Adam Seidl, MD - Board Certified Orthopaedic Surgeon - Shoulder and Elbow Specialist

Adam Seidl, MDBoard Certified Orthopaedic SurgeonShoulder and Elbow Specialist

Shoulder Fractures

ORIF Clavicle

PHASE I: Protect fixation (1 to 2 weeks)

  • Sling: for comfort
  • Motion: Immediate Pendulum ROM exercises, No overhead motion
  • Strengthening: No resistive exercises/actvities

PHASE II: Advance ROM (2-6 weeks)

  • Sling: for comfort
  • Motion: Immediate Pendulum ROM exercises, Begin gentle PROM above shoulder level, Begin AROM, AAROM in all planes to pain tolerance
  • Strengthening: Begin gentle theraband resistive exercises

PHASE III: Restore function (6-12 weeks)

  • Sling: Discontinue sling
  • Motion: full motion by week 12
  • Strengthening: Progress to higher weights and sports specific training at week 10
  • Return to sports 3-6 months from surgery

ORIF Proximal Humerus Fracture

Outpatient Physiotherapy PHASE 1: (Weeks 2-4)

ROM

  • Cervical, elbow and wrist ROM
  • Pendulum exercises
  • Supine Passive ROM forward elevation to: ___ external rotation to: ___
  • Instruct Home Exercise Program

Strengthening

  • No cuff strengthening
  • Begin and instruct in program of postural correction
  • May begin scapular retraction and depression
  • Grip strengthening

Sling

  • Arm in sling at all times except for exercises and bathing; includes sling at night (sleeping in recliner chair optimal); Discontinue sling between 2-4 weeks

Outpatient Physiotherapy PHASE 2: (Weeks 5-8)

ROM

  • Begin self-assisted forward elevation to 90° and progress in 20° increments per week
    • Use Pulleys
  • Begin self-assisted ER with progressive return to full in 20° increments per week
  • IR in scapular plane as tolerated (No IR behind back)
  • No cross body adduction
  • Grade I-II scapulothoracic and glenohumeral mobilizations

Strength

  • No cuff strengthening
  • Continue scapular retraction and depression
  • Lower extremity aerobic conditioning

Other

  • Modalities to decrease pain and inflammation
  • Cryotherapy as necessary

Outpatient Physiotherapy PHASE 3: (Weeks 9-12)

ROM

  • Progressive return to full forward elevation and external rotation
  • May begin posterior capsular stretching program
  • May begin IR behind back
  • Grade III-IV glenohumeral and scapulothoracic mobilizations
  • Begin anterior chest wall stretches (pectoralis minor)

Strength

  • Instruct in home program and begin submaximal isometrics in flexion, abduction, IR, ER and extension
  • Add progressive isotonics with low resistance, high repetitions as tolerated
  • Emphasize anterior deltoid strength and scapular stabilization
  • Emphasize upper trapezius, serratus anterior force couple rehabilitation to create stable scapular base
  • Assess for and correct compensatory movement patterns
  • UBE with low resistance
  • Continue aerobic conditioning

Outpatient Physiotherapy PHASE 4: (> Week 12)

ROM

  • Progressive return to full motion in all planes
  • Emphasize posterior capsule stretching
  • Maintenance home flexibility program

Strength

  • Continue rotator cuff and scapular strengthening program
    • Progressive increase in resistance as strength improves
  • Continue UBE with progressive resistance as tolerated
  • Recreation/vocation specific rehabilitation
  • Maintenance aerobic conditioning home program

Proximal Humerus Fractures: Nonoperative Treatment

Outpatient Physiotherapy PHASE 1: (Weeks 2-4)

ROM

  • Cervical, elbow and wrist ROM
  • Pendulum exercises
  • Instruct in home program

Strengthening

  • No cuff strengthening
  • Begin and instruct in program of postural correction
  • May begin scapular retraction and depression
  • Grip strengthening

Sling

  • Arm in sling at all times except for exercises and bathing; Includes sling at night (sleeping in recliner chair optimal); Discontinue sling between 2-4 weeks

Outpatient Physiotherapy PHASE 2: (Weeks 5-8)

ROM

  • Begin self-assisted forward elevation to 90° and progress in 20° increments per week
    • May use pulleys
  • Begin self-assisted ER with progressive return to full in 20° increments per week
  • IR in scapular plane as tolerated (No IR behind back)
  • No cross body adduction
  • Grade I-II scapulothoracic and glenohumeral mobilizations

Strength

  • No cuff strengthening
  • Continue scapular retraction and depression
  • Lower extremity aerobic conditioning

Other

  • Modalities to decrease pain and inflammation
  • Cryotherapy as necessary

Outpatient Physiotherapy PHASE 3: (Weeks 9-12)

ROM

  • Progressive return to full forward elevation and external rotation
  • May begin posterior capsular stretching program
  • May begin IR behind back
  • Grade III-IV glenohumeral and scapulothoracic mobilizations
  • Begin anterior chest wall stretches (pectoralis minor)

Strength

  • Instruct in home program and begin submaximal isometrics in flexion, abduction, IR, ER and extension
  • Add progressive isotonics with low resistance, high repetitions as tolerated
  • Emphasize anterior deltoid strength and scapular stabilization
  • Emphasize upper trapezius, serratus anterior force couple rehabilitation to create stable scapular base
  • Assess for and correct compensatory movement patterns
  • UBE with low resistance
  • Continue aerobic conditioning

Outpatient Physiotherapy PHASE 4: (> Week 12)

ROM

  • Progressive return to full motion in all planes
  • Emphasize posterior capsule stretching
  • Maintenance home flexibility program

Strength

  • Continue rotator cuff and scapular strengthening program
    • Progressive increase in resistance as strength improves
  • Continue UBE with progressive resistance as tolerated
  • Recreation/vocation specific rehabilitation
  • Maintenance aerobic conditioning home program

ORIF mid-humerus

Coming soon

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Location Map

  • Orthopedics - University of Colorado Hospital

    1635 Aurora Ct
    4th Floor
    Aurora, CO 80045

  • UCHealth Lone Tree Clinic

    9548 Park Meadows Dr
    Lone Tree, CO 80124

Credibility Logos

  • The American Board of Orthopaedic Surgery logo
  • American Academy of Orthopedic Surgeons logo
  • American Shoulder And Elbow Surgeons logo
  • Western Orthopaedic Association logo
  • Alpha Omega Alpha
  • Moon Shoulder