Clavicle and Proximal Humerus Fracture Rehabilitation

Clavicle Fracture Rehabilitation Protocol

Consolidation: 6-12 weeks | Rehabilitation: 10-12 weeks

Treatment: Suburethral support (load distribution for secondary consolidation). Open Reduction and Internal Fixation (ORIF) using plates and screws for primary consolidation, or needle fixation for secondary consolidation.

Phase 1: Days 1 to 7

• Do not mobilize the extremity.
• Keep the shoulder adducted with internal rotation and the elbow at 90 degrees of flexion.

Phase 2: Weeks 2 to 4

• Maintain shoulder adduction and internal rotation.
• Perform isometric exercises for the deltoid and distal muscles by the 4th week.

Phase 3: Weeks 4 to 6

• Assisted passive movement until week 6.
• Week 5: Soft active movement (maximum 80-degree abduction).
• Pendulum exercises without gravity and shoulder isometrics.

Phase 4: Weeks 6 to 8

• Active assisted movement at all levels.
• Mechanotherapy: Rocher cage, Sanders wheel, and pulley therapy.
• Finger ladder, scapular mobilization, and shoulder isometrics.
• Progressive resisted active exercises (65% of maximum Active Range of Motion - AROM) starting from a 500g load.

Phase 5: Weeks 8 to 12

• Active assisted exercises and strengthening of the deltoid, rotator cuff, and trapezius (0.5 kg to 5 kg).
• Motor control: Isometric ball compression.

Proximal Humerus Fracture Recovery

Neer Classification: Grades 1-4 depending on displacement and angulation.

Mechanism of Injury: Fall on the shoulder or an outstretched hand with the elbow extended, or lateral impact.

Consolidation: 6-8 weeks | Rehabilitation: 12 weeks to 1 year

Treatment Options: Suburethral support, Open Reduction and Internal Fixation (ORIF), closed reduction and percutaneous fixation, prosthetic arthroplasty, closed reduction and immobilization, or external fixator.

Phase 1: Days 1 to 7

• No extremity movement.
• Active elbow exercises (prone-supination only).
• Free range of motion for the wrist and distal isometrics.

Phase 2: Weeks 2 to 4

• For non-displaced fractures with sling exercises: pendulum exercises (without gravity).
• No rotation movement.
• Active-assisted distal isometrics.

Phase 3: Weeks 4 to 6

• Tilting exercises with varying degrees of rotation against gravity.
• Not yet at full Range of Motion (ROM).
• Finger ladder and Sanders wheel.
• Muscle strengthening through rubber compression and deltoid isometrics.

Phase 4: Weeks 6 to 8

• Passive movement.
• Adhesive Capsulitis: If symptoms appear, perform low-intensity movements with greater frequency.
• Active assisted pulley therapy and exercises using a cane for assistance from the other extremity.
• Muscle strengthening with rubber compression.
• Distal resisted exercises with a minimum load of 500g for patients treated conservatively.

Phase 5: Weeks 8 to 12

• Full ROM in all planes.
• Strengthening of the deltoid, rotator cuff, and triceps (0.5 kg to 5 kg).
• Patients should recover a normal swinging gait.