Shoulder or Clavicle Fracture Fixation

Fixation of Proximal Humerus, Clavicle, Scapula and Glenoid

Indications

• Proximal Humeral Fractures
• Clavicle fractures 
• Scapula / Glenoid fractures

Protocol

This protocol is based on maintaining range of movement in the first phase and then gradually building strength in the middle to the last phase.

Day 1 - 3 weeks

• Arm Immobiliser
• Wrist/hand/finger exercises
• Elbow flex/ext, pro/supination
• Shoulder girdle exercises
• Scapula setting exercises
• Passive ROM in all directions as tolerated - Do not force or stretch

3 - 6 weeks

• Gentle isometric exercises in neutral as pain allows
• Wean off sling
• Begin active assisted exercises ensuring glenohumeral movement, not scapulothoracic - Do not force or stretch

6 weeks +

• Progress to full active exercises in all ranges
• Begin rotator cuff strengthening (pain free)
• Closed chain exercise
• Begin stretching the capsule
• Begin proprioceptive exercises

Milestones

4 Weeks

• 50% pre op passive ROM

6 Weeks

• Passive ROM 50% of pre op level

12 Weeks

• Active ROM equal to pre op level
• Passive ROM equal to pre op level
• Any acute loss of active movement should be referred to the next shoulder clinic                                   

Return to functional activities

Return to work

• Sedentary job:  As tolerated
• Manual job:      12 weeks

Driving

• 6 - 8 weeks

Swimming

• Breaststroke:  6 weeks
• Freestyle:       12 weeks

Golf

• 3 months

Lifting

• Avoid lifting heavy items for 12 weeks

Contact/High Impact Sports     (e.g. Rugby League, AFL, martial arts, racket sports and Surfing)

• 12 weeks

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