Rehabilitation for a shoulder fracture


In the hospital

The first meeting with a physiotherapist can take place immediately after the injury in the hospital.

It is likely that the arm must be carried in a sling to protect and immobilize the shoulder during the healing process.

The physiotherapist can show the affected person how to put the noose on correctly.
He or she may also teach the patient some gentle pendulum exercises (according to Codman) to maintain shoulder flexibility as the fracture consolidates.
The doctor will tell you whether you can carry out a training program without danger.

In practice

Four to six weeks after the injury, rehabilitation can usually begin.
If the patient is unable to drive or leave the house because the state of health does not allow it, a physical therapist can treat through home visits.

The physiotherapist evaluates the situation at the first appointment.
He or she asks for information about the injury and performs some measurements and tests to decide how to proceed.
The evaluation helps the physiotherapist to choose the best method of treatment.

Measurements after an upper arm fracture are used to assess:

  • Range of motion
  • Force
  • Shoulder pain
  • Functionality and mobility
  • Mobility of the scar (if an ORIF, i.e. an open reposition and internal fixation has been performed)

After a thorough evaluation, treatment begins to improve the functionality of the arm. The physiotherapist should inform the patient about the rehabilitation program and what the patient needs to do about it. Physiotherapy and rehabilitation for a shoulder fracture require the active cooperation of the patient in order to achieve good results.

Some common ailments that the patient needs to work on with the physiotherapist are:

Range of motion. After a proximal humeral fracture, movement may be restricted at the shoulder and elbow.
This loss of elasticity leads to difficulties with arm movements.
The physiotherapist may prescribe exercises that help improve mobility.

Power. It is likely that the shoulder will be immobilized with a sling for four to six weeks after the injury.
Most often, this immobilization causes a significant loss of strength and muscle mass.
The strengthening exercises focus on the muscles of the rotator cuff and upper arm: biceps and triceps.
The muscles that hold the shoulder blade may be weaker, but are crucial for keeping the shoulder healthy and should therefore be trained together with the others.

Pain. After the fracture of any body bone, one feels at least a small pain. This is normal and to be expected. The severity of the pain should subside day by day, but you may still feel pain after starting physical therapy.
The physiotherapist can help relieve the pain with movement exercises or with treatments such as heat, ice or magnetic therapy.
If the treatment causes severe pain, the physiotherapist must be informed so that he can change the therapy and thus make adequate pain control possible.

Mobility of the scar. If an operation to reposition the humeral fracture has been performed, a surgical scar is created in the anterior and lateral area of the shoulder.
Occasionally, minor adhesions of the scar lead to the feeling of “blockage” and limited mobility.
The physiotherapist can then perform fascia massage of the scar tissue and mobilization to increase the elasticity of the scar. He or she can also show how the patient can perform a massage at home.

Functionality. The rehabilitation program should focus on restoring the normal functioning of the arm and shoulder.
The physiotherapist can show how normal everyday activities should be performed in order to improve the movement of the shoulder and arm. In this way, the injury no longer restricts activities.
One should also discuss with the physiotherapist the activities made difficult (or impossible) by fracture, so that he or she can tailor the rehabilitation program to personal needs.

Eight to twelve weeks after the injury, strength and mobility should have improved sufficiently to ensure normal functionality of the arm.
The pain should be minimal.
At this point, the rehabilitation program can be gradually reduced.
You may need to continue with the exercises at home for a few more months to maximize mobility.
One should talk to the doctor and physiotherapist to find out exactly what to do and what to expect.

A proximal humeral fracture (near the shoulder) is a painful injury that limits the mobility of the arm and shoulder.
This can have a significant impact on the ability to work, run the household, and pursue hobbies in leisure time.
A physiotherapy program after a proximal humeral fracture can help to quickly and safely return to normal activities.

Complications of a shoulder fracture

Early rehabilitation is very important. An upper arm fracture that requires immobilization of the arm can lead to inability to move the shoulder (adhesive capsulitis).

As a result, a long rehabilitation or surgery is required to loosen the adhesions.
The weakness of the shoulder manifests itself after healing.

Proximal humeral fractures can consolidate shifted or the bone fragments cannot grow together at all, especially if the tuberculum majus was broken.

Injury to the brachial plexus and nerves (axillaris, suprascapularis, musculocutaneus, radialis) occurs in 50% of proximal humeral fractures and causes permanent loss of muscle strength in 8%.
The risk of nerve injury increases in people who have suffered a fracture on the surgical neck of the humerus or a displaced fracture and in the elderly.

Most vascular injuries occur in people over the age of 50.
Injury to blood vessels on the proximal humerus (lateral arm of the anterior circumflex humerior artery) can lead to avascular necrosis, which occurs in 14% of fractures with 3 fragments and in 34% of fractures with four fragments (Frankle).
This complication often occurs with fractures of the surgical neck of the humerus and may require joint replacement (endoprosthesis).

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