Physiotherapy for fracture of the collarbone

Collarbone (lat. Clavicula) is a bone that connects shoulder joint to breastbone. Thus, the collarbone acts as an important connecting factor in the connection of the upper limb to the body. So the fracture of the collarbone affects the functioning of the entire upper limb. The collarbone can break for example in sports or for various other reasons and fractures have been observed both in children and adults.

Bone fractures do not always require surgical treatment to heal, and a good fracture can be conservatively rehabilitated, ie without surgery. Depending on the situation, physiotherapy is usually started within 0-6 weeks after the fracture. However, I remember from my career a case where a client only came to rehabilitation nearly half a year after a collarbone fracture surgery and we were still able to rehabilitate the fracture site very well.

Because the collarbone connects the upper limb to the torso, fracture of the collarbone affects the function of the upper limb. As a result of a fracture, the operation of the upper limb causes pain in the clavicle and shoulder, and after the fracture, and in some cases it may not even be possible to move the upper limb due to pain after a collarbone fracture. Physiotherapy focuses on restoring upper limb and shoulder joint movement, reducing pain, and gradually strengthening the muscles involved in upper limb and shoulder joint activity.

Where to start in collarbone fracture physiotherapy?

At the beginning of rehabilitation, physiotherapy focuses on increasing and restoring movement capabilities. It is important to take into account all different movement angles that naturally occur from the shoulder.

The loading and volume of movement are first increased in the easiest and most painless positions possible. This can be done by changing position, for example, lying on your back, stomach, or side can make the same workout very different. In addition, movement paths can be restored and maintained with manual help from the physiotherapist as the therapist can move the upper limb passively, i.e., when the client is completely relaxed.

At the beginning of the rehabilitation, light exercises for upper limb and shoulder muscles, such as isometric muscle tension exercises, may also be included. These refer to exercises where the muscle contracts but does not move the joints. These exercises can be carried out e.g. by pressing the forearm against the wall or pressing the palms together.

How does the rehabilitation progress?

As the upper limb movement capabilities increase and the pain decreases, we move on to the upper limb and rotator cuff muscle strengthening exercises. Exercise can be done using body weight, elastic band and small dumbbells, so that the shoulder joint is strengtened in every direction of movement.

Even though the fracture line is already ossified and the doctor has given the green light to practice all directions of motion and allow the upper limb to work fully, there may still be caution and fear in the use of the upper limb. The client may be excited about leaning on the upper limb or leaning on their hands, so physiotherapy also focuses on overcoming these fears step by step. Initially, leaning on hands can be practiced against a wall moving step by step to the push-up position on the ground.

When the fracture line is certain to be in good shape, physiotherapy can also progress to exercises that stress the collarbone more strongly.For example throwing the ball, starting with lighter weight and progressing to heavier gym balls. Throws should be made from the sides, front, top and bottom, and also catching should be done from all directions.

What is the rehabilitation goal?

Post-fracture rehabilitation aims to restore upper limb range of motion, strength and performance to pre-injury levels or even beyond. Rehabilitation requires a lot of work and training, but it is possible to get the upper limb back into a functional whole if the client commits to practice according to the instructions of the physiotherapist.