Functional rehabilitation after clavicle fracture

- Dec 24, 2019-

The clavicle is an S-shaped connection and support device for the upper limbs and torso. The distal condyle is flat and convex toward the back, which is conducive to the attachment and stretching of muscles and ligaments. The distal end forms the acromioclavicular joint with the acromion, and the coracoclavicular ligament fixes the clavicle; the proximal condyle is diamond-shaped convex to the ventral side, and the sternoclavicular joint is formed by the strong ligament tissue and the sternal handle, and there is a sternocleidomastoid process. Muscle attachment.


The clavicle is located under the skin and its position is shallow. Once a fracture occurs, swelling and ecchymosis occur, and shoulder pain can further aggravate the pain. This article will discuss the recovery of upper limb function after a clavicle fracture in conjunction with the period of the clavicle fracture.


Brachial plexus nerves and subclavian blood vessels pass behind the clavicle. When the clavicle is subjected to strong violence, fractures, lung injury, vascular injury, and brachial plexus injury in other parts may occur, and a series of upper limb dysfunction.


Depending on the type of clavicle fracture, surgery or conservative treatment can be chosen. With the increasing maturity of internal fixation technology and the rapid development of internal fixation equipment, surgical treatment of clavicle fractures has been recognized by most experts and patients, and anatomical reduction can be achieved.


After the clavicle fracture and local soft tissue damage, blood circulation disorders, local pain and swelling, and limb movement disorders after surgery. Functional exercise can promote blood circulation and achieve swelling and pain relief. Therefore, doctors should encourage patients to begin functional exercise early in the postoperative period, to intervene in rehabilitation treatment, to choose appropriate training according to different periods, and gradually to achieve the purpose of restoring upper limb function.


After the anesthesia disappeared on the day after the operation, active finger fists, finger extensions, finger extension exercises, wrist back extension and palm flexion exercises, and elbow flexion and extension exercises can be performed.


After the X-ray examination on the first postoperative day confirmed that the fracture was well reset, the patient was assisted in passive shoulder function exercises. When standing, the triangle suspends the affected limb in front of the chest, the body flexes laterally to the affected side, and swings the shoulder back and forth; the body flexes toward the affected side, and leans forward slightly, swinging inside and outside the shoulder.


From 2 days after the operation, you can perform pendulum exercises such as bending down, draping the upper limbs and making the forearm of the affected side with a clockwise or counterclockwise circle.


Patients were instructed to perform exercises such as flexion and extension of the forearm of the affected limb and grasping of boxing for 3 days after the operation, each time is not less than 10 minutes. If the shoulder was swollen, wound oil and hot compresses could be given. Within 1 week after surgery, except for the training time, the affected limb should be suspended with a triangle towel.


After 7 days, active movements of the shoulder joint in all directions and axes were performed. details as follows:


1. Shoulder joint circular motion (ie upper limb circle): The patient bends forward, the upper arm naturally hangs down perpendicular to the ground, and the shoulder joint performs clockwise and counterclockwise circular motion.


2. Internal rotation: put the affected side with the backside and put the opposite side


3. External rotation: touch the opposite ear with the affected side's hand across the face


4. Climbing the wall method: The patient stands facing the wall, the affected limb straightens forward and crawls upward.


The supine position is mainly adopted within 2 weeks after the operation. A small air cushion of 4-6cm on the ipsilateral scapular region is used to extend the affected shoulder backward; When the healthy side is lying, the head, neck, and back are slightly sideways to the healthy side, taking the patient's comfort as the degree. Early rehabilitation is essential for active and passive joint activities. You can start with a shrug. The activity can stimulate mechanoreceptors to reduce pain, and it can have beneficial effects on collagen fiber arrangement and joint cartilage. Combine small-scale shoulder ROMs for painless abduction, forward flexion, internal rotation, and isometric contraction exercises. The total amount of training is not to increase the pain and inflammation of the shoulder. If there is pain, intervention methods such as cold therapy and painkillers are timely. This is a very important point for rehabilitation intervention.


Three to six weeks after surgery, pull training in all directions of the shoulder joint can be performed, such as pulley pull, wall climbing, etc., while continuing the isometric contraction training in the previous stage. It should be noted that the forearm sling must be supported and protected within 1 month after operation to keep the acromioclavicular joint in a functional position without bearing weight.


After 6 weeks, the purpose of rehabilitation training is to restore the mobility of the affected joints, increase muscle strength, and restore limb function. It can strengthen the active activity and weight-bearing exercise intensity, range, amount of exercise and duration of the injured limb joints, and gradually resume daily activities and sports to restore the activity of the affected joints, strengthen muscle strength, and restore limb function.


After the clavicle fracture, if the affected limb is in a fixed state for a long period of time, the limbs and joints cannot perform normal functional activities, and the costly atrophy of muscles, joint adhesions, osteoporosis, and fracture nonunion occur in the long-term. After a clavicle fracture, regular functional exercise can improve the prognosis of the fracture site, improve muscle strength, prevent muscle atrophy, and prevent dysfunction of the upper limbs and hands.