Rehabilitation Precautions
• The first goal of rehabilitation is to ensure fracture healing in acceptable alignment.
• Emphasis should be placed on the frequency and consistency of exercises rather than the intensity of any single exercise.
• At completion of the program, the exercises should continue indefinitely as a maintenance regimen.
• Home therapy should be instructed, with transition to independent home therapy when appropriate.
Phase I: Fracture Healing and Pain Relief (0–2 Weeks)
During the first two weeks, the focus is on decreasing pain and ensuring fracture stability and healing.
• Use pain modalities as indicated
• Sling immobilization of the shoulder when not performing exercises
• Elbow, wrist, and hand exercises — flex and extend the elbow, wrist, and hand for 10 repetitions, 3–5 times per day
Phase II: Continued Fracture Healing and Restoration of ROM (2–6 Weeks)
• Discontinue sling entirely
• Begin formal physical therapy with pendulum exercises
• Continue elbow, wrist, and hand exercises
• Continue use of pain modalities as indicated
Phase III: Restore Range of Motion (6–12 Weeks)
• Continue formal physical therapy; begin active and active-assisted ROM in all planes as tolerated
• Add scapular stabilizer exercises to promote scapular retraction
• Emphasize restoration of overhead motion
• Initiate JPL Exercises Phase I, transitioning to Phases II and III as tolerated
• Continue elbow, forearm, and hand range-of-motion exercises
• Resume activities of daily living; no lifting heavier than a fork, knife, or toothbrush
Phase IV: Strengthen Shoulder (>12 Weeks)
• Continue patient-directed passive ROM and active ROM exercises
• Initiate gentle rotator cuff strengthening with Therabands:
– Choose a band that allows fatigue but not pain within 10–20 repetitions
– When 20 repetitions can be completed without fatigue or pain, progress to the next resistance band
– Internal rotation strengthening
– External rotation strengthening
– Anterior deltoid strengthening
– Posterior deltoid strengthening
– Lateral deltoid strengthening
• Continue scapular stabilizer strengthening
• Avoid strengthening in positions of impingement
• Resume functional activities as tolerated
Phase V: Maintenance
• Perform once daily:
– Patient-directed passive ROM JPL Exercises
– Rotator cuff strengthening exercises
