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proximal humerus fracture exercises pdf
A proximal humerus fracture is a common injury, especially in elderly individuals due to osteoporosis. It significantly impacts shoulder mobility and daily activities, requiring structured rehabilitation.
1.1 Definition and Prevalence
A proximal humerus fracture occurs when there is a break in the upper portion of the humerus bone near the shoulder joint. This area includes the humeral head, anatomic neck, surgical neck, and greater and lesser tubercles. It is a common injury, particularly among older adults, often resulting from falls or osteoporosis. The fracture can range from non-displaced (minimal bone misalignment) to displaced (significant separation of bone fragments). Proximal humerus fractures account for approximately 4-6% of all adult fractures, with a higher incidence in individuals over 60 years old. Understanding the definition and prevalence is crucial for effective diagnosis, treatment, and rehabilitation planning.
1.2 Common Causes and Risk Factors
Proximal humerus fractures are often caused by falls onto an outstretched arm or direct trauma to the shoulder. Osteoporosis is a significant risk factor, weakening bones and increasing susceptibility. Elderly individuals, particularly women, are at higher risk due to hormonal changes and bone density loss. Other causes include motor vehicle accidents and sports injuries. Activities requiring repetitive overhead movements may also contribute, though this is less common. Understanding these causes and risk factors aids in prevention strategies, such as fall prevention programs and bone health management, reducing the likelihood of fractures in vulnerable populations.
Rehabilitation Overview
Rehabilitation for proximal humerus fractures involves a structured process to restore shoulder function and mobility. It includes exercises, physical therapy, and gradual progression to strengthen the shoulder and improve range of motion over several months.
2.1 Importance of Early Mobilization
Early mobilization is crucial for preventing stiffness and promoting recovery in proximal humerus fractures. Gentle exercises, even while wearing a sling, help maintain joint mobility and muscle strength. Starting with wrist, elbow, and hand movements in the initial weeks ensures that the shoulder remains functional. Gradually introducing pendulum swings and active-assisted range of motion exercises after 2-3 weeks helps restore shoulder mobility without risking fracture displacement. Early mobilization also reduces pain and inflammation, enabling patients to resume daily activities sooner. It lays the foundation for more advanced exercises in later stages, making it a cornerstone of effective rehabilitation protocols.
2.2 General Principles of Recovery
Recovery from a proximal humerus fracture follows a structured, phased approach to ensure proper healing and restoration of function. Immobilization in a sling is typically required for the initial 2-4 weeks to allow the bone to heal. Pain management and gradual progression of exercises are key to avoid discomfort and prevent complications. Most fractures heal within 6-8 weeks, with non-displaced fractures requiring less intensive rehabilitation. Weight-bearing and heavy activities are avoided during this period to minimize risk of displacement. The goal is to restore shoulder mobility, strength, and functionality through a carefully planned rehabilitation program tailored to the patient’s specific injury and progress.
Exercise Guidelines
Exercise guidelines for proximal humerus fractures are divided into stages, focusing on pain reduction, mobility restoration, and strength rebuilding, tailored to the injury’s progression and healing phase.
3.1 Immediate Post-Injury Exercises (0-2 weeks)
Immediate post-injury exercises focus on maintaining mobility in the unaffected joints while immobilizing the shoulder. Patients are advised to wear a sling full-time, except for hygiene and specific exercises. Exercises include wrist and hand range of motion, elbow flexion, extension, pronation, and supination. Shoulder movement is strictly avoided to prevent displacement. These exercises are gentle and aim to prevent stiffness without compromising the fracture healing process. Pain should be minimal, and any significant discomfort warrants stopping the exercise. Compliance with the sling and early mobilization guidelines is crucial during this phase to ensure proper alignment and healing of the fracture.
3.2 Early Stage Exercises (2-6 weeks)
During the early stage, exercises progress to include gentle shoulder movements while continuing wrist, elbow, and hand exercises. Patients may begin pendulum swings and active-assisted range of motion exercises, such as shoulder flexion and abduction, using the unaffected arm for assistance. Scapular exercises, like shrugs and pinches, are introduced to maintain shoulder girdle mobility. These exercises aim to restore basic shoulder function without overloading the fracture site. Resistance or heavy lifting is still avoided. Patients are encouraged to perform these exercises 3-4 times daily, gradually increasing repetitions as comfort allows. Proper form and adherence to prescribed limits are essential to prevent setbacks and promote healing.
3.3 Intermediate Stage Exercises (6-12 weeks)
At this stage, exercises focus on strengthening the shoulder and improving range of motion. Patients can gradually introduce light resistance using bands or weights. Active shoulder flexion, abduction, and external rotation are emphasized, along with controlled internal rotation. Scapular exercises, such as wall slides and push-ups, are continued to enhance stability. Gentle rotational exercises with a wand or light resistance are also incorporated. Patients are encouraged to perform these exercises 3-4 times daily, ensuring proper form to avoid strain. Progression to more dynamic movements, like arm circles and shoulder rotations, helps restore functional strength. Avoiding heavy lifting remains crucial, but controlled resistance is introduced to build muscle endurance and prepare for advanced activities.
3.4 Advanced Stage Exercises (Beyond 12 weeks)
Beyond 12 weeks, exercises focus on restoring full shoulder mobility and strength. Patients progress to higher-level activities, such as overhead reaching and dynamic movements. Resistance exercises with weights or resistance bands are intensified to improve functional strength. Plyometric exercises, like medicine ball throws, may be introduced to enhance power and endurance. Advanced scapular stabilization exercises, such as single-arm wall slides and dynamic rotational movements, are emphasized. Patients are encouraged to gradually resume normal activities or sports-specific drills, ensuring proper form to prevent re-injury. The goal is to achieve near-normal shoulder function, with continued focus on maintaining strength and flexibility. These exercises are tailored to individual needs and activity levels, preparing the patient for unrestricted use of the arm.
Rehabilitation Protocols
Rehabilitation protocols for proximal humerus fractures focus on structured recovery, starting with immobilization and progressing to exercises. These protocols are tailored to fracture type and patient needs.
4.1 Non-Operative Rehabilitation Protocol
The non-operative rehabilitation protocol for proximal humerus fractures focuses on gradual recovery without surgery. Initial immobilization in a sling is crucial for 2-4 weeks to allow healing. During this phase, patients perform wrist, elbow, and hand exercises to maintain mobility. After 2-4 weeks, shoulder range-of-motion exercises are introduced, starting with gentle movements like pendulum swings. Strengthening exercises begin around 6-8 weeks, focusing on scapular stabilization and shoulder muscles. Progression is based on fracture stability and clinical assessment. The goal is to restore functional mobility and strength, avoiding heavy lifting or overhead activities for at least 6 weeks. Regular follow-ups with a shoulder specialist ensure proper healing and guide the rehabilitation process effectively.
4.2 Post-Operative Rehabilitation Protocol
The post-operative rehabilitation protocol for proximal humerus fractures emphasizes a structured approach to restore shoulder function after surgery. Immediate post-surgery care involves immobilization in a sling for 2-4 weeks to protect the repair. Patients begin with passive range-of-motion exercises, such as pendulum swings, and active-assisted movements to maintain joint mobility. Strengthening exercises, including scapular stabilization and rotator cuff activation, are introduced around 6-8 weeks post-operatively. Progressive resistance and functional activities are incorporated beyond 12 weeks to enhance strength and mobility. The protocol avoids heavy lifting or overhead activities for at least 6 weeks. Regular clinical assessments and imaging ensure proper healing and guide the progression of exercises, with the goal of achieving full functional recovery.
Long-Term Recovery and Prevention
Long-term recovery from a proximal humerus fracture focuses on restoring full shoulder function and preventing future injuries. Most patients achieve significant improvement within 6-12 months, though complete recovery may take up to a year. Consistent participation in physical therapy is crucial to regain strength, flexibility, and range of motion. Patients are encouraged to continue with low-impact exercises, such as swimming or cycling, to maintain joint health. Strengthening exercises using resistance bands or light weights can help restore muscle balance around the shoulder. Preventative measures include addressing osteoporosis through calcium and vitamin D supplementation, especially in elderly patients. Fall prevention strategies, such as removing home hazards and improving balance, are also essential to avoid recurrent fractures.