Rehabilitation after a fracture of the shoulder (shoulder neck) in Moscow

A humerus fracture is a serious injury. The shoulder joint is the most mobile. His injuries significantly affect a person’s ability to work and activity. Shoulder fractures can be open or closed, with or without displacement. Depending on the location of the violation of the integrity of the bone tissue, the following types of humerus fractures are distinguished:

fracture of the head, surgical, anatomical neck, tubercles;
fracture of the body of the humerus;
fracture of the trochlea, external and internal epicondyles.

After a shoulder fracture, the patient abstains from any activity that causes pain for a long time. Doctors recommend avoiding pulling and pushing movements, lifting heavy objects, and activities that involve raising your arms. Physical therapy allows the healing process to proceed without complications. Rehabilitation specialists at the Yusupov Hospital individually select a set of exercises, taking into account the time and location of the fracture, the patient’s condition and the presence of concomitant diseases. To speed up the recovery of upper limb function, physiotherapists provide complex treatment, including massage and electrical procedures.

At the Yusupov Hospital, all conditions have been created for the rapid recovery of patients with a fracture of the humerus. Exercise therapy for a shoulder fracture begins as soon as possible. Patients perform exercises under the guidance of a senior exercise therapy instructor. During rehabilitation, patients are consulted by a neurologist and traumatologist. Rehabilitation specialists use innovative methods of physical rehabilitation.

Types of humerus fractures and principles of treatment

Types of fracture

Depending on location:

intra-articular - anatomical neck and head;
extra-articular - surgical neck. It can cause damage to nerves and blood vessels, so it is characterized by bleeding and sensory disturbances. If help is not provided in time, the injury becomes the cause of paresis;
the main (middle) part of the bone or diaphysis of the shoulder;
distal section, located closer to the elbow.

Fractures are also classified as non-displaced, displaced and impacted.

Principles of treatment

It is important to begin recovery from a humerus fracture as soon as possible. Most often, conservative treatment is sufficient (plaster cast, physiotherapy, massage and exercise therapy); in especially severe cases, surgery is required. Therapy should be carried out daily, sometimes up to several times a day, unless the doctor selects a different schedule. It is not recommended to interrupt training unless indicated.

All methods are selected individually, taking into account the diagnosis and characteristics of the patient: rehabilitation after a fracture of the humerus with displacement differs significantly from treatment after an injury without displacement, since the immobilization period in the first case will be longer.

During the rehabilitation period, the recovery program changes: the doctor adjusts it based on intermediate results and the type of limb immobilization (plaster cast, soft tissue bandage, etc.).

Stages of rehabilitation

Immobilization. Lasts up to three weeks. During this period, it is important to ensure the immobility of the limb. To avoid circulatory and metabolic disorders and prevent muscle atrophy, the doctor prescribes massage and physical therapy (breathing exercises, passive exercises and active ones, during which loose joints work).
Functional. Lasts up to 6 weeks. The main role during this period is played by active exercises - both classical physical therapy and exercises in water. Gradually, the load on the joint increases, the patient can use weights, work on simulators with biofeedback, and do yoga. Ordinary household activities help develop fine motor skills: the patient brushes his teeth, gets dressed, laces his shoes, makes the bed, etc. It is not recommended to strain the limb too much. It is important to report any pain or discomfort to a specialist.
Training. Lasts up to 8 weeks. As a rule, by this period the patient can already serve himself independently, and it is important to strengthen the muscles and restore the range of motion. You can also exercise only under the supervision of a doctor and only after the integrity of the bones and other tissues has been completely restored. Remember that a fracture of the humerus is a serious injury; starting intense strength exercises within 2-3 months after the injury is contraindicated.

How quickly does rehabilitation take place?

Whatever the cause of mechanical damage to the humerus, its treatment may take different periods that differ significantly from each other.

Treatment time depends on the following factors:

Is there a bias;
Where exactly did the bone break;
Has the integrity of muscle tissue and skin been compromised?
General condition of the patient’s body;
Age of the patient;
Whether surgery was performed and much more.

Fixing the arm in a cast for a long period leads to disruption of the muscle tissue and the arm as a whole. To restore its functionality, it is necessary to carry out a series of rehabilitation procedures that will help restore tone and strength to the arm muscles.

Contraindications for fracture

Only a qualified specialist can determine the type of injury and draw up a treatment and rehabilitation program after examination and examination (usually an x-ray). It is contraindicated to strain the limb, as this can lead to displacement of bone fragments; you should not self-medicate and make a diagnosis yourself, postponing a visit to the doctor.

Each treatment method has a number of its own contraindications, which may include diabetes, pregnancy, bleeding disorders, endocrine and mental diseases, benign and malignant tumors, etc. That is why Blagopoluchiya doctors carefully examine all patients before drawing up a treatment program.

Stretching with a stick

Stand straight with your feet shoulder-width apart. Take the stick behind your head with your healthy hand, move your affected hand behind your back and take the other end of the stick. With your healthy hand, pull the stick up, thereby increasing the flexion of your affected arm. Hold for 5 seconds. Repeat 10 times.

Signs of a fracture of the shoulder and body of the humerus

Sharp pain at or near the site of injury, aggravated by exertion.
Crunching in the hand upon palpation or movement.
Change in the shape of the hand, shortening, swelling, edema, drooping hand.
Bruising, bruising or bleeding - a hematoma can even appear in the hand area. Also, when injured, the color of the skin may change: it becomes pale.
Stiffness in movements: in some cases, the patient cannot even move his arm to the side.
Sensory impairment, not only directly in the area of the fracture, but also in the area of the hand, which is associated with nerve damage.

Symptoms can be both severe and mild, depending on the fracture itself and the individual characteristics of the patient, in particular, his pain threshold. We recommend not to ignore even minor symptoms and consult a doctor in a timely manner - then both treatment and rehabilitation will take less time, and the likelihood of regaining lost functions will be much higher.

Hand development includes massage

How to quickly recover an arm after a fracture? To do this, it is important to pay attention not only to physical exercise, but also to massage. It allows you to stretch stiff muscles and restore impaired blood flow. This will enhance the transfer of oxygen to muscle fibers, which will significantly improve their condition.

Warm muscles will be more responsive to exercise. This will improve the effectiveness of rehabilitation measures.

In addition, massage can be used without reference to gymnastics, for example, in the morning and evening. It is better to use a massage ball or rings for this. They are easy and pleasant to work with.

We hope that our article has given you enough information on how to develop an arm after a fracture. Take care of yourself and always be in good shape!

Therapeutic exercises for shoulder joint injuries

Therapeutic exercise allows you to avoid muscle atrophy, normalizes their tone, improves blood circulation in tissues, thanks to which they receive the necessary microelements. Regular (several times a day) exercises activate regeneration processes, reduce pain, and return the limbs to their former mobility.

We recommend performing exercises on the injured arm, doing breathing exercises, and developing a healthy limb. This allows you to strengthen the body as a whole and increase ventilation of the lungs, especially when the arm is still in a cast. It is advisable to alternate dynamic and static exercises, for large and small muscles, strength and stretching.

The rhythm, amplitude, number of repetitions, and duration of the workout are selected by the doctor. It is important that the load increases gradually - first the patient develops the shoulder joint, then returns the usual mobility to the entire arm, and then strengthens the muscles.

Is it possible to study on your own?

After healing the damaged bones and removing the plaster, the doctor must make individual recommendations for the development of the shoulder, elbow joint and the entire injured arm. Of course, we should not forget about the stress on a healthy limb.

It is better to entrust a massage to a competent specialist. If it is difficult to find one, ask someone close to you to master the necessary complex; in extreme cases, perform the elements of the massage yourself.

Of course, the last option is the most difficult; the main thing to remember is that recovery and the absence of problems in the future depend on the systematic nature of the exercises and their correctness.

The same can be said about the complex of physical therapy: of course, classes under the supervision of a competent specialist are preferable, but, if necessary, you can carry them out independently, the main thing is that the load is selected optimally. After a fracture, many people unnecessarily spare the injured arm, while others put unnecessary strain. Both cause a lot of harm.

Resistance to bending

Stand with your back to the door. Attach the end of the expander to the door at waist level, and take the other end of the expander with your developing hand. Pull your arm forward, bending it at the shoulder. 2 sets of 15 reps.

Horizontal rotation

Stand up straight, take the stick with both hands and raise it to shoulder level. Rotate the stick to the side until you feel tension. Hold the achieved position for 5 seconds. Then repeat the exercises on the other side. Repeat 10 times.

External rotation

Stand with your extended arm away from the door. Attach the end of the expander to the door at waist level, and take the other end of the expander with your developing hand. Bend your elbow 90 degrees and place it on your stomach. Keeping your elbow tucked in, rotate your forearm away from the door—outward. Then slowly return your hand to the starting position. It is important to keep your forearm parallel to the floor. 2 sets of 15 reps.

Shoulder extension

Stand straight with your feet shoulder-width apart. Extend your arm backwards (as shown in the picture) and hold for 5 seconds. Then return to the starting position. Repeat 10 times.

Movement errors and contraindications

Accurate client data is required to determine a correction strategy. A trained technician with experience can accurately identify movement errors. Repetition and training will sharpen assessment skills.

The most common shoulder dysfunctions are:

Unintentional shrugs. It's pretty easy to notice. Insufficient activity of the lower trapezius muscles allows the upper trapezius and levator scapulae muscles to lift the shoulder girdle. This negatively affects the shoulder joint, the position of the cervical spine and can lead to headaches, neck stiffness and inflammation of the joint capsules of the shoulder.
Violation of protraction and retraction. Imagine a client performing a horizontal row using only the shoulder and elbow joints. Restricted scapular motion increases the range of motion of the elbow and shoulder joints and can lead to tendonitis over time. It also results in restriction of the anterior supraglenoid space, which can cause overload of the biceps brachii tendon, subacromial bursa, and rotator cuff tendon.

When creating programs, pay attention to the following features:

Be careful with the recommendation to “Put your shoulder straps in the back pockets of your pants.” This can be useful when performing the cobra exercise while lying on your stomach, but does not mean that the shoulder girdle should always be pulled back and down. Scapular elevation and external rotation are critical actions during overhead movements.
Avoid barbell rows, full-range dips, or other similar activities beyond a safe range of motion if your shoulder joints are injured. Overhead presses are also dangerous. When the barbell drops below the top of the head, two things happen: the head deviates anteriorly along with cervical extension, which leads to an uneven distribution of stress on the cervical intervertebral discs; the bar continues to move and the load is redistributed from active systems to passive ones. With such an amplitude of abduction, external rotation and extension of the shoulder joint, elongation of the ligaments and joint capsule is necessary to produce movement. Asymmetry further increases the risk. The combination of ambidextrous grip, barbell, and asymmetry is an unhealthy mixture.
Be aware that abduction and weighted shoulder flexion increase the risk of impingement and add tension to the cervicothoracic region (Osar, 2012). Fixed range of motion machines can be dangerous in this situation, and you may simply not use them for a safe and effective workout. Lower the seat on your seated press machine to its lowest position to limit the impact of excessive range of motion. To summarize: know the range of motion in the joint and do not exceed the physiologically available amplitude.

Important Tips:

Think globally - act locally. Pay attention to the entire kinematic chain, and then to the details of the shoulder complex.
Pain is a messenger, don't kill it. When your rotator cuff screams during every pull-up, don't just shut it up with a roller or tennis ball. Try to find out the reason for the scream. If you suspect anything more than an imbalance or overload, contact a qualified professional.
Before working with the shoulder blades, release the thoracic spine. The shoulder blades slide along the surface of the chest and are closely connected to the vertebrae. The shoulder blades will not move properly until the base of the rib cage and spine is functioning optimally.
Incorporate some overhead exercises. In most cases, the shoulder blades are “stuck” in the internal rotation position. Restore external rotation before beginning overhead exercises.
Let your shoulder joints do their job. There is no need to shift the load from the hips or abdominal muscles. Poor core or hip mobility causes the shoulder girdle to tighten more during full body movements.
Remember: practice creates a pattern. Make sure your clients are practicing the right patterns, not the ones that got them into trouble.
Don't rush things. Shoulder dysfunction takes time, and it will take time for your clients to regain both the aesthetics and functionality of their shoulders.

Shoulder Anatomy: Passive Systems

The shoulder is more than a single joint. The complete kinematic chain runs “from nose to toes” and it is impossible to list all the relationships in this case. However, when we look at the shoulder we will include some of its broad connections to other parts of the body.

The human movement system includes the actions of the joint, nervous and muscular systems (Clark & Lucett, 2010). In what follows, we will call the articular system, including bones, joints and ligaments, the “passive” system, and the muscular system the “active” system.

The passive system provides fulcrum, support, and leverage for the muscular system. The main bones of the shoulder girdle include the humerus, scapula and clavicle. The shoulder girdle complex interacts with the rib cage, thoracic and cervical spine. The lumbar region and pelvis can also be included due to muscular and fascial connections. When the passive system is asymmetrical, it can result in shortening of the active system, causing decreased performance, reduced endurance, and increased risk of injury (Travell & Simons, 1983).

The joints most closely associated with the work of the shoulder are the humerus (HL), acromioclavicular (AC), sternoclavicular (SC) and scapulothoracic (SL) joints. An in-depth description of these joints is beyond the scope of this article, but personal trainers should thoroughly research these joints before creating programs for clients.

The LH joint is classified as a false joint due to the lack of direct interaction between the bones. The scapula simply glides across the surface of the chest, however, the significance of these movements to shoulder function warrants their inclusion in the review. The intercostal and costovertebral joints associated with the thoracic spine can influence local and general musculature (Epstein et al. 1993). Despite their small size, these joints are an integral part of the chest.

When the bones are in perfect alignment, a full range of motion is possible at the joints. For example, flexion, abduction, adduction, internal and external rotation, and circumduction will be possible in the shoulder joint. This joint is extremely mobile and can provide a large range of motion. High mobility is accompanied by a low level of stability. The scapulothoracic muscles help slow down the movement when throwing, acting as a kind of anchor: the chest in relation to the scapula, and the scapula in relation to the humerus through the glenoid fossa.

The scapula is a kind of platform for the humerus. If the scapula is in the correct position, the humerus follows (Sahrmann, 2001). The scapula is capable of ascending, descending, moving forward and backward (protraction and retraction), and rotating outward and inward. Also sometimes referred to as forward and backward deviation of the scapula. The acromion process of the scapula is connected to the clavicle by the AC joint.

The acromion is the wide, ridge-like end of the bone and can have three shapes. Type 1 - flat, type 2 - curved, type 3 - hooked - which determines the amount of free space for the rotator cuff, biceps tendon and joint capsule. Anomalies of the acromion are congenital and no corrective exercises will create more free space. Type 3 uncinate acromion is associated with the highest incidence of rotator cuff injuries (62%) and impingement (30%) (Epstein et al. 1993).

The correct position and functionality of the HA and AC joints can be difficult to assess. Maintaining their delicate interaction promotes shoulder health and function. If you suspect their function is impaired, contact a licensed physician for evaluation (Lee, 2003).

Normalizing the position and function of the thoracic region is often forgotten. In people who move extremely little during the day, the thoracic spine is often excessively flexed and extension and rotation are limited. A posture that increases thoracic kyphosis reduces the effectiveness of the scapular stabilizers and rotator cuff muscles (Clark & Lucett, 2010). Violation of the position of the shoulder blades is a sufficient basis for analyzing and assessing the mobility of the thoracic region.

The structure of the ligamentous apparatus of the shoulder girdle is of particular interest. Ligaments are not only flat, straight formations that provide static support to joints. They can twist like a rope.

Closer to the limit of the range of motion, ligament tension and support from the joint capsule increases to prevent damage. Ligaments also contribute to proprioception, providing the nervous system with valuable feedback about joint position and tension (Osar, 2012).

Cartilage provides a smooth surface for joint interactions. Disturbances in the kinematics of joints and bones wear down this tissue over time. The destruction of cartilage is immediately followed by pain and inflammation.

The subacromial, subdeltoid and other bursae reduce friction in the shoulder joint. The subacromial bursa most often becomes inflamed after repeated impingement between the humerus and acromion.

Repeated stress destroys active systems faster than passive ones. If a client is experiencing pain as a result of a passive system injury, the movement disorder is likely to have appeared somewhat earlier. The functions of the active system are much more easily disrupted. Tendenitis will immediately appear with poor posture and repeated incorrect movements.

Shoulder abduction

Stand up straight, arms at your sides, palms facing you. Move your straight arm to the side and then as high as possible. Hold for 5 seconds, return to starting position. Repeat 10 times. Take a small weight in your hand when the exercise is no longer difficult.

Vertical layout

Stand straight, feet shoulder-width apart, arms hanging freely. Move your arms to the sides (as shown in the figure) and raise them as high as possible. Hold for 5 seconds. Return to the starting position. Repeat 10 times.

Application

Assessment and corrective exercises in the clinic

For a more in-depth understanding of how to safely perform an assessment and develop a corrective program, see the following resources from the IDEA archive (www.ideafit.com/fitness-products):

The Fundamentals of Structural Assessment, by Justin Price, MA (DVD)
Shouldering the Load From the Ground Up, by Chuck Wolf, MS (CEC course and DVD)
Designing a Self Myofascial Release Program, by Justin Price, MA (CEC course)
Corrective Exercise for Shoulder Impairments, by Eric Beard, MS (CEC course)
Six Steps to Better Program Design, by Michol Dalcourt (CEC course and DVD)

Source:

IDEA Fitness Journal, Issue 10, Number 10