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Rehabilitation for an upper arm fracture
The majority of upper humeral fractures (near the shoulder) heal in a satisfactory position if the patient holds the arm immobilized against the upper body and maintains vertical positioning as much as possible in bed.
In this way, gravity ensures that the fragments of the fracture remain aligned. After about 3-6 weeks you can start to move your arm.
Some types of proximal humeral fracture should be better treated surgically.
How long does it take for a proximal humeral fracture to heal?
In adults of all ages, proximal humeral fractures take between four to eight weeks to heal sufficiently, eliminating the need for further external support.
Good muscle strength is usually achieved after a period of around 12 weeks, but full recovery with bone consolidation can only take 6 months or later.
Children recover faster and can remove the cast after 3-4 weeks.
What types of proximal humeral fractures are there?
There are many types of fractures, the most common consists of “two fragments” and is a fracture of the humeral neck that separates the humeral head from the shaft (diaphysis).
Another type with “two fragments” is the fracture between the majus tuberculum and the tuberculum minus, a kind of injury to the rotator cuff.
More complicated fractures consist of three or four fragments.
A fracture with four parts includes the head, the tuberculum minus, tuberculum majus and the diaphysis and is often surgically supplied by replacing the bone with a prosthesis (endoprosthesis replacement).
What does “fragment” mean?
The usual classification of fractures often uses the term “fragment” to indicate that a bone has shifted out of its anatomical seat. Even if several fracture lines run through the proximal humerus, a fracture is considered a ‘single-fragment fracture’ (which therefore does not require surgery) as long as it is not displaced.
What does it mean if a reposition is necessary?
If the position of a fragment is significantly shifted, the fragments must be returned to their original position to ensure good healing.
The process by which the fragments are returned to their position is called “reposition”.
In proximal humeral fractures, the repositioned fracture does not remain in position if the fragments are not fixed, for example with sutures, pins, plates or screws.
Why do some fragments shift in proximal humeral fractures?
Even if the fragments of the humerus are satisfactorily positioned, sometimes they do not remain in this position. Due to some characteristics, a fracture is more susceptible to displacement: unstable models, osteoporosis or osteopenia, inappropriate use of the shoulder strap and excessive activity on the part of the person with the fracture.
Because of this danger, patients must be checked by regular X-rays for several weeks and if the fragments shift, surgery should be performed.
What type of fractures are more likely to require surgery?
Fractures in which the need for surgical intervention is lower are those of the humera neck.
Here, the help of gravity is usually sufficient for them to consolidate in the right position. Proximal humeral fractures with detachment of the tuberculum majus will most likely require surgery, as well as fractures with three or even four fragments.
Why are there different surgical methods?
In some cases, it is necessary to fix the fragments of the proximal humerus. The fixation (retention) is carried out using suture material, wires, plates and screws.
In other cases, the fracture fragments are too small and fragile to withstand fixation. With such fractures, especially if they consist of three or four fragments, it is often decided to replace the fracture fragments with a metal prosthesis: endoprosthesis replacement instead of an attempt at fixation.
What problems are associated with a proximal humeral fracture?
Proximal humeral fractures can cause a stiff shoulder, stiff elbow, or stiff hand. To regain normal range of motion, physiotherapy and rehabilitation are needed.
In addition, shoulder fractures can cause nerve injury or other nerve disorders, such as carpal tunnel syndrome. In some cases, a shoulder fracture is associated with injuries to soft tissues, especially the muscles of the rotator cuff.
Are therapies needed to achieve better results?
Not everyone needs physiotherapy treatment after a shoulder fracture, even if it is usually done in order to recover in a shorter time and to the full extent.
Should the arm be moved as long as it is supported by the orthosis?
When the orthosis has been applied, it should fit snugly against the body and allow the arm to hang under the influence of gravity. The arm must not be pressed firmly to the chest.
It is very important to use your hand and fingers, even if you wear an orthosis. On the other hand, it is not allowed to lift objects heavier than a cup of coffee or a telephone receiver.
The orthosis should be removed at least twice a day to stretch the elbow and thus prevent stiffening of this joint.
When does the shoulder no longer hurt?
Most shoulder fractures cause severe pain in the first two weeks. After that, the pain passes until complete healing.
It takes about two to three months for the pain to subside noticeably.
The pain worsens with movement and weather changes.
These symptoms may persist for a year or two before they go away.
Why are the fingers so stiff?
If the humerus is broken, immobilization of the shoulder causes swelling. This restricts the flow of blood from the hand and arm towards the heart, just as an accident on a highway lane affects traffic in this area.
The result is swelling and stiffness.
In addition, blood and fluids from the fracture travel to the fingers until the body can absorb them.
What makes the condition worse is that some individuals have arthritis in their finger joints, even though they have never felt pain before.
What to expect while the arm heals?
In the first two weeks, the shoulder hurts very badly and you can feel something like a “sustained movement of the bones”. The arm and hand swell and finger movements become tedious.
Physiokinesitherapy (exercise therapy) for the elbow, wrist, fingers and thumb are important for a good result.
One must expect that the fingers will become cold and take on a bluish color, but their sensitivity should always be maintained and the hands must not fall asleep.
One should sleep in a vertical position on an armchair or couch without putting on the tutor, so that the arm is pulled down in relation to the shoulder.
Over time, the pain decreases. As soon as the orthosis can be removed, the recovery of mobility must be started.
During the healing process, the effect of physiotherapy and rehabilitation regains one’s strength.
The resumption of sports activities should be postponed for at least 4-6 months after the fracture.
It can take up to a year or more for swelling and pain to pass.
The discomfort you feel when the weather changes can occur up to 3 years after the fracture.
The shoulder may appear slightly larger and may not regain all its mobility compared to the healthy shoulder.
