Open reduction internal fixation of Clavicle
Sling for up to 4-6/52 for pain relief. Can be removed for washing, dressing and exercise.
Day 1 on ward - Active assisted elevation 0-60° in forward lean standing (assisted pendular elevation). Teach elbow, wrist, hand and scapular setting exercises. Keep Shoulder in neutral plane for assisted elevation. Start elevation with short lever against gravity in standing. If pain allows can commence active assisted elevation thro scaption to 60 degrees only with weight of arm assisted in sit/standing. Can use ball roll on table.
Care NOT to let scapula move too early.
Teach sling care and washing.
Active External Rotation as pain allows.
N.B. AVOID axial loading for 3/12. NO long lever strengthening for 12/52.
Shoulder clinic review 6/52 (with X-ray on arrival) to discuss progression then 4-6/12 review with XR
Aim for controlled quality early motion to 90° by 4/52, pain limiting.
N.B. CARE not to impinge rotator cuff.
May progress beyond 90° after 5/52 if pain allows.
Early Isometric Rotator Cuff activation after 2/52 – GHJ in neutral i.e. post/ant deltoid then medial and lateral rotation – light resistance (30% MVC).
Progress after 6/52 to regain full ROM as pain and muscle control allows.
Clinic review with Mr Cole at approx 6/52.
No long lever strengthening for 10/52. Progress controlled rotator cuff and deltoid strengthening 6-12/52.
Ensure scapular dynamic control through full range of movement.
Return to work: Sedentary 4 weeks (as pain allows). Physical 3 months (as guided by surgeon).
Driving: 4-6 weeks (as pain and range allows) patient confirms safety to drive.
Sport: Non contact 3 months. Contact 6-9 months (as guided by surgeon).
Swimming: Gentle with modified stroke 6-8 weeks. Freestyle 12-16 weeks.