Clavicle Fracture (Broken Collarbone) - Complete Rehabilitation Guide

Anatomy & Why Rehab Matters

Rehabilitation Phases - Step by Step

PHASE 1: Weeks 0-6 (Protection & Early Motion)

Exercise 1 - Pendulum Swings

1. Stand next to a table or chair
2. Bend forward at the waist (about 90°), support yourself with the uninjured arm on the surface
3. Let the injured arm hang straight down, completely relaxed
4. Using gentle body rotation (NOT shoulder muscle effort), swing the arm:
   • Forward and backward (10 circles)
   • Side to side (10 circles)
   • Clockwise and counterclockwise small circles (10 each)
5. Keep the motion small and pain-free

Exercise 2 - Grip Strengthening

1. Hold a soft stress ball, therapy putty, or rolled towel
2. Squeeze firmly for 5 seconds
3. Slowly release over 3 seconds
4. Repeat 10-15 times per session

Exercise 3 - Wrist and Elbow Circles

1. With arm resting in sling, gently flex and extend the wrist (up/down)
2. Rotate wrist in circles (10 each direction)
3. Gently bend and straighten the elbow within comfort range
4. Perform these slowly and smoothly

Exercise 4 - Shoulder Shrugs

1. Sit or stand upright with arm in sling
2. Shrug both shoulders straight up toward your ears
3. Hold for 3-5 seconds at the top
4. Slowly lower back down
5. Keep movement controlled - no rapid jerking

Exercise 5 - Scapular Pinches (Retraction)

1. Sit or stand upright
2. Gently squeeze both shoulder blades backward and together
3. Imagine holding a pencil between your shoulder blades
4. Hold for 5 seconds
5. Slowly release

PHASE 2: Weeks 6-12 (Active Range of Motion + Isometrics)

Exercise 6 - Assisted Arm Elevation (Wand/Cane Exercise)

1. Hold a cane, umbrella, or broomstick with both hands, shoulder-width apart
2. Lie on your back (supine position) or stand
3. Use your good arm to slowly push the injured arm upward (forward flexion) to the point of mild resistance
4. Hold for 5-10 seconds, then slowly lower
5. Gradually increase the height over days/weeks

Exercise 7 - Wall Crawl (Finger Walking)

1. Stand facing a wall, arm's length away
2. Place your fingertips on the wall at waist height
3. Slowly "walk" fingers up the wall as far as pain allows
4. Mark your highest point with a small piece of tape - try to beat it each session
5. Hold at maximum height for 5-10 seconds, then walk fingers back down

Exercise 8 - Isometric Internal Rotation

1. Stand in a doorframe or at the corner of a wall
2. Bend elbow to 90°, keep elbow tucked against your side
3. Place the palm of the hand against the wall/doorframe
4. Gently push palm INTO the wall (as if trying to rotate arm inward) without actually moving
5. Hold 5 seconds, relax

Exercise 9 - Isometric External Rotation

1. Stand with the back of your hand/forearm against a wall
2. Elbow bent to 90°, tucked at your side
3. Push the BACK of your hand into the wall (as if trying to rotate arm outward) without moving
4. Hold 5 seconds, relax

Exercise 10 - Supported Shoulder Rotation (Forearm Slide)

1. Sit at a table with your elbow resting on the surface, bent to 90°
2. Keeping elbow fixed, slide the forearm forward (internal rotation) and backward (external rotation)
3. Move within a comfortable, pain-free range
4. Do not force at end range

PHASE 3: Weeks 13-18 (Strengthening Phase)

Exercise 11 - Theraband Internal Rotation

1. Attach a resistance band to a fixed point at elbow height
2. Stand sideways with injured arm closest to the anchor
3. Elbow bent 90°, arm at your side; hold band in hand
4. Slowly rotate forearm across your body (inward rotation)
5. Hold 1-2 seconds, return slowly to start

Exercise 12 - Theraband External Rotation

1. Anchor band at elbow height; stand with injured side AWAY from anchor
2. Elbow bent 90°, tucked at side
3. Rotate forearm outward (away from body)
4. Hold 1-2 seconds, return slowly

Exercise 13 - Prone Row

1. Lie face down on a bed or bench, arm hanging off the edge
2. Holding a light weight (0.5-1 kg to start), bend elbow and pull arm upward
3. Squeeze shoulder blade back and down at the top
4. Slowly lower back down

Exercise 14 - Prone Extension

1. Lie face down, arm hanging off the edge of bed
2. With a light weight, raise arm straight back behind you (extension)
3. Squeeze at the top for 2 seconds, slowly lower

Exercise 15 - Standing Scaption (Scapular Plane Elevation)

1. Stand upright, arm at your side with thumb pointing up
2. Raise arm diagonally forward (about 30° forward from the side - the "scapular plane")
3. Elevate to 90° (shoulder height) then slowly lower
4. Do NOT shrug the shoulder when raising

Exercise 16 - Forward Punch (Serratus Activation)

1. Lie on your back with arm pointing toward ceiling (90° flexion)
2. Reach your hand further toward the ceiling by pushing the shoulder blade forward
3. Do not bend the elbow; movement is purely from the shoulder blade
4. Hold 2 seconds, relax

PHASE 4: Weeks 19-28+ (Return to Full Activity)

• Closed Kinetic Chain (CKC) exercises: Ball against wall (weight-bearing through arm), wall push-ups progressing to standard push-ups
• Plyometric exercises (for athletes): Rebounder throws, wall dribbles overhead, deceleration drills with weighted ball
• Overhead pressing with gradual weight increase
• Return to sport interval programs (swimming, throwing, tennis, golf) - begin at 19-20 weeks, per physiotherapist guidance
• Weight training: Resume gradually between 28-32 weeks

Precautions - What to Avoid

During Phase 1 (0-6 weeks) - STRICT

During Phase 2 (6-12 weeks) - MODERATE

• Avoid lifting more than 1-2 kg
• Avoid forceful pushing, pulling, or pressing overhead
• Avoid reaching behind your back or placing hand behind your head
• Stop any exercise that produces sharp pain (mild discomfort is acceptable)
• Do NOT progress to weights until callus confirmed on X-ray

During Phase 3 (13-18 weeks)

• No push-ups or pushing movements until Phase 4
• No lifting heavy weights overhead or across the body
• Avoid ballistic/jerky movements
• Always warm up before strengthening exercises

Warning Signs - STOP Exercise and Seek Review

• Sharp, sudden increase in pain at the fracture site
• Visible deformity or new "bump" at the collarbone
• Numbness, tingling, or weakness in the hand/fingers
• Shortness of breath (may indicate pneumothorax - a rare complication)
• Skin becoming red, warm, or swollen over the fracture
• Fever (possible infection, especially after surgery)

Patient Education - Key Messages

Understanding Your Injury

• The clavicle is one of the most commonly fractured bones - you are not alone. Over 90% of uncomplicated fractures heal successfully without surgery.
• Healing has three stages: Inflammatory (0-2 weeks), Reparative/callus formation (2-8 weeks), Remodeling (months). Exercises must match the healing stage.
• X-ray evidence of healing (callus) is the GREEN LIGHT to progress exercises - do not self-advance based on pain alone.

Sling Care

• Wear your sling 24 hours a day, including during sleep, for the first 3-6 weeks unless told otherwise.
• You may remove it only to bathe - support your arm with the other hand during bathing.
• When putting on shirts, dress the injured arm first; when undressing, remove the uninjured arm first.
• Sleep positions: Elevate head of bed slightly; sleeping semi-reclined (30-45°) is often most comfortable.

Pain Management

• Ice application: 15-20 minutes to the fracture area, 3-4 times daily for the first 1-2 weeks - place a cloth between ice and skin to prevent frostbite.
• Take pain medications (e.g., paracetamol, ibuprofen) as prescribed - do not exceed recommended doses.
• Do not mix pain medications without physician guidance.
• Mild aching after exercise is normal. Sharp pain = stop.

Posture & Daily Life

• Avoid slumping forward - poor posture strains the healing bone. Consciously sit tall.
• When standing or walking, keep shoulder blades gently drawn back (not squeezed tightly).
• Avoid carrying bags on the injured shoulder for at least 3 months.
• Use the uninjured arm for all lifting and carrying tasks during Phase 1.
• When typing or using a phone, support the elbow to avoid fatigue.

Nutrition for Bone Healing

• Calcium: Aim for 1000-1200 mg/day (dairy, leafy greens, fortified foods). Adequate calcium accelerates callus formation.
• Vitamin D: 800-1000 IU/day recommended - essential for calcium absorption. Get 15-20 minutes of sunlight or use a supplement.
• Protein: Adequate protein intake (0.8-1.2 g/kg/day) supports tissue repair.
• Avoid smoking - nicotine severely impairs bone healing and increases non-union risk by up to 40%.
• Limit alcohol - disrupts calcium metabolism and bone repair.

Driving

• Do NOT drive while wearing a sling or while range of motion is restricted.
• Most patients can return to driving at 6-8 weeks (after sling removal), but check with your doctor first - depends on which side is injured and whether the car is manual or automatic.

Return to Work

• Desk/office workers: Generally return within 1-3 weeks, using the uninjured arm.
• Manual workers or those lifting >5 kg: Wait for fracture union (typically 8-12 weeks) and medical clearance.
• Heavy labor / overhead work: May require 3-4 months before return.

Follow-Up Schedule (Typical)

• Week 1-2: Wound check (if surgical)
• Week 3-4: Clinical review and X-ray
• Week 6: X-ray to assess callus
• Week 12: Assessment for return to activity
• Week 20-28: Return to sport evaluation

Psychological Recovery

• Feeling frustrated about activity restrictions is normal and expected.
• Communicate with your physiotherapist if pain is interfering with sleep or daily function - this can be addressed with positioning aids or medication adjustment.
• Stay active within restrictions (walking, stationary cycling with one hand) to maintain cardiovascular fitness and mood.

Summary Timeline at a Glance