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Proximal Humeral Fractures


Anatomy

The shoulder joint is a ball and socket joint. The “ball” is the head of the humerus. The humerus is the bone of the upper arm. When the head of humerus breaks, it can break into 2 or more pieces, and these pieces can either remain in position (non-displaced) or move out of position (displaced).   A fractured neck of humerus is a common injury of the upper limb. There are a wide range of potentially suitable treatments for a fractured neck of humerus, which depend on the type of fracture and the activity level of the patient.

Most fractures can be treated non-operatively, with a supportive sling for 3 to 6 weeks. During the time that the patient wears the sling, it is important that one  comes out of the sling to practice hand, wrist and elbow exercises to prevent stiffness from setting in. During this period xrays will need to be repeated to ensure the bone fragments do not displace. From 3 to 6 weeks the patient can usually commence some shoulder exercises, ranging from gentle pendular exercises to assisted forward elevation.

Some fractured shoulders may need an operation. This is usually the case if the some of the bone fragments, namely the tuberosities are widely displaced from the rest of the head of humerus.

 

Proximal Humeral Fractures

 
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The most common operation performed for a fractured neck of humerus is fixing the bones with plates, screws, and sutures. Other potential operations include humeral nails, half a shoulder replacement (hemiarthoplasty), or rarely a reverse shoulder replacement.

Regardless of the form of treatment, stiffness is a very common problem after a fractured neck of humerus. It is therefore very important that the exercises listed below are performed as described. Your doctor may modify those exercises depending on the type of injury that one has.  In addition, a prolonged course of physiotherapy is usually required to assist in regaining a functional range of motion.

Home Shoulder Range of Motion Program:

  • All exercises to be done 4 times per day
  • Perform each movement 10 times during each session
  • Hold each stretch for a count of 10 seconds
  • Each time you perform your exercises try to increase the range of motion within the limits stated. 
  • Use pain as your guide. You should feel some discomfort with each stretch, however, it should not be severe pain
  • These exercises are important to prevent the development of a stiff / frozen shoulder


Sling

One should wear the sling for a minimum of 3 weeks, and a maximum of 6 weeks. Your doctor will determine this. Between 3 to 6 weeks you may trial not wearing the sling- if you are comfortable then you may keep the sling off. If you are getting a lot of pain then you should keep wearing the sling.

Weeks 0 to 6

  • Hand & Wrist Exercises: Begin these exercises now Open and close your hand by making a fist then straightening out your fingers. Bend your wrist back and forth as if knocking on a door (keep arm at side)
  • Elbow Exercises: Begin these exercises now Bend and straighten your elbow. You may perform this exercise initially with the help of the other arm but you can use the muscles of the operated arm. With your elbow at our side and bent at a right angle, turn palm up and palm down.

Weeks 2 to 4 
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Continue hand, wrist and elbow exercises.

Commence Pendular exercises:

  • Bend at the waist.
  • Let the broken arm hang down with the force of gravity.
  • Move the arm in gentle circles as though you were stirring a pot.

 

Weeks 4 to 6

Continue hand, wrist and elbow exercises.

Continue pendular exercises.

Commence assisted forward elevation exercises:
While lying on your back, gently raise your arm up towards your head and over your shoulder. You should initially perform this exercise by using the good arm and helping to push the operated arm up. As you slowly feel more comfortable you can increase the range of motion over the shoulder and decrease the amount of help from your good arm.

It can take six months or longer to achieve a full recovery. In most cases one achieves a pain free shoulder but there will be a permanent restriction in range of motion. This restriction will be moderate only and will still allow you to perform most activities of daily living.

 

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