Rehabilitation after a clavicle fracture: exercises, recovery periods, exercise therapy, physical therapy, contraindications, nutrition

A clavicle fracture is a common injury that can happen to people of any age. The duration of rehabilitation and the timing of restoration of working capacity after a clavicle fracture depend on many factors, including the presence of complications, general condition, and the age of the patient. Rehabilitation treatment also plays an important role: exercise therapy, massage, physiotherapy.

Objectives of exercise therapy after clavicle fractures

The main tasks that exercise therapy solves for a clavicle injury are as follows:

Acceleration of bone fusion;
Normalization of blood flow and metabolic processes in the damaged area;
Restoration of blood vessels and nerve fibers damaged by injury;
Reducing pain;
Returning mobility to the joints of the affected limb;
Prevention of contractures and muscle atrophy;
Restoring posture and proper breathing.

How to reduce post-operative pain

Experts include the following tasks for postoperative pain management:

quality recovery period,
acceleration of rehabilitation and discharge from hospital,
reduction in the number of complications, including the development of chronic postoperative pain.

The most effective is the so-called multimodal scheme4 of postoperative pain relief, the concept of which involves the use of an optimal combination of drugs from different groups in minimal doses4.

Groups of drugs that are used as painkillers after surgery:

Opioid analgesics. Traditionally, they were considered the basis for surgical anesthesia, but their isolated use gives the expected result in only 25-30% of cases4, and the introduction of the maximum effective dose is associated with a high risk of side effects4, including respiratory depression. Also, after their withdrawal, even greater pain sensitivity often occurs.
Nonsteroidal anti-inflammatory drugs (NSAIDs). The formation of postoperative pain syndrome is directly related to tissue injury and inflammation. Therefore, the prescription of NSAIDs, as drugs that have a powerful anti-inflammatory and analgesic effect, is indicated from the first minutes after surgery, and sometimes during surgery.

They act directly on the cause of the development of hypersensitivity, namely the production of prostaglandins and other biologically active substances involved in the inflammatory process. There are methods that suggest using NSAIDs 20-30 minutes before the incision, which can reduce the intensity of pain in the area of postoperative sutures.4

When prescribed with drugs from the previous group, NSAIDs make it possible to reduce the dose and enhance the effect of opioids and prevent their side effects4.

Non-opioid centrally acting painkillers. They do not affect the mechanisms of inflammation, but are able to suppress secondary increased pain sensitivity at the level of transmission of nerve impulses. Their use half an hour before the end of the operation ensures a calm and painless awakening after anesthesia4. They have proven themselves well in complex pain relief.
Drugs that affect the perception of pain. Introduced to prevent hypersensitivity and the development of chronic pain syndrome4.
Regional anesthesia (analgesia). The application of the method is based on interrupting the flow of pain impulses from the damaged area to the spinal cord and brain4.

For each patient, a comprehensive pain relief regimen is selected individually. Factors such as age, gender, extent of surgical intervention, concomitant pathology, mental characteristics, sensitivity to pain and its presence before surgery are taken into account.

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Features of rehabilitation in case of non-displaced fracture

If after the fracture the ends of the clavicle remain in the same position, then surgical treatment is not performed. Immobilization of the shoulder joint is sufficient. At the same time, it is retracted upward and posteriorly to reduce the load on the collarbone, and a complex bandage is applied: figure-of-eight, Deso, Delbe rings.

It is uncomfortable for the patient to walk in this position for a long time, so the fixation in this case is not too rigid; minimal mobility in the hand is still preserved. At this time, it is already possible to conduct therapeutic exercises and massage, but active movements in the shoulder are still prohibited. Loads on the elbow should also be limited. The duration of immobilization is determined individually.

Emergency medical care

First of all, you need to call an ambulance, but if independent transportation is required, then first aid will play a big role in the effectiveness of subsequent treatment.

If the victim has a pronounced pain syndrome, then it is necessary to give him any available non-narcotic painkiller.
In the case of an open fracture, a tourniquet must be applied to stop the bleeding. If after applying it the skin becomes darker, loosen the tightening bandage. Next, you should treat the wound and fix the bone in one position.
Immobilization of a limb occurs by applying a bandage to the arm and attaching it to the body. Before the fixation procedure, it is recommended to place something in the victim’s armpit.

Under no circumstances should you attempt to independently compare displaced fragments when providing first aid.

Contraindications to exercise therapy classes

Exercise therapy after a clavicle fracture has a number of contraindications:

Acute infectious diseases;
General serious condition of the patient due to blood loss, shock;
Malignant tumors;
Foreign bodies near large neurovascular trunks;
Severe disorders of the heart and lungs;
Lung injury due to a broken collarbone;
High risk of bleeding;
Intense pain syndrome.

First signs

The most common signs of a displaced clavicle fracture are:

severe pain in the injured area;
the occurrence of swelling of the injury site;
the appearance of internal hemorrhage;
visual change in the bruised area;
shortening of the upper limb;
deterioration in motor function of the hand;
with palpation and load on the bone, the pain syndrome intensifies;
in the case of an open fracture, bleeding is present, and the fragments protrude outward;
the shoulder of the injured side protrudes forward.

Recovery in case of a displaced fracture

A displaced fracture usually requires surgical treatment: installation of a metal plate, wire or pin. Subsequently, the limb is fixed for approximately 3 weeks. However, this is not a reason to refuse exercise therapy. Even at the immobilization stage, training is possible. Let's look at the features of each rehabilitation stage in more detail.

Important!
During training, there should be no significant pain, especially at the initial stage. All movements are performed smoothly, at a slow pace, doing 7-10 approaches. You need to do gymnastics an average of 4 times a day.

First stage of rehabilitation

It lasts from 2 to 20 days from the moment of injury - the entire period of immobilization. During the first week, the fixing bandage is not allowed to be removed; exercises must be performed with extreme caution. Then the scarf is allowed to be removed for a short period of time, and development of the elbow joint becomes possible. Gymnastic elements for the first stage:

Fan out and connect your fingers together.
Forcefully clench your fingers into a fist and unclench it back. In this case, the first finger should alternately be inside the palm, then on top of the other fingers.
Perform incomplete bending of the fingers, while straining them strongly. How to “show your claws”.
Touch each other with the pad of your thumb one at a time.
Move in a circle with each finger in different directions.
Bend and straighten the hand at the wrist.
Make rotational movements in the wrist in different directions.
After removing the scarf, move the bent elbow up and back no more than 75°. Then lower the limb and connect the shoulder blades.

Note!
In the first days after injury, special attention is paid to breathing exercises necessary to saturate the body with oxygen and restore the normal biomechanism of respiratory movements. In the acute period, it is disrupted due to severe pain.

Second stage of rehabilitation

It begins approximately on the 21st day after the fracture and continues until the 35th day. The criterion for moving to the second stage is the formation of callus confirmed by x-ray examination. During this period, the restoration of mobility of the shoulder joint, which has been in a forced position for a long time, comes to the fore. The following complex will help with this:

Place the hands to the shoulder girdles, raise and lower the bent elbows to the sides and forward.
In the previous position, rotational movements are carried out in the shoulder joints from front to back and back.
Extend your arms straight parallel to the floor, spread them to the sides and back, and lower them.
Perform simultaneous swings with your arms: right - forward, left - back, and vice versa.
Lean forward, straighten your arms and swing to the sides, crossing your arms below.
Take a gymnastic stick, grab it with your hands slightly wider than shoulder-width apart. Raise the stick up and down.
Holding the stick with your arms extended upward, place it behind your head and return it to its original position.
Now bend your arms with the stick slightly and extend them in front of you. Move the stick in a circle in different directions.
Take the stick by the ends and turn it in front of you into a vertical position so that first one or the other hand is at the top.

Third stage of rehabilitation

It occurs 35 days after the collarbone injury and can last indefinitely. The main task of this stage is to completely restore the function of the hand. To do this, the following exercises are required:

Take a three-kilogram ball, lift it above your head with outstretched arms, then lean forward, lowering your arms, and push the ball between your legs.
In the same starting position, perform rotational movements with your arms above your head, without letting go of the ball.
Place your hands with the ball at approximately chest level. Throw up and catch the ball.
Stand at arm's length against the wall bars and clasp the bar with your palms. Perform squats without letting go of the bar.
From the same position, do push-ups from the bar.
Take dumbbells weighing 2-3 kg. Place your hands with dumbbells on your shoulders and then extend them vertically upward.
Still holding the dumbbells, perform rotational movements in the shoulder joints back and forth.

Restorative rehabilitation

One of the most common injuries is a collarbone fracture. In newborns, a fracture occurs due to rapid passage of the birth canal or incorrect actions of obstetricians. In adults and older children, a clavicle fracture occurs when falling on the shoulder or as a result of a strong blow to the collarbone area.

The rehabilitation period depends on how quickly medical care was provided and what methods were used. The rehabilitation period is the final and important stage, because the functions of the bone and shoulder in the future largely depend on it.

The bones of the collarbone fuse within a month, and a thickening forms at this place. Motor function is impaired. Its restoration is possible only after a set of therapeutic and physical exercises.

Treatment for a clavicle fracture rarely requires surgery. The operation is performed in case of a complex fracture with displacement.

A traumatologist treats the fracture.

Initially, the doctor must:

give the bone the correct position by moving the shoulder up and back;
then a special plaster cast is applied to the fracture site;
Then the fracture site is bandaged.

At the same time, the bandage is not rigid, which allows the hand to perform some actions that are necessary for rehabilitation. It takes place in three stages and allows you to completely restore motor activity. If treatment and rehabilitation are carried out correctly, then the fracture will never remind you of itself in the future.

Possible complications after a collarbone injury

If the regimen or treatment tactics are violated, or if you do not consult a doctor in a timely manner, the following complications may develop:

Displacement of fragments;
Callus protruding above the surface of the clavicle;
Bleeding from a wound with an open fracture;
Infection of surrounding tissues;
Skin sensitivity disorders in the incision area after surgery;
Damage to nerve trunks by fragments;
Lung injury;
Rejection of a metal plate in case of surgical treatment.

Rehabilitation

In the early postoperative period, the patient is in the hospital. The arm on the side of the damaged collarbone is immobilized using a Deso bandage. After some time, doctors allow simple movements of the hand, but physical activity, even small ones, is completely prohibited until the end of the rehabilitation period.

After surgery, a control x-ray is required. The drainage is removed after 1-2 days, and the sutures are removed after 10-12 days. After this, the patient needs observation on an outpatient basis. A month later, a repeat photo is taken. If everything is in order, you are allowed to move your arm fully.

Patients who have undergone clavicle osteosynthesis in our clinic quickly recover and return to their normal rhythm of life. There are no complications after the operation. You can make an appointment by phone. The price of treatment is affordable for every patient.

Features of a clavicle fracture in children

In childhood, subperiosteal greenstick fractures of the clavicle are common. In this case, only the bone tissue of the clavicle itself is damaged, and the periosteum covering it on top remains intact. Such fractures usually heal quickly and often remain undiagnosed, since the shape of the collarbone does not change and the pain is not too intense.

Information!
A fracture of the collarbone occurs even in newborns in the case of rapid labor, when the baby passes through the birth canal too quickly, or due to improper manipulations by obstetricians.

In the case of an uncomplicated fracture without displacement, plaster is not applied, but is treated with a regular bandage fixation bandage. If displacement of the fragments occurs, then use a figure-of-eight bandage or Deso.

Recovery

Since the patient’s arm is as immobilized as possible throughout the entire period of bone fusion, it happens that the muscles partially atrophy. Therefore, as a displaced clavicle fracture heals, rehabilitation is necessary, regardless of whether a fixation bandage was used for treatment or surgery was performed to install a plate.

Physiotherapeutic procedures

Such procedures are necessary at all stages of the recovery period for a clavicle fracture, both with and without surgery. Often in such cases the patient is prescribed courses of:

electrophoresis,
magnetic therapy,
UHF,
phonophoresis.

The use of physiotherapeutic procedures helps restore blood flow and improve reparative processes in the bones.

Massage

Massage is used from 2 days after injury. The patient is stroked and kneaded the healthy part of the chest and back in a sitting position. The massage is used twice a day and lasts about 10 minutes. After removing the bandage, the injured arm is also gently massaged.

Physiotherapy

Its use helps strengthen temporarily inactive muscles, promotes joint mobility and restores blood flow to the injured limb. When practicing physical therapy, it is important to strictly follow the sequence of loads. Treatment of the collarbone after a fracture begins on the day the bandage is applied or from the moment the operation is performed. The first classes are limited to developing the hand and gradually become more complex over time, involving the arm and upper shoulder girdle in the process of performing therapeutic exercises.

Physiotherapeutic procedures

Physiotherapy accelerates the patient’s rehabilitation: it stimulates the formation of callus, prevents complications, reduces pain, and restores blood vessels and nerves. Some procedures (for example, magnetic therapy) are prescribed during the period of immobilization. The following therapeutic methods are considered the most effective:

Magnetotherapy;
Electrophoresis and phonophoresis;
UHF therapy;
Ultraviolet irradiation;
Paraffin applications;
Mud therapy.

It is recommended to do only one physiotherapy procedure at a time, but it should be combined with exercise therapy and massage.

Rehabilitation period

When a non-displaced clavicle fracture occurs, the recovery period begins even before the bandage is removed. This is necessary so that the bone heals faster and blood and fluid do not stagnate in the tissues. To restore the functionality of an injured arm, the attending physician must draw up a rehabilitation plan that will allow the injury site to heal faster.

To ensure the patient gets physical activity as quickly as possible, during the rehabilitation period the doctor prescribes:

Physiotherapy;
Massage;
Physiotherapy;
Special diet.

Recovery should be under the supervision of the attending physician and include all these points.

Physiotherapeutic procedures

In order for physical therapy to have a positive effect, it should begin a week after the patient is injured. To restore the functionality of the limb, the following procedures are used:

electrophoresis;
magnetic therapy;
phonophoresis;
UHF;
UV therapy;
paraffin applications;
hydrotherapy;
mud therapy.

Massage

Depending on the complexity of the fracture, massage can begin 3-10 days after the injury. This procedure increases blood supply to the damaged area, accelerating metabolism and tissue regeneration, and also restores sensitivity to the skin in case of damage to the integrity of the nerve fibers.

While the shoulder is under the bandage, only visible parts can be massaged: arm, fingers, chest, back. All movements are soft, gentle, and performed in a sitting position. Kneading, stroking, and pinching techniques are allowed. It is important that the massage is performed by a professional, otherwise the risk of displacement of fragments increases.

Nutrition after a fracture

In order for the bone to heal faster, the body must receive a sufficient amount of minerals (calcium, phosphorus, fluorine), as well as vitamin D, which is necessary for the absorption of calcium. These elements strengthen bone tissue and accelerate the formation of callus. The highest content of calcium and other minerals is found in the following products:

Milk products;
Fish;
Whole wheat bread;
Legumes;
Beans;
Sesame;
Almond;
Spinach.

Helpful advice!
Some foods, on the contrary, interfere with the absorption of calcium. These are smoked foods, spicy, salty and too fatty foods, alcohol, carbonated drinks, coffee, cocoa, chocolate. During the recovery period, their use should be limited.

At the rehabilitation stage, it is important to correctly combine all the methods described above so that they give the fastest possible positive effect. It is necessary to follow all the recommendations of the attending physician, who will select adequate comprehensive therapy for a clavicle fracture. Then you can return to your usual active life in 1.5 months.

When is removal necessary?

Treatment of clavicular fractures has long advanced, eliminating the need to wear bulky plaster casts or even uncomfortable wooden splints for a long period.

Today, surgeons around the world prefer to use lighter structures for identical purposes, be it wires, full metal plates or single high-strength screws. All of them are designed to speed up the recovery process after serious damage to the collarbone.

Some innovative techniques provide the ability to introduce stable metal structures directly into damaged bone structures. This allows you to reliably fix their position in one position, which has a beneficial effect on the speed of fusion.

But classic plates, which are sometimes installed together with adjacent screws for strength, are usually fixed over the bones. The effect from them is approximately the same. The only difference is the type of initial injury. For the convenience of traumatologists, the developers of the method have provided a separate classification for all metal fixators supplied to the medical market. They differ in size, purpose, and types of fractures of the clavicular region.

Instead of suffering with uncomfortable plaster casts that severely limit normal activities and are difficult to even wash with, patients now enjoy the benefits of high-strength plates. They have a number of advantages over outdated methods of helping victims of fractures:

increasing the mobility of the victim;
reduction of the rehabilitation period;
the opportunity to return to sports activities much earlier.

But for a successful return to normal activity, even after a relatively simple clavicular fracture, you will first need to get rid of the metal assistant. Reverse intervention is especially important if, during the examination, the doctor discovers signs of a purulent process in the victim. This situation indicates the body’s inability to accept a foreign body even for good purposes, or a carelessly performed surgical intervention.

Another important reason for the need to get rid of the plate even before the time recommended by the doctor is often osteosynthesis. This is what professional terminology refers to as unsatisfactory fixation of bones, which indicates strong compression or too little pressure.

Clinical cases stand apart when the victim has an individual intolerance to the implant or an allergic reaction to its components. Here it will not be possible to conduct a full allergy test, since the body’s response may not manifest itself immediately. Because of this, neutralizing a potentially dangerous device is an emergency indication.

If we are talking about an extensive fracture, which often entails additional damage to the ligaments of the acromioclavicular joint, then here too one cannot do without installing a special plate. But usually the operation is accompanied by additional installation of screws necessary to enhance the fusion effect.

Damaged ligaments usually heal, regaining their former functionality, after about three months. It is also worth making allowance for the fact that bone structures with fragmentation versions of damage can take much longer to heal.

Once the restoration of all structures has been successfully completed, it will be necessary to get rid of the previously installed metal structure. If you ignore such a doctor’s order, the patient is likely to experience plate failure in the near future.

The outcome is explained by the fact that certain devices are designed for a strictly specified operational period. Although they can continue to perform their assigned duties longer, this will not lead to any good.