| Time | Day 0 | 0–2 weeks | 2–4 weeks | 4–6 weeks | 6–12 weeks | 12+ weeks |
| Immobilisation & Protection | Sling or brace worn continuously (often with abduction pillow) to offload graft. Ensure graft is protected[4]. | Sling at all times except for hygiene. No weight-bearing or lifting. | Continue sling use; gradually wean as per surgeon (often after 6 weeks). | Sling discontinued (typically ~6 weeks). Emphasise graft protection; avoid stress. | No sling. Normal daily use encouraged within limits. | Return to full activities as tolerated; continue strengthening. |
| Mobilisation/Exercises | Elbow/wrist/hand exercises. Begin very gentle scapular retractions, isometric deltoid in brace. | Maintain hand/elbow ROM. No active shoulder motion. Initiate pendulum exercises ~week 5[4] (20–30 reps, gentle). | Wean out of sling by 6–7 weeks. Begin passive-assisted ROM in safe planes (forward flexion/scaption). Do not isolate supraspinatus. | Gradual active-assisted → active ROM as tolerated. Begin gentle submaximal isometrics (deltoid, subscapularis, teres minor) near end of Phase II[5]. | Progress to full active ROM; start light resistance (e.g. theraband) for deltoid, scapula, subscapularis; avoid isolated supraspinatus loading. | Advance strengthening, including rotator cuff and deltoid. Return to sport-specific rehab (avoiding high supraspinatus stress). |
| Activity | Keep arm elevated on pillow; avoid any lifting. | Pain-free ADLs with arm supported at waist level only. No lifting. | Light ADLs (e.g. feeding, grooming) within shoulder height. | Increase functional use (e.g. desk work, light driving); avoid abduction >60° or ER past neutral under load. | Begin gentle contact-free exercise (e.g. light swimming by 3–4 months). | Return to most activities by ~6 months; return to overhead sport guided by strength, typically 6–9 months. |
Key clinical points: SCR is a salvage procedure for irreparable cuff tears. Strict protection is required early: the graft must heal to bone at glenoid and humerus, so immobilise (sling/brace) and avoid active shoulder motion for ~6 weeks. Pendulum exercises may start only around week 5. Progress ROM very gradually and only if shoulder remains stable and pain is controlled. Emphasise the deltoid/subscapularis strengthening later, avoiding overload of the new superior capsule (isolated supraspinatus tensions are contraindicated).
Movement restrictions: No active shoulder flexion/abduction without support for first 6 weeks. Avoid combined abduction/ER and any aggressive stretching. No heavy lifting or resistive elbow flexion for 8–12 weeks.
Return to function: Sedentary work ~6–8 weeks post-op. Light manual tasks ~3–4 months. High-load activities or sports only when full ROM/strength achieved (often 6–9 months or longer), under surgeon advice.
