Rehabilitation After Clavicle Fracture and Patellar Ligament Tear: What to Know

Rehabilitation for a clavicle fracture combined with a patellar ligament rupture (on the same side, right arm/right leg) should be approached carefully and typically involves the following steps: 1. Initial Phase (0-6 weeks): - Immobilization: Use a sling for the clavicle fracture and a knee brace for the patellar ligament injury to allow for healing. - Pain Management: Utilize ice, elevation, and prescribed pain medications as needed. - Gentle Range of Motion (ROM) Exercises: As tolerated,

On February 18, a car accident resulted in a clavicle fracture and a rupture of the patellar ligament (on the same side, right arm/right leg).
After undergoing right clavicle plate fixation surgery on February 22, patellar ligament surgery was performed on March 5.
I would like to ask the physician: Is it appropriate to start rehabilitation less than 24 hours after the ligament surgery? (The attending physician suggested lying prone and pulling a towel at a 30-degree angle.) I am questioning whether this is suitable given that it has only been 12 days since the clavicle surgery.

2.
Can you recommend appropriate rehabilitation exercises? I am concerned that the ligament, which was injured two weeks prior to surgery, may atrophy and affect rehabilitation.

Xiao Ping, 30~39 year old female. Ask Date: 2021/03/06

Dr. Chen Bochen reply Orthopedics

Is it appropriate to start rehabilitation less than 24 hours after ligament surgery? Is it reasonable to question the rehabilitation of the right clavicle just 12 days post-surgery?
1.
As long as the movements are moderate and appropriate, the sooner rehabilitation begins after surgery, the better.

2.
Can you suggest suitable rehabilitation exercises? It is best to consult a rehabilitation specialist, as a physical therapist can guide you through the exercises more effectively than written descriptions.

I am concerned about potential ligament damage since the surgery was performed two weeks after the injury.
Will this lead to atrophy that could affect rehabilitation? A timeframe of 2-3 weeks is considered reasonable; early rehabilitation is less likely to result in atrophy.

Reply Date: 2021/03/06

More Info

Rehabilitation after a clavicle fracture and patellar ligament tear is a crucial process that requires careful planning and execution to ensure optimal recovery. Given your situation, where you sustained both injuries in a car accident, it’s essential to follow a structured rehabilitation program that addresses both the clavicle and the knee.

1. Timing for Rehabilitation: After surgery for a ligament tear, it is generally recommended to start rehabilitation as soon as possible, often within 24 to 48 hours post-surgery, depending on the specific surgical procedure and the surgeon's recommendations. In your case, since you had surgery on the patellar ligament on March 5, starting gentle rehabilitation exercises as advised by your physician is appropriate. The suggestion to perform exercises like pulling a towel while lying on your stomach at a 30-degree angle is a good start. This position helps to minimize strain on the shoulder while allowing for some mobility.

2. Rehabilitation Exercises: For your clavicle fracture, focus on gentle range-of-motion exercises to prevent stiffness. Here are some exercises you might consider, but always consult your physical therapist or physician before starting:
- Pendulum Exercises: Lean forward and let your arm hang down. Gently swing your arm in small circles to promote mobility without putting too much stress on the clavicle.

- Shoulder Shrugs: While sitting or standing, lift your shoulders towards your ears and then relax them down. This helps to maintain shoulder mobility.

- Scapular Retraction: Sit or stand with your arms at your sides. Squeeze your shoulder blades together and hold for a few seconds, then relax. This helps strengthen the muscles around the shoulder.

For your knee rehabilitation after the patellar ligament surgery, consider the following exercises:
- Quadriceps Sets: While sitting or lying down, tighten your thigh muscle (quadriceps) and hold for a few seconds, then relax. This helps maintain muscle strength.

- Straight Leg Raises: While lying down, keep one leg bent and the other straight. Slowly lift the straight leg to the height of the bent knee and lower it back down.

- Heel Slides: While lying down, slide your heel towards your buttocks, bending your knee as much as possible, then slide it back out. This helps improve knee flexion.

3. Concerns About Muscle Atrophy: It’s common to worry about muscle atrophy, especially when there’s a delay in surgery. However, starting rehabilitation exercises as soon as you are cleared by your physician can help mitigate this risk. The key is to perform the exercises within a pain-free range and gradually increase intensity as tolerated.
4. Monitoring Progress: Keep track of your pain levels and range of motion during rehabilitation. If you experience significant pain or swelling, it’s essential to communicate this with your healthcare provider. They may adjust your rehabilitation plan based on your progress.

5. Long-Term Recovery: Recovery times can vary significantly based on the severity of the injuries and individual healing rates. Generally, you can expect a gradual return to normal function over several months. Consistent rehabilitation and following your healthcare provider's advice will be critical in achieving the best possible outcome.

In summary, starting rehabilitation soon after surgery is beneficial, and focusing on gentle exercises for both the shoulder and knee will aid in recovery. Always consult with your healthcare provider or physical therapist to tailor a rehabilitation program that suits your specific needs and circumstances.

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