Clavicle Fracture Non-Operative Treatment

Physical Therapy Protocol

1. Introduction

Most clavicle fractures heal successfully with nonoperative management. Initial care typically involves temporary immobilization for comfort, followed by a gradual increase in activity as tolerated.

2. Activities of Daily Living

Sleeping:

• Patients should sleep on their back or on the non-injured side while wearing the sling.
• Place a pillow across the chest to support the injured side when sleeping on the side.
• When sleeping on the back, use a pillow under the arm for support or rest in a semi-reclined position for added comfort.

Hygiene:

• Use a non-slip mat in the shower or bath for safety.
• Let the injured arm hang gently at the side while bathing.
• Use a long-handled sponge for axillary hygiene or areas that are hard to reach if assistance is unavailable.

Dressing:

• Loose-fitting, button-up shirts are recommended.
• When dressing, start with the injured arm first, followed by the non-injured arm.
• Reverse the process for undressing.

3. Progressive Exercises

General Guidelines:

• Maintain sling support until the patient can comfortably start shoulder motion or until healing on X-ray is evident.
• Non-weight-bearing for the injured arm is required for approximately 6 weeks or until progressive healing is observed.

Phases of Exercises:

• Passive/Assisted Range of Motion: Begin gentle, guided movements.
• Active Range of Motion: Progress to unassisted movements as tolerated.
• Progressive Resistance Exercises: Gradually strengthen the shoulder and surrounding musculature.

4. Phases of Non-Operative Treatment

Phase I: Day 1–3 Weeks Post-Injury

Focus on maintaining mobility in unaffected joints to reduce swelling and preserve function.

• Elbow straightening and bending
• Hand opening/closing and soft ball squeezing
• Wrist bending forward, backward, and in circles
• Shoulder blade squeezes while keeping shoulders relaxed

Phase II: 3–6 Weeks Post-Injury

Introduce passive and assisted range of motion exercises as pain subsides and healing progresses.

• External and Internal Rotation
• Flexion using a table or a ball against a wall
• Sub-maximal Isometric Exercises:
  • Internal/external rotation
  • Abduction and extension

Phase III: 6–12 Weeks Post-Injury

Begin gradual strengthening exercises once permitted by the surgeon.

• Resistance exercises to restore strength and mobility
• Return to full activities or sports only after healing is confirmed on X-ray and full strength is regained (typically around 6 months)
• If healing is not evident after 3 months, further evaluation or surgical intervention may be necessary