Feb 03, 2020 a proximal humerus fracture is a crack or break in the top of your upper arm bone. Proximal humerus fracture postoperative orif jason dieterle, do considerations. Acute shoulder injuries in adults are often initially managed by family physicians. A broken upper humerus can make everyday tasks that involve movement of your shoulder very difficult. It is therefore very important that the exercises listed below are performed as described. Mar 19, 2020 proximal humerus fracture open reduction internal fixation activity try and rest the first few days following surgery.
Patient information proximal humeral fracture break in. Post fracture proximal humerus rehabilitation guidelines r l humerus fracture. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. This normally takes between 612 weeks to unite heal.
Apr 23, 2017 international healthcare awards 2018 winner among best physiotherapist in jammu dr. Rehabilitation programs for operative and nonoperative. Jul 26, 2018 famous physical therapists bob schrupp and brad heineck present. Extension and internal rotation not performed until 6 weeks 4. Famous physical therapists bob schrupp and brad heineck present. The type of fracture will be determined by taking several xrays of the shoulder.
A proximal humerus fracture usually occurs close to the shoulder joint and can be located at. Classification this information is current as of january 22, 2009 reprints and. Determining the optimal approach for proximal humerus fractures princeton university athletic medicine. In most cases these fractures can be treated without surgery. Proximal humerus fractures proximal humerus fractures are a very common injury that occurs in all populations but is certainly more prevalent in the patient population over the age of 65. It is therefore very important that the exercises listed.
Mathes shoulder pendular swing exercises spend about. Dr adam seidl offers treatment for shoulder fractures and clavicle fracture in denver and aurora. Pdf rehabilitation of proximal humerus fractures a. Patient information proximal humeral fracture break in the upper arm. Patient information proximal humeral fracture break in the. Most of these fractures can be treated with a sling, a swathe, and early mobilization. Fractures of the shaft and distal humerus on the other hand, are more common than proximal humeral fracture in the young population. Intramedullary nailing versus percutaneous pin fixation of pediatric proximal humerus fractures. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. Evaluation and management of pediatric proximal humerus fractures. Start these exercises 6 weeks after your injury and. If a fracture or fracture repair is stable, then therapy should be started early. Supine passive external rotation per to tolerance a.
In some complex fractures, a cat scan may be necessary to get a 3dimensional view of the shoulder to better assess the. An individual can sustain a humeral fracture due to a fall directly on the arm or elbow, a direct trauma to the hand in the form of a tackle while playing contact sports like football, rugby etc. Wiater md, in orthopaedic physical therapy secrets third edition, 2017. Proximal humerus fractures phf account for 56% of all adult fractures1. International healthcare awards 2018 winner among best physiotherapist in jammu dr. The most useful rehabilitation protocol is the threephase system.
Abstract the occurrence of proximal humerus fractures will continue to rise with the increasing elderly population. Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. This information will guide you through the next 6 weeks of your rehabilitation. Pdf rehabilitation of proximal humerus fractures a scoping. Other potential operations include humeral nails, half a shoulder replacement hemiarthoplasty, or rarely a reverse shoulder replacement. Navigate to learn more about shoulder fracture protocol. There was insufficient evidence from trials to support or refute the effectiveness of home exercise therapy compared with therapistsupervised exercise or therapy that included exercise following distal radius or proximal humeral fractures. Proximal humeral fractures can be treated conservatively with an arm sling, pain management, and supportive care. A proximal humerus fracture is a break of the upper part of the bone of the arm. Proximal humeral fractures are proximal to the surgical neck see figure key anatomic landmarks in the proximal humerus. Supine passive forward elevation in plane of scapula pfe to tolerance a.
Increase rom while protecting the fracture site you can be slightly more aggressive with this vs. Mathes shoulder pendular swing exercises spend about 15 minutes, 3 times a day exercising your shoulder. Proximal humerus fractures make up 4% to 5% of all fractures. Tuberosities are repaired and bony healing must occur before stress is applied to the rc tendons. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. A humeral fracture can be displaced or nondisplaced based on the nature of the injury sustained. Increase rom while protecting the fracture site you can be slightly more.
A physical therapy program after a proximal humeral fracture can help you return to normal activity quickly and safely. Regardless of the form of treatment, stiffness is a very common problem after a fractured neck of humerus. The neer classification of proximal humerus fractures is the most commonly used classification system. Fractures of the proximal humerus are a common occurrence, especially in the growing group of olderage americans. Interventions for proximal humerus fractures strengthening exercise. Return to normal function and motion may require 3 to 4 months overall goals. Sean griffin weeks 14 wear the sling full time for 2 weeks, and then only wear when outside the home for 4 more weeks. There is increasing recognition given in regard to managing these fractures in the setting of elderly, lowenergy. Proximal humeral fracture protocol home premier bone. Victoria bc v8z 0b9 tel 250 940 4444 fax 250 385 9600 page 6 april 2015 v1s. Most unstabledisplaced fractures or fractures with accompanying vascular insult require surgical intervention. A patients guide to adult proximal humerus shoulder fractures ciansurgeon will be specific about the type of fracture you have incurred.
Non displaced 2 part fracture good alignment does not involve an articular surface. Exercise reduces impairment and improves activity in people after upper limb fractures early commencement of exercise beneficial for conservatively managed proximal humerus fractures supervised exercise and home exercise program leads to reduction in impairment, particulary rom. Proximal humerus fracture is also one of the common injuries in athletes who participate in contact sports. We will take xrays a couple of weeks after your injury, then get the shoulder moving. Postoperative protocols orif proximal humerus fractures general rehabilitation guidelines tuberosities are repaired and bony healing must occur before stress is applied to rotator cuff tendons precautions no external rotation past 40 deg for 6 weeks no active internal rotation for 6 weeks. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder. Proximal humerus fractures phfs are common, particularly among older adults, and account for a large proportion of all fragility fractures 1. Nonoperative proximal humeral fracture rehabilitation protocol general principles. Proximal humerus fracture includes the fracture of shaft of the humerus and greater tuberosity. Generally most patients will end up staying in the sling for the first 2 weeks following surgery. Humerus fx orif protocol proximal, midshaft, or distal orif dr.
Acute shoulder injuries in adults american academy of. Range of motion exercises for fractured shoulder recovery. Symptoms include pain, swelling, and a decreased ability to move the shoulder. The humerus also known as the upper arm bone is a long bone that runs from the shoulder and scapula shoulder blade to the elbow. A fracture occurs when the arm bone humerus is broken as a. Home shoulder range of motion program all exercises to be done 4 times per day. Proximal humerus fracture this information will guide you through the next 6 weeks of your rehabilitation. Minimize pain and inflammatory response achieve rom goals establish stable scapula weeks 0 to 6 1. In addition, a prolonged course of physiotherapy is usually required to assist in regaining a functional range of motion. Humerus fx orif protocol proximal, midshaft, or distal orif. Control pain and swelling with exercise and modalities 3. A sarmiento, pb kinman, eg galvin, rh schmitt and jg phillips functional bracing of fractures of the shaft of the humerus this information is current as of january 22.
Many patients with proximal humerus fractures have osteoporosis and have poor neuromuscular control mechanisms. Rehabilitation guidelines for proximal humerus fracture nonoperative 2 p a g e phase ii continued precautions dc sling x 3 weeks if cleared by md aarom to 90 degrees forward flexion and 40 degrees er suggested therapeutic exercises arom cervical, elbow, wrist and hand pendelums gripping exercises scapular pnf. Bony healing occurs usually within 6 to 8 weeks in adults 3. Proximal humerus fracture specific pt university of utah. Nonoperative treatment of proximal humerus fracture rehabilitation considerations o usually nonoperative care is selected for those patients o thopae ic institute of ohio samir patel, who are medically unfit for surgery or have a minimally to nondisplaced fracture o depending on the severity of the fracture the best outcome may. Proximal humerus fracture book twin cities orthopedics. Your specific shoulder fracture rehab exercises will depend on your phase of recovery and the extent of your injury. The proximal humerus is composed of four distinct anatomic segments. Jan 06, 2020 proximal humerus fracture is quite a common injury among elderly population who are suffering with osteoporosis. Proximal humerus fracture you have a fracture break of your shoulder bone the proximal humerus. Post fracture proximal humerus rehabilitation guidelines. The pdf of the article you requested follows this cover page.
Mri is not typically indicated in the setting of proximal humerus fracture, although it may be useful in assessing injury to soft tissue structures such as the rotator cuff muscles. Fractures of the humerus are classified in one of two ways. Complications may include axillary nerve or axillary artery injury the cause is generally a fall onto the arm or direct trauma to the arm. Injury can cause the humerus ball or the glenoid socket of the shoulder joint to break fracture. Stable proximal humerus fracture rehab protocol introduction this protocol is for patients with nondisplaced proximal humerus fractures, or patients with proximal humerus fractures that have been surgically repaired. Shoulder fracture aurora clavicle fracture treatment denver.
Rehabilitation guidelines for proximal humerus fracture orif 4 p a g e phase iv continued suggested therapeutic exercsies pec minor stretching posterior capsule stretching anterior deltoid strength and scapular stabilization general ue strengthening cardiovascular exercises. Rehabilitation programs for nonoperative humeral fractures dr. A proximal humerus fracture is a crack or break in the top of your upper arm bone. Here we look at the typical causes, symptoms, diagnosis, treatment and recovery process for upper arm fractures. It is the third most common fragility fracture after distal radius and hip fractures. Maintain range of motion rom without displacing the proximal humerus fracture. We will take xrays a couple of weeks after your injury, then get the shoulder moving to avoid stiffness of the shoulder joint. Functional bracing of fractures of the shaft of the humerus. Rehabilitation guidelines for proximal humerus fracture orif 4 p a g e phase iv continued suggested therapeutic exercsies pec minor stretching posterior capsule stretching anterior deltoid strength and scapular stabilization general ue strengthening cardiovascular exercises no restrictions. A fracture occurs when the arm bone humerus is broken as a result of an accident such as a fall onto the arm.
A proximal humerus fracture is when the top part of the upper arm is broken. General principles of rehabilitation for fractures treat the patient not the fracture move all joints that are not immobilized prevent disuse atrophy use gravity to assist in mobilizing a joint be aware of peripheral nerve palsy signs. From a populationbased implant design, a patented screwtoplate interface, and streamlined instrumentation, our focus was on creating a welldesigned plating system, giving you. Humerus fracture upper arm fracture johns hopkins medicine. The humeral head is covered in articular cartilage and articulates. Postoperative instructions proximal humerus fracture open. Home rehabilitation exercises for a broken upper humerus.
Twentytwo trials were identified that evaluated 1299 participants with an upper limb fracture. Perform frequent gentle exercise to prevent adhesion formation. Use the video or information below to gain a better understanding of your injury and what can be done to maximise your recovery. A patients guide to adult proximal humerus shoulder fractures adult proximal humerus shoulder fractures anatomy the proximal humerus is the top portion of the humerus upper arm bone. The proximal humerus is one of the bones in your shoulder joint. Bony healing occurs usually within 6 to 8 weeks in adults 2. Amresh jamwal shows easy exercises which you should do following fracture of humerus. Shared care plan eastbourne 023 414928 conquest 01424 757576 email esht. The shoulder is a ball and socket joint and you have fractured just below the ball part. Nondisplaced means less than 1cm of displacement and less than 45 of angulation 2. Nov 18, 2019 proximal humeral fractures can be treated conservatively with an arm sling, pain management, and supportive care.
Trauma, such as a fall or highimpact injury, is the major cause of most shoulder fractures. Humeral fracturetreatmentrecoveryexercisecausessymptoms. Proximal humerus fracture east sussex healthcare nhs trust. Proximal humerus fracture shoulder 7 fracture care team. Prom progress gentle rom as shoulder pain allows wand supine er hold crossbody adduction until 6 weeks.
Microsoft word nonsurgical proximal humerus fracture protocol. Humeral shaft fractures hsfs are one of the most common injuries in trauma centers. Management decisions for the majority of these injuries are straightforward, though some cases lead to vigorous debate regarding classi. Sleep with arm out of sling, straight on pillows with arm elevated for edema reduction. Proximal humeral fractures msd manual professional edition. Exercises following fracture of humerus upper arm youtube. To regain maximum function after this injury, its important to follow the specific humerus fracture rehabilitation exercises prescribed by your physical therapist. Proximal means it is the end of the bone that is closest to the body. Neer, ii and evaluation displaced proximal humeral fractures.
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