Phase 01 · Weeks 0 – 2

0 – 2 weeks after surgery

Wear a sling all the time.
Elbow, wrist and hand movements as often as possible.
Ice the shoulder as often as possible to reduce swelling and pain.
Adequate pain control.
While lying supine, the distal humerus / elbow should be supported by a pillow or towel roll to avoid shoulder extension. Patients should be advised to 'always be able to visualize their elbow while lying supine.'
No shoulder AROM.
No lifting of objects with operative extremity.
No supporting of body weight with involved extremity.
Keep incision clean and dry (no soaking/wetting for 2 weeks).
Active / active-assisted ROM (A/AAROM) of cervical spine, elbow, wrist, and hand.
Begin periscapular sub-maximal pain-free isometrics in the scapular plane.
Begin sub-maximal pain-free deltoid isometrics in scapular plane (avoid shoulder extension when isolating posterior deltoid).
Ensure patient is independent in bed mobility, transfers and ambulation.
Ensure proper sling fit/alignment/use.
Instruct patient in proper positioning, posture and initial home exercise program.
Provide patient/family with written home program including exercises and protocol information.
Review with surgeon at 2 weeks before progressing.

Phase 02 · Weeks 2 – 6

2 – 6 weeks after surgery

Wear sling when walking or travelling.
Otherwise remove sling with arm supported on a chair, table or pillow; the hand can be used for eating, computer and paperwork etc.
Isometric shoulder muscle exercises including deltoid and scapula stabilizers.
Elbow, wrist and hand exercises 3 times a day.
Commence gentle passive elevation 0 – 90°, using the opposite hand to support the elbow, beginning supine and then progressing to the erect position.
Begin using deltoid to power shoulder forward elevation, initially supine 0 – 90°.
External rotation in scapular plane to tolerance, respecting soft tissue constraints.
Gentle resisted exercise of elbow, wrist and hand.
Continue frequent cryotherapy. Review with surgeon at 6 weeks before progressing.
Criteria for progression: tolerates shoulder PROM and isometrics; AROM minimally resistive program for elbow, wrist and hand; patient demonstrates the ability to isometrically activate all components of the deltoid and periscapular musculature in the scapular plane.

Phase 03 · Weeks 6 – 12

No more sling except if in a busy or crowded rowdy situation.
Begin active and passive movements concentrating on external and internal rotation and forward flexion, progressing to circumferential shoulder motion.
Forward flexion and elevation in the scapular plane in supine to 90°. External rotation in scapular plane to available ROM as indicated by operative findings — typically around 20 – 30°.
At 6 weeks post-op, start PROM internal rotation to tolerance (not to exceed 50°) in the scapular plane.
Begin shoulder AA/AROM as appropriate.
Forward flexion and elevation in scapular plane in supine, progressing to sitting/standing.
External and internal rotation in the scapular plane in supine, progressing to sitting/standing.
Initiate gentle scapulothoracic rhythmic stabilization and alternating isometrics in supine as appropriate. Minimize deltoid recruitment during all activities/exercises.
Progress strengthening of elbow, wrist and hand.
Continue use of cryotherapy as needed.
Patient may begin to use the hand of operative extremity for feeding and light activities of daily living, including dressing and washing.
The last movements to attempt are adduction and extension, such as reaching to the back pocket or toileting.

Phase 04 · From week 12

Begin gentle glenohumeral internal and external rotation sub-maximal pain-free isometrics.
Begin gentle periscapular and deltoid sub-maximal pain-free isotonic strengthening exercises.
Begin AROM supine forward flexion and elevation in the plane of the scapula with light weights (1 – 3 lb / 0.5 – 1.4 kg) at varying degrees of trunk elevation as appropriate (i.e. supine lawn-chair progression with progression to sitting/standing).
Progress to gentle glenohumeral internal and external rotation isotonic strengthening exercises in side-lying with light weight (1 – 3 lb / 0.5 – 1.4 kg) and/or with light resistance bands or sport cords.

Phase 05 · From week 16

Typically the patient is on a home exercise program at this stage to be performed 3 – 4 times per week with the focus on continued strength gains and progression toward a return to functional and recreational activities within limits identified by progress made during rehabilitation and outlined by the surgeon and physical therapist.
Criteria for discharge from skilled therapy: patient is able to maintain pain-free shoulder AROM demonstrating proper shoulder mechanics (typically 80 – 120° of elevation with functional external rotation of about 30°).
Typically able to complete light household and work activities.

Last reviewed: 2025-10-15.