A shoulder fracture, often involving the upper arm bone (humerus) or shoulder blade (scapula), requires a careful recovery process. The initial phase involves immobilization to allow the broken bone fragments to stabilize and begin healing. Once a physician or physical therapist clears the shoulder for movement, the focus shifts to restoring the joint’s basic mobility, known as range of motion. Gentle, controlled exercises are introduced during this post-immobilization stage to prevent stiffness and prepare the joint for future strengthening.
Pre-Exercise Safety and Preparation
Securing official medical clearance from a physician or physical therapist is non-negotiable before attempting any shoulder exercises. Starting motion too early can disrupt the fracture site, potentially leading to delayed healing or complications. Readiness is confirmed once acute pain has subsided, the sling has been removed, and imaging shows sufficient bone stability, often several weeks after the injury. Preparation involves ensuring a safe, clutter-free environment and adopting proper posture, sitting or standing tall to align the spine and shoulder blade. The guiding principle is to avoid active lifting using the injured shoulder’s own muscles, as the initial goal is passive or assisted motion.
The Seven Foundational Range of Motion Exercises
1. Pendulum Swings
The pendulum swing is typically the first exercise introduced, utilizing gravity to create gentle, passive motion at the shoulder joint. Stand with your uninjured hand supported on a table or chair, leaning forward so the injured arm hangs straight down. Relax the injured arm completely, letting it dangle like a weight. Use your body’s momentum, shifting your weight forward, backward, and side to side, to create small, free swings. Move your body in a small circle to make the arm swing in a circular pattern, performing 10 revolutions clockwise and 10 counter-clockwise. This passive motion lubricates the joint and prevents scar tissue formation without stressing the healing bone.
2. Assisted Table Slides (Forward Flexion)
This exercise restores forward elevation of the arm, known as flexion, using a smooth, supported surface. Sit facing a sturdy table with your forearm and hand resting on a small cloth or towel to reduce friction. Gently slide your hand forward along the table surface, simultaneously leaning your trunk forward to assist the movement. The sliding motion allows the non-contractile tissues of the shoulder to stretch, promoting mobility in the anterior capsule. Slide the arm only as far as you can comfortably manage before slowly returning to the starting position.
3. External Rotation with a Stick
External rotation is the movement of turning the arm outward, necessary for daily tasks like reaching behind the head. Sit or stand holding a lightweight stick or cane horizontally with both hands, keeping your elbows bent at 90 degrees and tucked close to your sides. Use your uninjured hand to gently push the stick horizontally across your body, causing the injured arm to rotate outward. The uninjured arm provides the force, ensuring the movement is passive and controlled. Hold the outward stretch for five to ten seconds, feeling gentle tension but no sharp pain.
4. Internal Rotation Towel Stretch
Internal rotation, the movement of reaching behind your back, is targeted using a towel for assisted leverage. Hold one end of a rolled-up towel with the injured hand behind your back near the waist. Hold the other end over the opposite shoulder with your uninjured hand. Use the uninjured arm to gently pull the towel upward, sliding the injured hand further up your back. This stretch improves the mobility of the posterior shoulder capsule, which often tightens after immobilization. Hold the maximum comfortable stretch for 15 to 30 seconds, then slowly release.
5. Finger Walks (Wall Slides)
Finger walks, or wall slides, are an assisted active range of motion exercise focusing on increasing forward flexion or abduction. Stand facing a wall or sideways to it, placing the fingertips of the injured arm against the surface. Slowly “walk” your fingers up the wall, using the surface to support the arm’s weight and guide the movement. The goal is to reach a point of comfortable stretch, not pain, ensuring the shoulder does not shrug or hike upward to compensate. Hold the highest point for 10 seconds, then slowly walk the fingers back down to the starting position.
6. Passive Abduction with Healthy Arm
Abduction is the motion of lifting the arm out to the side away from the body, and this exercise uses the healthy arm for assistance. Lie on your back with your injured arm resting by your side. Clasp the wrist of your injured arm with your healthy hand. Using the strength of your healthy arm, gently lift the injured arm out to the side and up toward your head. The injured arm remains completely relaxed during this movement, as the healthy arm provides the necessary force. Continue to lift the arm until a gentle stretch is felt, holding briefly before slowly lowering it.
7. Gentle Scapular Retractions
This movement focuses on the stability and control of the shoulder blade (scapula), which provides the foundation for shoulder movement. Sit upright with good posture, keeping your arms relaxed at your sides or supported on a surface. Gently squeeze your shoulder blades together and slightly down, as if trying to pinch a pencil between them. This is an isometric exercise, meaning the joint angle does not change significantly. It activates stabilizing muscles like the rhomboids and trapezius. Hold the squeeze for five to six seconds, then relax, focusing on the quality of the contraction rather than the force.
Recognizing Pain Signals and Advancing Rehabilitation
While performing these exercises, distinguish between the expected feeling of mild muscle fatigue or a gentle pulling sensation from a stretch, and actual pain. A low level of discomfort, often a dull ache, may occur as stiff tissue is mobilized, but this should subside quickly once the movement stops. Any sharp, stabbing, radiating, or rapidly increasing pain is a signal to immediately stop the exercise. This suggests the tissue is being pushed too hard, potentially irritating the healing fracture site or surrounding soft tissues. If pain persists or worsens over several days, consult your physical therapist or doctor to adjust the rehabilitation plan. Once you can perform all seven range of motion exercises easily and without pain, and have achieved a nearly full range of motion, you are ready to discuss the next phase of recovery. This subsequent stage involves moving beyond mobility work to light strengthening exercises, such as gentle isometric holds and resistance band work, to rebuild lost muscle strength.