Broken Collar Bone (Clavicle Fracture) Post-Operative Physical Therapy Protocol

General Considerations:
- DO NOT elevate surgical arm above 70º in any plane for the first 4 weeks post-op.
- DO NOT lift any objects over 5 pounds with the surgical arm for the first 6 weeks.
- AVOID REPEATED reaching for the first 6 weeks.
- Ice shoulder 3 - 5 times (15 minutes each time) per day to control swelling and inflammation.
- An arm sling is used for 3 - 4 weeks post-op.
- Maintain good upright shoulder girdle posture at all times and especially during sling use.
- Intermittent X-ray to monitor healing as needed.
- MD follow-up visits at Day 1, Day 8 - 10, Month 1, Month 3, and 1 Year Post-op.

Week 1:
- MD visit Day 1 post-op to change dressing and review home program.
Exercises (3 times per day):
- Pendulum exercises
- Squeeze ball
- Triceps with Theraband
- Isometric rotator cuff external and internal rotations with arm at side
- Isometric shoulder abduction, adduction, extension, and flexion with arm at side

- Soft tissue treatments for associated shoulder and neck musculature for comfort.
- Cardiovascular training such as stationary bike throughout rehabilitation period.

Weeks 2 – 4:
- Soft tissue treatments for associated shoulder and neck musculature for comfort.
- Gentle pulley for shoulder ROM 2 times/day.
- Elbow pivots PNF, wrist PNF.
- Isometric scapular PNF, mid-range.

Weeks 4 – 8:
- MD visit and will usually be progressed to a more aggressive ROM and strength program.
- At Week 4: Start mid-range of motion (ROM) rotator cuff external and internal rotations and active and light resistance exercises (through 75% of ROM as patient's symptoms permit) without shoulder elevation and avoiding extreme end ROM.
- Strive for progressive gains to active 90º of shoulder flexion and abduction.

Weeks 8 – 12:
- Seek full shoulder active ROM in all planes.
- Increase manual mobilizations of soft tissue as well as glenohumeral and scapulothoracic joints for ROM.
- No repeated heavy resisted exercises or lifting until 3 months.

Week 12 Post-op and Beyond:
- Start a more aggressive strengthening program as tolerated.
- Increase the intensity of strength and functional training for gradual return to activities and sports.
- Return to specific sports is determined by the physical therapist through functional testing specific to the injury.

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.