Physiotherapy medicine of Shoulder Fractures

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Humeral fractures occur ordinarily with up to five percent of all fractures falling into this category, eighty percent of humeral fractures being minimally displaced or undisplaced. Osteoporosis is a contributing factor in many of these fractures and a fracture of the forearm on the same side is a typical presentation. Nerve or arterial damage from the fracture is an leading consideration but not common. Typical sites of fractures are the top of the arm (neck of humerus - "shoulder fracture") and the middle of the shaft of the humerus.

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How is Physiotherapy medicine of Shoulder Fractures

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The usual cause of a humeral fracture is a direct fall on the arm, whether on the hand, elbow or directly onto the shoulder itself. Due to all the muscles that attach to the upper humerus, there can be a lot of muscular force at the time, dictating how much the bones are pulled into a displaced position. Humeral fractures are more common in the elderly with an mean age of fracture of nearby 65 years and younger citizen usually have a history of forceful trauma such as motor accidents or sport.

If the fracture occurred without important force then a pathological cause such as cancer must be suspected. On physio examination pain will occur on movement of the shoulder or the elbow, there may be allinclusive bruising and swelling, the arm may appear short if the fracture is displaced in shaft fractures and there is very restricted shoulder movement. Radial nerve damage is rare in upper humeral fractures but more common in fractures of the shaft, leading to "wrist drop", feebleness of the wrist and finger extensors and some thumb movements.

Management of Humeral Fractures

After the fracture the patient's movements are kept restricted and sufficient analgesia provided to keep them comfortable. With tiny or no displacement the management is non-operative but if the greater tuberosity is fractured then it is leading to guess rotator cuff injury. This is more common in injuries with high forces, when the patient is older or the tuberosity is displaced significantly. Humeral neck fractures can be kept in line with a collar and cuff, allowing the elbow to hang free, while shaft fractures are difficult to administrate but can be braced.

Open allowance internal fixation (Orif) is often performed for displaced fractures with three or four fragments and more ordinarily in younger patients, while older patients have humeral head exchange to prevent pain and stiffness in the shoulder. Nailing or plating is used in shaft fractures if important but these usually heal without surgery. Humeral fractures can have complications together with injury to the radial nerve in shaft fractures, frozen shoulder and death of the humeral head due to loss of blood supply. Although normal healing time is 6-8 weeks, older sufferers may never re-establish normal range of shoulder movement.

Shoulder Fracture treatment by Physiotherapy

Initially the physio assesses the arm, request the patient about their pain level as this varies greatly, examining the swelling and bruising of the arm. The physiotherapist then checks the ready range of movement of the shoulder, elbow, forearm and hand. Any muscle feebleness and sensory loss is noted as this may denote nerve damage. If not operated on, a sling is continued with and if the fracture is not too painful or severe, early exercises are started by the physiotherapist. Pendular exercises, with the patient bending over at the waist, are leading in the early stages as they allow movement of the shoulder joint without much force.

Three weeks after the fracture bone healing will be well under way so the physiotherapist will instruct the patient in auto-assisted exercises, using the other arm, to help sacrifice stress on the injury. Unassisted exercises are the next step as the arm becomes stronger, to custom lateral and medial rotation and flexion. At six weeks the bone will be clinically sound so the physio can develop to more vigorous movements with resistance and gentle end-range stretching. Joint mobilisations can be useful to free up the sliding and gliding movements of the joint and strengthening and joint range work continued with Theraband.

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