肩部骨折后康复

发布:2026年7月26日更新:2026年10月6日

14周、每周3次、每次45分钟，无特殊设备，逐步恢复肩部功能。

摘要速览

专业康复计划，旨在有效康复和疼痛管理

医学审核:WellAlly 编辑团队最后审核 2026年10月6日编辑政策

关键信息一览

检查部位: 上肢 · 肩关节
损伤类型: 骨折后康复
级别: 初级
疗程: 14
每周次数: 3
每次时长（分钟）: 45
证据等级: 中度
ICD-10: S42
费用档位: 中度

计划概览——初学者肩部骨折后康复（14周）

本计划适用于肩部骨折后正在恢复、并已获得临床医生许可开始温和康复训练的人。这是一个为期14周的初学者计划，每周三次，每次45分钟。目标是逐步恢复肩部活动、重建肩袖和肩胛骨肌肉的力量、改善关节周围的协调与控制，并帮助您更有信心、更少不适地回归日常活动。进展取决于肩部的反应，而不是急于赶日历进度。

开始之前

运动前务必热身；如果疼痛加重应停止，而不是硬撑。本计划不适合在急性炎症期或剧烈疼痛时进行，请等这些情况缓解并由临床医生确认您已准备好后再开始。保持动作轻柔可控，避免让肩部负担过重。如果出现尖锐或加重的疼痛、新的肿胀、关节不稳的感觉、手臂或手部麻木或刺痛，或者日常活动变得比以前更困难而不是更容易，请停止并联系您的临床医生。

每周结构

本计划共14周，每周三次，每次约45分钟。您将使用网球、弹力带、沙袋和泡沫轴。早期几周注重保护和温和活动；中间几周引入主动运动和轻度力量训练；后期几周则着重建立控制力、耐力和肩胛骨稳定性。只有在您达到基于耐受度的活动范围、舒适度和控制标准后，临床医生才会让您进入下一阶段——因此进度因人而异。

一次典型训练的样子

每次训练都遵循热身、主体训练和放松的模式。热身可能包括轻柔的钟摆摆动、肩胛骨收缩和上背部泡沫轴放松。主体训练结合活动范围练习、按指导进行的关节和软组织松动、弹力带或沙袋力量训练，以及使用网球的简单控制或平衡练习。放松包括缓慢拉伸、放松呼吸，以及——如果临床医生建议——冷疗或TENS以增加舒适度。

跟踪进展

您的临床医生使用阶段标准——例如舒适的活动范围、轻微的肿胀和良好的肩胛骨控制——来决定何时进阶。这些会与结果测量一起检查，如ASES和Constant-Murley评分、DASH问卷、疼痛评分、关节量角器测量活动范围以及徒手肌力测试。长期跟踪这些指标可以看出您是否耐受该计划，并帮助临床医生安全地调整进度。

恢复与自我照护

遵循临床医生关于缓解疼痛的指导；不要自行增加或更改药物。安排休息日，保持良好姿势，避免突然提重物或重复的过头动作。需要及时复查的危险信号包括严重疼痛或夜间痛醒、突然肿胀、新的无力、发热，或肩部感觉不稳或"发软"。出现这些情况时应暂停并寻求临床建议，而不是继续锻炼。

康复阶段

第 1 周Protection Phase

Pain at rest <3/10 on visual analog scale,Glenohumeral joint swelling minimal or resolved,Acceptable tolerance to passive forward flexion to 45 degrees,Scapular stabilization against gravity maintained,No signs of rotator cuff tendon irritation with gentle pendulums,AC joint stability confirmed on clinical examination

进入下一阶段： Early Motion Phase

第 2 周Protection Phase

Progressive passive forward flexion to 60 degrees without pain,Glenohumeral external rotation to 15 degrees achieved,Scapular retraction and protraction movements initiated,Rotator cuff isometrics at subpainful level tolerated,Biceps tendon resisted flexion without exacerbation,Patient demonstrates proper shoulder mechanics during ADL

进入下一阶段： Early Motion Phase

第 3 周Early Motion Phase

Passive forward flexion to 90 degrees achieved,Glenohumeral abduction to 60 degrees tolerated,Scapular control during shoulder elevation movements,Rotator cuff isometrics progressed to pain-free level,Active assisted range of motion initiated within tolerance,Labrum integrity maintained during arm positions

进入下一阶段： Early Motion Phase

第 4 周Early Motion Phase

Passive forward flexion to 110 degrees achieved,Glenohumeral external rotation to 30 degrees at 90 degrees abduction,Scapular upward rotation during arm elevation,Active assisted range of motion transitioned to active,Biceps tendon strengthening in neutral position initiated,No reproduction of AC joint pain during elevation

进入下一阶段： Strengthening Phase

第 5 周Early Motion Phase

Passive forward flexion to 130 degrees achieved,Glenohumeral external rotation to 40 degrees at 90 degrees abduction,Active forward flexion to 90 degrees against gravity,Scapular stabilization during push-up plus progression,Rotator cuff external rotation against gravity initiated,Labrum symptoms absent with functional movements

进入下一阶段： Strengthening Phase

第 6 周Strengthening Phase

Passive forward flexion to 145 degrees achieved,Glenohumeral external rotation to 45 degrees at 90 degrees abduction,Active forward flexion against resistance to 90 degrees,Scapular strengthening with theraband initiated,Rotator cuff external rotation against resistance progressed,Biceps tendon resisted flexion progressed to functional level

进入下一阶段： Strengthening Phase

第 7 周Strengthening Phase

Full passive forward flexion achieved,Glenohumeral internal rotation to 70 degrees at 90 degrees abduction,Active abduction to 90 degrees against resistance,Scapular strengthening with dumbbells initiated,Rotator cuff internal rotation strengthening progressed,Functional reach patterns without labral symptoms

进入下一阶段： Strengthening Phase

第 8 周Strengthening Phase

Full active range of motion in all planes,Glenohumeral rotation strength 4/5 or better,Scapular control during overhead activities,Rotator cuff strengthening at 50% capacity,Biceps tendon functional strengthening without pain,Proprioception training initiated

进入下一阶段： Advanced Strengthening Phase

第 9 周Advanced Strengthening Phase

Full range of motion with resistance,Glenohumeral external rotation strength 4+/5,Scapular strengthening at 75% capacity,Rotator cuff endurance training initiated,Biceps tendon advanced strengthening tolerated,Shoulder complex endurance improved

进入下一阶段： Advanced Strengthening Phase

第 10 周Advanced Strengthening Phase

Symmetrical range of motion bilaterally,Glenohumeral internal rotation strength 4+/5,Scapular stabilization during functional tasks,Rotator cuff power training initiated,Plyometric training introduced if tolerated,Return to light work activities

进入下一阶段： Return to Function Phase

第 11 周Return to Function Phase

Full strength in all rotator cuff muscles,Scapular stability during high-demand tasks,Functional reaching above shoulder level,Biceps tendon full functional capacity,Proprioception at near-normal levels,Patient reports >80% confidence in shoulder

进入下一阶段： Return to Function Phase

第 12 周Return to Function Phase

Strength >85% of contralateral side,Endurance testing within normal limits,Scapular control during sport-specific movements,Rotator cuff response to high-velocity activities,Tolerance to overhead activities,Patient satisfaction >8/10

进入下一阶段： Return to Function Phase

第 13 周Return to Function Phase

Isokinetic testing near symmetry,Functional movement patterns normalized,Scapular dyskinesis resolved,Return to recreational activities initiated,AC joint loading without symptoms,Biceps tendon stability confirmed

进入下一阶段： Final Progression Phase

第 14 周Final Progression Phase

Full return to pre-injury activity level,ASES score >85 points,Glenohumeral and scapulothoracic kinematics normalized,Rotator cuff and labral function restored,No AC joint compensation during loading,Patient discharged with maintenance program

进入下一阶段： Discharge

活动恢复里程碑

Pain-free basic activities of daily living

Week 4

No sign of shoulder impingement with resisted empty can test

Light functional activities and conditioning

Week 6

Able to tolerate light resisted flexion and extension without flare

Moderate activity and sport-specific conditioning

Week 8

Pain ≤ 3/10 during functional reaching and lifting activities

Full return to sport, occupation, and recreation

Week 14

Patient adherence to home exercise programme ≥ 5 days per week

注意事项

训练前充分热身
疼痛加重时立即停止
避免过度负荷

禁忌症

急性炎症期
未控制的剧痛

疼痛管理

Cryotherapy (ice pack application for 15-20 minutes post-exercise)
Non-steroidal anti-inflammatory medication as prescribed
Gentle soft tissue mobilization to trapezius and pectoralis minor
TENS (Transcutaneous Electrical Nerve Stimulation) for pain modulation
Patient education on positioning and activity modification

设备与检查方式

Therapeutic exercise (range of motion and strengthening)Joint mobilization (glenohumeral and scapulothoracic)Soft tissue mobilization (rotator cuff, pectoralis minor, thoracic spine)Proprioception and neuromuscular trainingModalities (cryotherapy, TENS as needed)网球弹力带踝部沙袋泡沫轴

常见问题

如果感觉有点酸痛，我应该用多大力？

轻微的、会消退的不适是常见的，但尖锐或加重的疼痛是减量的信号。保持动作轻柔，让临床医生指导进阶。

如果时间不够，我可以跳过热身吗？

尽量不要；热身能准备好肩部并减少拉伤。花几分钟做温和活动和肩胛骨练习是值得的。

如果我错过训练或需要放慢进度怎么办？

偶尔错过训练没关系——从上次停下的地方继续，而不是跳到前面。如果症状加重，请暂停并在进阶前与临床医生确认。

本信息仅供教育用途，不能替代专业医疗建议、诊断或治疗。

医学免责声明

本内容仅供一般信息和教育用途，不能替代专业医疗建议、诊断或治疗。对于任何医疗问题，请务必咨询合格的医疗服务提供者；切勿因阅读本站内容而忽视专业医疗建议或推迟就医。

如果您认为自己可能出现医疗紧急情况，请立即拨打当地急救电话或前往最近的急诊科。

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