Clavicle Fracture Open Reduction Internal Fixation Rehabilitation Protocol

Restrictions:

  • Immobilisation of the shoulder joint in a broad arm sling for 6 weeks coming out of sling for elbow and wrist exercises.

  • Shoulder abduction, flexion, and external rotation passively for the first 6 weeks post operatively

  • No strength training for 6 weeks

  • No contact activity or heavy impact manual work for minimum 12 weeks postoperatively

 

Patients should have a grasp of exercises and use of sling and simple ADL functions prior to discharge home

Aim to get early control of shoulder girdle and interscapular muscles

Light pendular and rotation exercises within range of motion limits

Circulation exercises

Do exercises 3 - 6 x per day

Aim for relaxed exercises to avoid tension about the shoulder and neck

 

At 2 and 8 week follow up

Wound review

Check pain levels

Observe simple ADLs

Range of motion in flexion, abduction and rotation should be measured

Check control of shoulder girdle and interscapular muscles

 

Phase 1: Post-operative day 1 to discharge

Goals

Swelling and pain management and gentle range of motion

Action

  • Cryotherapy may begin once sensation has returned to normal

o   20 minutes

  • Use of sling training

  • Axillary hygiene

  • Circulation exercises for the hand

  • Gentle elbow and wrist exercises

  • Gentle pendular exercises

  • Scapular stabilisation exercises and posture training

  • Independent walking / mobilising training

  • Direct on limitation of passive motion

o    External rotation to 0 degrees

o   Abduction 45 degrees

o   Flexion 45 degrees  

Criteria to move to next phase includes

  • Safe mobility

  • Pain and swelling well controlled

  • Able to undertake axillary care and sling management

 

Phase 2 : Discharge to 2 weeks post-operatively

Goals

Continue with baseline exercises, swelling management, gentle controlled range of motion

Action

  • Continue hand and wrist exercises

  • Continue pendular exercises

  • Continue gentle passive range of motion

  • Posture and scapular stabilisation

Criteria to move to next phase includes

  • Swelling and pain well controlled

  • Able to perform the basic exercise regime daily with limited pain and swelling

Phase 3: From 2 - 6 weeks post-operatively

Goals

To achieve comfortable range of motion, control of scapular motion and positioning

Action

  • Daily active exercises. Continue pendular exercises. Active elbow flexion and extension, hand circulation exercises and scapular muscle activation

  • Passive range of motion exercises with limits: abduction 90 degrees, flexion 90 degrees and external rotation 20 degrees up to week 4 then progress gently

  • Relaxation and posture exercises to reduce tension in the neck and shoulder girdle

Criteria to move to the next phase

  • Near non tender, near pain free for all movements, achieve range of motion as stipulated above (90/90/20). Scapulohumeral rhythm control.

Phase 4: From 6 weeks post-operatively to week 12

Goals

Increase range of motion (free range of motion within pain limits), scapulohumeral rhythm control, gradual increased activation of shoulder girdle musculature

Action

  • Passive and active assisted scapular range of motion exercises for flexion, abduction, internal and external rotation – focus on good quality motion

  • Scapular mobility exercises

  • From week 6 begin with light isometric shoulder girdle strength including abduction, adduction, flexion, and extension.

  • Increase strength in graded manner moving to concentric and eccentric training.

Criteria to move to the next phase

  • Minimal swelling and pain associated with exercise.

  • Achieving good range of motion.

Phase 5: From week 12 onwards

Goals

Return to and normalise activities of daily living including sporting activities.

Action

  • Increase strength training loading as tolerated

  • Strength for scapulothoracic musculature

  • Aim for normal active and passive range of motion

  • Functional training for ADLs and sporting activity