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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