Standard Post Clavicle Fracture Fixation Rehabilitation Protocol:
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The clavicle is typically stabilised with a plate and screws, although an intramedullary nail or pin may be used.

Aims:
The aim of the rehabilitation is to protect the repair in the early stages and to maximally optimise function in the long-term.

General Points:
• Do not push through pain – remember pain inhibits rotator cuff control
• Do not sacrifice quality of movement for range of movement
• Remember the patho-physiology of the repaired tendon is often degenerative and needs to be considered when progressing rehabilitation.

Immobilisation:
• The patient is to wear a sling for 6 weeks. It can be removed to perform exercises as instructed by the physiotherapist.

Post Operative Instructions:

0-6 weeks:
Sling to be worn.
Hand, Wrist and Elbow exercises.
Pendular exercises.
Encourage optimal Scapulo-Thoracic position.
Active assisted External Rotation to 30o.
Active assisted elevation as comfort allows.

From 6 weeks:
Wean out of sling – light activities only.
Gradually increase External Rotation.
As External Rotation increases gradually increase Elevation Range of movement.
Active assisted exercises progressing to active exercises – utilise short lever, supine & closed kinetic chain if appropriate.

8 weeks onwards:
Long lever exercises may be started from 8 weeks.
Isometric exercises in variable starting positions progressing through to resisted movements through range and strengthening from 10 weeks.

Full range of movement and recovery of strength should be obtained by 12 weeks providing satisfactory progression towards union has occurred.

Functional Milestones and Activity Time Scales:

Driving See general principles of rehabilitation.
Swimming 12 weeks plus.
Golf 12 weeks plus.