/ER in 90/90 – Pull-ups, biceps curls |
| Phase 5: Dynamic Control + Loading | 12–16 weeks | – Start resisted biceps flexion – Introduce eccentric control – Continue kinetic chain integration – Start controlled overhead work |
– Throwing or high-speed loading |
| Phase 6: Return to Throwing | 16–24 weeks | – Initiate throwing program if: pain-free, no biceps tenderness, full ROM, good scapular control – Strength ≥90% side-to-side – Gradual sport-specific drills |
– Return to contact or power-based sports before clearance |
