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Clavicle fracture. Physical therapy during the week 4 to 8 of rehab. Part 1.

December 13, 2011


So we successfully passed week 2 to week 4 of our rehabilitation program. Make sure that you don’t feel any collarbone pain and keep a steady schedule of your visits to the therapist. Now that you are healing quite well it is time to start increasing the range of motion for the rotator cuff and start working on the strengthening exercises.

When performing those exercises always remember not to go past your shoulder height in any of the arm movements. Gradually build the intensity and let the pain be a red flag for you. If you would feel a collarbone pain, decrease the intensity and\or the weight. Always consult your therapist before going forward with this plan.

Strength development exercises:

1. Arm abductions.

 a. Dumbbell lateral raises.

Hold a 2 pound dumbbell in your arm, standing straight. Lift the dumbbell directly out to your side. Make sure not to pass the shoulder level and keep your elbow slightly bended to decrease the strain. Stay within the comfortable range of motion. Keep a balanced posture and contract your core muscles. Perform 10 raises and rest. Repeat 3 times.

 b. Tubing or elastic bands attached low.

Utilizing the same method we will perform the same exercise basically, only with the resistance tube. There are different types; they all differ based on the resistance level. Please start with the easiest tube first. Safely position the tube on the bottom and start performing side raises similar to the previous example.

2. Arm adduction

Cable cross over.

Grasp pulley dumbbell attachments. Stand with pulley to your side. Bend over slightly by flexing hips and knees. Bring cable attachment down with elbow in fixed position. Monitor your condition and avoid overextending the arm. Do not let it go pass the shoulder height. Perform 10 pulls and rest. Repeat 3 times.

3. Rotator cuff strengthening exercise.

Elastic band.

Tie a piece of elastic band to the door knob. With your elbow bent 90 degrees hold one side of the bend with the hand of the effected arm. Rotate the forearm out away from your body keeping your elbow and upper arm tucked against the side of your body until you begin to feel tightness in your shoulder. Then rotate your forearm toward your body till it touches your belly. Rest. Repeat 3 times.

This will conclude part one of strengthening exercises. Rehabilitation from clavicle fracture can be a long ordeal so please be patient and don’t rush your progress. Always stop if you feel sudden pain and\or discomfort. See you in part 2!

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Clavicle fracture. Physical therapy during week 2 to week 4.

December 12, 2011

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Clavicle fracture rehabilitation. Part 2.

In the previous article for the clavicle fracture rehab, we guided you through the rehab exercises for the first week: pendulum, isometric and grip strength. You should have maintained a steady pace with a maximum attention to the collarbone pain feedback or any pain in the damaged area. Personal mileage always varies so please consult your doctor regularly, once a week is ideal; to proper monitor your progress.

Let’s assume that the healing process is being properly followed up and your therapist establishes that you have no structural imbalances caused by the clavicle fracture. At this point we can safely go ahead and start the following exercises.

1. Wall crawl.

With your elbow straight, use your fingers to “crawl” up the wall as high as you can. Hold for ten seconds. Repeat three times. Include about 3 sessions a day.  Monitor the discomfort level and do not let yourself to perform it if you feel the pain. Remember – you are not fully healed so the range of any exercise right now needs to be well within a safe corridor.

2. Simple easy pulley exercise.

Sit with the injured arm closest to the pulley; sit at a 45 degree angle. Back far away extend from the pulley so that your arm is comfortably extended. Grasp the handle with your thumb facing out and your palm facing up.  As you start the exercise remember to keep your shoulder blade down and do not lift your elbow higher than your shoulder socket. Bring it down to a comfortable position. Use your healthy arm to pull down and bring the impaired arm up. Go up and down as fast as you are comfortable, keeping the fractured collarbone side arm relaxed. If you feel the pain, do not go up quite so high and if you cannot find a pain free range of motion, stop.

3. Shoulder abduction.

Raise the fractured clavicle arm to the side with your elbow straight and palm down. Hold for 10 seconds. Repeat 10 times.

4. Isometric shoulder abduction.

Sit down next to a sofa or a large chair so you can push your arm, bended in the elbow against it. Resist upward motion to the side; push your arm against back of the chair. Hold for five seconds then rest. Repeat 10 times.

5. Isometric shoulder adduction.

Put a small pillow between your shoulder blade and your side. Bend your arm in the elbow creating a 90 degree angle. Push against the pillow. Hold for five seconds then release.  Rest and repeat 10 times.

6. Shoulder extension.

Back up to the wall and start with your arms straight down to your sides. Keeping your arms straight push your arms back into the wall. Hold for 5 seconds, and then take a rest for 1 minute. Repeat ten times.

This will conclude week 2 to week 4 exercise plans. As you can see we are slowly building up the range of motion and strength loads. Be very careful and always consult your doctor. A clavicle fracture sometimes takes very long time to heal so if you feel uncomfortable with the exercise progression plan you can always rollback to week one.

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Clavicle fracture. Physical therapy during week 1.

December 11, 2011


Clavicle fracture rehabilitation. Part 1.

Here, at collarbone pain website, we are trying to aggregate all the information pertaining the collarbone pain and clavicle fracture, the reasons of it and rehabilitation techniques that are being used currently in physical therapy. By all means, consult you private health provider before utilizing this information.

In this article we would like to discuss methods and techniques used for clavicle (collarbone) fracture rehabilitation. But let’s start with the disclaimer – the exercises that we are giving here should be utilized after the initial healing period. During this period please do not raise the injured arm above 90 degrees and do not load more than 5 pounds. Were you to have a sling prescribed, you should always watch your posture and maintain your body mechanics so that to maintain balanced shoulder position and bone alignment. Start the physical therapy exercises only when your doctor gives you a go.

Exercises are:

1. Basic static isometric exercises.

 This method is based on the isometric muscle contraction, when the muscle is fired but the joints are staying immobile. The main benefit of this method is that we can safely use it for rehabilitation without putting stress on the joints, thus isolating the muscle groups that we need to be engaged. For the collarbone (clavicle) fracture we would use the isometric triceps exercise: place your injured collarbone side arm on the table, creating a 90 degree angle. Make a vertical fist and press down on the table with it. As a result your arm would not move but the triceps will contract.

2. Pendulum exercise.

 This basic exercise helps you reestablish you shoulder joint range of motion and stimulates the muscles and ligaments around the fractured area. Bend forward so that you injured arm is hanging free perpendicular to the floor. Make ten rotations with your arm clockwise and ten counterclockwise so that the whole arm is rotating relating to its vertical axis. Next, move your arm forward and backward and side to side. 10 times each. Remember to initiate the arm movement, utilizing your legs as is shown in the video below. As you get comfortable utilizing this method you can start incorporating some additional weight – use light dumbbell (1 to 5 pounds).

3. Small squeeze ball exercise.

 Grab a tennis ball sit down by the table. Place the injured arm on the table creating a 90 degree angle. Start squeezing the ball applying even pressure. Make several sessions a day with the duration from 1 to 10 minutes. Increase the frequency of the exercise depending on your progress. Do not perform it if you feel pain in the collarbone area.

One thing to always keep in mind during you first week of rehabilitation from the clavicle fracture is that to always monitor your collarbone pain and be very careful with the intensity of the physical therapy. Always consult your doctor and schedule a weekly appointment to monitor the rehabilitation process.

In the next article we will discuss the clavicle fracture exercise progression plan for week 2.

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Collarbone Pain Treatment

December 4, 2011


Collarbone pain treatment.

Collarbone pain treatment depends on the injury diagnosis.

Collarbone fracture treatment:

 collarbone painThe first step is to inject a Novocain anesthesia shot into the area of the fracture to reduce the collarbone pain. Special techniques are used for the clavicle fragments to get pieced together and positioned correctly followed by placing a cotton-gauze roll into the armpit. Then the shoulder must be immobilized as the fragments of the collarbone could be easily moved again from their designated position. Most common are a figure-8 brace and a sling that are used to support the arm and assure resting and healing. A figure-8 brace is an older method used to facilitate and maintain the symmetric positioning, but lately the most preferred suspension method is a sling. The healing period is usually stays with a month, month and a half period.  This treatment accounts for the 95% of all collarbone fracture cases. Only in very special circumstances the surgical method is required: open fracture, skin penetration, vascular and nervous trauma caused by the fracture. In this case the bone fragments are fixated with the use of Open Reduction Internal Plate Fixation method. This method uses titanium plate that is affixed along the collarbone via long screws.collarbone pain

Collarbone dislocation treatment:

For partial dislocations of the acromioclavicular joint a functional treatment normally takes place: the arm is placed in a sling and the joint is anesthetized by a local injection of 10-15 ml. of the 1-2% Novocain solution. In this case the prolonged immobilization of the joint is not required. Within 2 or 3 days after the collarbone pain is reduced the exercise therapy is assigned with limited shoulder abduction of 90 degrees for the duration of 7 to 10 days.  Physiotherapy is assigned to accelerate the hematoma desorption.

For full dislocations a complete hospitalization is required. Very accurate joint repositioning and fixation is needed for up to 6 to 8 weeks to make sure the proper regeneration of damaged ligaments.  This is achieved by the methods of external fixation or in some cases with the surgical intervention.collarbone pain

Surgical treatment using modern methods of fixation eliminates the need for external immobilization a

nd allows for earlier rehabilitation and significantly reduce the disability time.

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