Shoulder Unit- Humeral Fractures

Question 1

Humeral fracture

Answer 1

Fracture of the humerus can cause severe disability

• 85% nondisplaced, rarely require surgical fixation
• Recovery is not as involved since the joint surfaces are not involved in the injury

Question 2

Treatment of Humeral Fractures

Fracture needs to be stabilized for how long?

Answer 2

at least 6 weeks for bony union to occur- will be in immobilizer

-Aggressive therapy is not performed until sufficient healing is confirmed by x-ray

Question 3

What happens during immobilization phase?

Answer 3

• Use ice to decrease pain
• Begin ROM exercises for elbow, wrist, and hand
• Train balance and gait
• Do not use affected arm for ADL

Question 4

What to do as fracture stabilizes?

Answer 4

• Discontinue the sling immobilization on MD orders
• Begin active scapular exercises
• Begin active-assisted shoulder exercises
• Begin using arm for daily activities to tolerance

Question 5

What to do as the fracture heals?

Answer 5

• Discontinue the functional brace on MD order
• Begin joint mobilization and passive stretching
• Retrain proper scapulohumeral rhythm and coordination
• Use full spectrum exercises to restore strength and ROM
• Emphasize functional activities

Question 6

Displaced fracture of surgical neck and head

Answer 6

require surgery to stabilize them properly

> Can be fixated with a variety of materials
Presently no accepted “fixation of choice”

Question 7

What complications can be included w displaced fractures?

Answer 7

• Avascular necrosis of humeral head
• Subacromial impingement
• Nerve lesions
• Vascular damage

Question 8

Important Treatment Consideration- humeral head fracture

IMPORTANT

Answer 8

PROM and stretching are contraindicated in the early stages of healing for humeral head fractures

Question 9

Humeral Head Fractures- Postfracture weeks 1-2

Answer 9

• Patient is generally in excruciating pain despite pain medications
• The arm is usually in a sling to immobilize it
• Patient requires assistance with basic ADL’s

-Therapy is limited at this time
 >Patient education
  >>Recommend sleep in semi-upright position 
 >Ice 
-Balance and gait training

Question 10

Humeral Head Fractures- Postfracture weeks 3-6

Answer 10

-Exercise progression is dependent on the stability of the fracture fragments and varies greatly from patient to patient

-With MD approval, can begin active GH motions in a very restricted range
>Concentrating on the quality of the motion and allowing no muscle substitution to occur

Question 11

Humeral Head Fractures- Postfracture weeks 3-6

— If Stable

Answer 11

-Patient removes the sling 3-5 times a day for gentle ROM exercises, some MD’s DC sling at this time
>Pendulum, AAROM elevation activities, scapular motions, gentle isometrics

Question 12

Humeral Head Fractures- Postfracture weeks 6-12

Answer 12

-AROM exercises progress in the pain-free range to the patient’s tolerance

Question 13

What happens when the humerus is completely healed?

Answer 13

Which is at approx. 8 weeks, therapy becomes more aggressive