 
 
Rehabilitation Protocol for Clavicle ORIF 
  
This protocol is intended to guide clinicians through the post-operative course for clavicle ORIF. This protocol is time 
based (dependent on tissue healing) as well as criterion based. Specific intervention should be based on the needs of the 
individual and should consider exam findings and clinical decision making. The timeframes for expected outcomes 
contained within this guideline may vary based on surgeon’s preference, additional procedures performed, and/or 
complications. If a clinician requires assistance in the progression of a post-operative patient, they should consult with 
the referring surgeon. 
  
The interventions included within this protocol are not intended to be an all-inclusive list of exercises. Therapeutic 
interventions should be included and modified based on the progress of the patient and under the discretion of the 
clinician.  
  
Considerations for the Post-operative Clavicle ORIF 
Many different factors influence the post-operative clavicle ORIF rehabilitation outcomes, including bone health, blood 
supply, pre-operative shoulder range of motion (ROM), strength, and function. Other individual considerations include 
patient age and co-morbidities, such as: increased BMI, smoking, and diabetes. It is recommended that clinicians 
collaborate closely with the referring physician regarding specific ROM or loading guidelines for each individual case. 
 
Post-operative considerations 
If the patient develops a fever, unresolving numbness/tingling, excessive drainage from the incision, uncontrolled pain 
or any other symptoms you have concerns about you should contact the referring physician. 
 
PHASE I: IMMEDIATE POST-OP (1-4 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Protect healing bone and soft tissue 
• Minimize pain and inflammation  
• Restore shoulder PROM 
• Maintain elbow wrist and hand ROM 
Sling 
• Wear sling for at least 3 weeks. Sling should be taken off at least four times per day to perform 
exercises and daily activities such as eating, dressing, and bathing 
• Sling should be worn while sleeping 
Precautions 
• No active motion of involved shoulder 
• No lifting or carrying objects with involved arm 
• No weight bearing through involved arm 
• No shoulder flexion or abduction beyond 90 degrees 
Intervention 
Pain/Swelling management 
• Cryotherapy and modalities as needed 
 
Range of motion/Mobility 
• PROM: ER and IR in the plan of the scapular to tolerance. Flexion/Scaption/abduction </= 90 
degrees. Table slides, pendulums  
• AAROM: Shoulder ER c dowel/cane in neutral 
• AROM: Elbow, wrist, hand, and cervical AROM 
 
Strengthening (Week 2) 
• Elbow, wrist, hand: resisted wrist extension, resisted wrist flexion, resisted 
pronation/supination, ball squeezes 
 
 
 
 
Cardio 
• Walking with arm in sling 
• Recumbent bike with arm in sling 
Criteria to 
Progress 
• 90 degrees PROM Flexion/Scaption  
• 30 degrees shoulder PROM ER 
• IR PROM to belt line 
• < 4/10 pain at rest 
• Full elbow, wrist and hand AROM 
 
PHASE II: INTERMEDIATE POST-OP (5-8 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Wean from sling 
• Progress shoulder PROM, AA/AROM 
• Improve distal arm strength 
• Decrease pain 
Sling 
• Continue to use sling for sleep up until 6 weeks post op 
• Can wean from sling throughout the day and discharge sling completely at 6 weeks post op 
Precautions 
• No lifting or carrying objects > a coffee cup with involved arm 
• No forceful stretching of involved shoulder or positions that cause pain 
Additional 
Intervention 
*Continue with 
Phase I 
interventions 
Range of motion/Mobility 
• PROM: Full shoulder PROM in all planes of motion per tolerance 
• AAROM: Supine shoulder flexion with dowel (Lawn Chair progression), standing shoulder 
flexion with dowel, rail slides, wall slides, pulleys 
• AROM: Supine shoulder flexion, standing shoulder flexion, seated shoulder ER, side-lying 
shoulder ER 
 
Strengthening 
• Periscapular: scap retraction, prone scap retraction, low row, mid row, resisted straight arm 
extension, supine serratus punches 
• Elbow: biceps curls, triceps extension 
 
Cardio 
• Walking with arm out of sling 
• Recumbent bike 
• Stationary bike after 6 weeks, or if cleared by surgeon 
Criteria to 
Progress 
• Full shoulder PROM 
• 120 degrees or greater shoulder AAROM flexion 
• > 30 degrees shoulder ER AROM 
• Minimal compensation pattern with shoulder movements 
• < 4/10 pain with shoulder AROM 
 
PHASE III: LATE POST-OP (9-12 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Maximize shoulder AROM 
• Initiate shoulder girdle muscle activation 
Precautions 
• No lifting objects > 5 lbs 
Additional 
Intervention 
*Continue with 
Phase I-II 
Interventions  
Range of motion/Mobility 
• AROM: Continue to progress shoulder AROM and minimize compensatory patterns 
• Stretching: Lat stretch, doorway stretch, pec/biceps stretch, posterior capsule stretch, sleeper 
stretch 
 
Strengthening: 
• Shoulder: Isometric flexion, Isometric extension, Isometric ER, Isometric IR, resisted IR, resisted 
ER 
 
Cardio 
 
 
• Biking 
• Swimming if cleared by surgeon 
• Running if cleared by surgeon 
Criteria to 
Progress 
• >/= 90% shoulder AROM compared to uninvolved side 
• Appropriate muscle activation with isometric contraction of rotator cuff and periscapular 
muscles 
 
PHASE IV: TRANSITIONAL (12-16 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Initiate and progress isotonic shoulder strengthening 
• Return to normal ADLs  
Additional 
Intervention 
*Continue with 
Phase I-III 
interventions 
Range of motion/Mobility 
• Continue with ROM and stretching exercises as needed 
 
Strengthening 
• Shoulder: wall push-ups, scaption raises, serratus roll ups, chest pulls, rhythmic stabilizations, 
plantigrade shoulder taps 
 
Cardio 
• Swimming, Running, Biking, Elliptical  
Criteria to 
Progress 
• Good form with strengthening exercise 
• Full shoulder ROM 
• 0/10 pain at rest, </= 3/10 pain with resisted exercises 
• 4/5 shoulder strength or greater 
• No difficulties with ADL and light work-related activities  
 
PHASE V: RETURN TO SPORT (4-6 MONTHS AFTER SURGERY) 
Rehabilitation 
Goals 
• Progressive strengthening and stability of involved shoulder 
• Return to normal sport activities 
Additional 
Intervention 
*Continue with 
Phase II-IV 
interventions 
Strengthening 
• Counter push-ups, standard push-ups, resisted IR in abduction, resisted ER in abduction, wall 
walks, face-pulls, resisted PNF diagonals,  
• Interval return to sport training 
Criteria to 
Progress 
• 90% strength or greater of involved shoulder compared to uninvolved side with dynamometry 
testing 
• 0% disability on Quick DASH 
• No pain with strength training 
Revised 1/2023 
 
Contact 
Please email MGHSportsPhysicalTherapy@partners.org with questions specific to this protocol 
References: 
 
1. 
Lädermann A, Abrassart S, Denard PJ, Tirefort J, Nowak A, Schwitzguebel AJ. Functional recovery following early mobilization after middle third clavicle 
osteosynthesis for acute fractures or nonunion: a case-control study. Orthopaedics & Traumatology: Surgery & Research. 2017 Oct 1;103(6):885-9. 
2. 
Lynch, B., Christain, H., McCrum, C. L., Vyas, D.,  Postoperative management of Orthopsedic Surgeries: Shoulder. La Crosse, WI. Academy of Orthopaedic 
Physical Therapy. 2020. 
3. 
Rabe SB, Oliver GD. Clavicular fracture in a collegiate football player: a case report of rapid return to play. Journal of athletic training. 2011 
Jan;46(1):107-11. 
4. 
Robertson GA, Wood AM. Return to sport following clavicle fractures: a systematic review. British medical bulletin. 2016 Sep 1;119(1). 
5. 
Waldmann S, Benninger E, Meier C. Nonoperative Treatment of Midshaft Clavicle Fractures in Adults. The open orthopaedics journal. 2018;12:1. 
