Intended for licensed physical therapists coordinating care with Dr. Vasileff. Defer to the operative note and the surgeon’s office for patient-specific direction.
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Shoulder · Fracture

Clavicle Fracture ORIF

Post-operative protocol · Dr. Chris Vasileff, MD
For the treating physical therapist. This protocol is a guideline; progression is criteria-based and individualized. Defer to the operative note and the surgeon’s office for patient-specific direction.

Clavicle ORIF

  • Sling for 3 weeks

Phase 0 – Quiet (Week 0 - 2)

  • Elbow-wrist-hand ONLY
  • Ok to come out of sling for hygiene
  • Gentle pendulums (lean forward and passively swing arm in small alternating circles) (every 1-2 hours for 3-5mins)

Phase I – Passive Motion (Week 3 - 6)

Pendulums to warm-up - Passive range of motion

  • Passive shoulder range of motions - - as tolerated
  • Supine external rotation - GRADUALLY increase to full by week 12
  • Supine forward elevation - GRADUALLY increase to full by week 12
  • may start rehab in warm water pool at 3 weeks
  • Begin PROM activities - - codman’s, posterior capsule mobilizations, avoid stretch of anterior capsule and extension, closed chain scapula
  • Passive and active assist elbow range of motion - - as tolerated
  • Ice: continue to ice on a regular basis. At least 20 minutes at a time, 4-5 times per day.
  • Shower: On post-op day 3
  • Appointment: your first therapy appointment should begin 1 week after surgery.

Phase II – Active Motion (Week 7 - 11)

Pendulums to warm-up

Active range of motion with passive stretch

  • Supine🡪Seated External Rotation
  • Supine🡪Seated Forward Elevation
  • Internal rotation – GRADUALLY increase to full by week 12
  • Active shoulder range of motion to full
  • Active elbow range of motion to full
  • Begin light resistive exercises for scapular stabilizers, biceps, triceps, and rotator cuff

Phase III – Resisted (Week 12 & Beyond)Pendulums to warm up and continue with phase 2

  • Increased ROM to full with passive stretching at end range
  • Begin muscle endurance activities
  • Aggressive scapular stabilization and eccentric strengthening
  • Begin plyometric and throwing/racquet program
  • External and Internal Rotation
  • Standing forward punch
  • Seated Rows
  • Shoulder Shrugs
  • Bicep Curls
  • Bear Hugs

Phase IV – Weight Training (Week 16)

  • Keep hands within eyesight, keep elbows bent, no long lever arms
  • Minimize overhead activities (below shoulder level)
  • No military press, pull-downs behind head, or wide grip bench
  • Gradual progression of resistance controlling velocity, duration, intensity, and frequency
  • MMI is usually at 12 months post-op

RETURN TO ACTIVITIES

Computer as tolerated

Driving When no longer taking narcotics

Elliptical 1 months

Jogging 2 months

Light Swimming 3 months

Golf (Chip & Putt) 3 months

Golf (Irons & Driver) 4-5 months

Tennis 4-5 months

Weight training 4-5 months

Skiing 6 months

Contact Sports 6 months

**Heavy overhead lifting (military press), pull-down behind head, wide grip bench and dips are discouraged.

Questions about a protocol? Contact Dr. Vasileff’s office at (704) 865-0077.