Humeral fractures typically occur with up to 5% of all fractures dropping under this group, 80% of humeral fractures either minimally displaced or undisplaced. Osteoporosis is a common factor in all of these injuries, and standard diagnosis is a fracturing of the forearm on the same side. great post to read Nerve or arterial injury from the fracturing is a significant but not universal concern. Typical fracture sites are the top of the arm (humerus neck-” shoulder fracture), “and the centre of the humerus shaft.
A humeral fracture is typically induced by a sudden fall on the limb, either on the wrist, the elbow or directly onto the shoulder itself. There can be a lot of muscular force at the time owing to all the muscles that bind to the upper humerus, dictating how much the bones are forced into a rotated location. Humeral fractures are more frequent in older people with an average fracture age of around 65 years and younger people typically have a history of severe injuries such as car crashes or competition.
If the fracturing occurs without substantial force than it is appropriate to assume a pathological origin, such as cancer. On physio-examination discomfort may arise on shoulder or elbow movement, severe bleeding and swelling will arise, the arm can look small if the bone is distorted in shaft joints and the shoulder mobility is very limited. Radial nerve injury in upper humeral fractures is uncommon but more frequent in shaft fractures, contributing to “wrist drop,” wrist and finger extensor weakening and certain thumb movements.
Managing Humeral Fractures
The patient’s motions are kept controlled after the injury and adequate analgesia is given to maintain them calm. The treatment is non-operative with little to no movement so if the greater tuberosity is broken then it is necessary to consider damage to the rotator cuff. This is most likely with high-force accidents, where the patient is elderly or the tuberosity is greatly displaced. Humeral neck fractures may be held in line with a collar and belt, enabling free hanging of the elbow while fractures of the shaft are tough to treat but can be braced.
Simple internal repair reduction (ORIF) is often done with three or four pieces for fractured injuries, and most usually in younger people, while older patients have humeral head reconstruction to reduce discomfort and swelling in the leg. Where appropriate, nailing or plating is used in shaft fractures but these typically cure without surgery. Humeral fractures may have consequences involving damage to the radial nerve in shaft breaks, frozen leg, and lack of blood flow to the humeral head. Although average healing period is 6-8 weeks, older patients can can not reestablish full shoulder mobility ability.
Shoulder fracture: Physiotherapy care
The physio assesses the arm first, informing the patient about their degree of discomfort as this differs widely, assessing the arm’s swelling and bleeding. The physiotherapist also tests the variety of shoulder, elbow, forearm and hand motions required. Note some muscle fatigue and sensory disturbance as these may signify injury to the nerves. If not operated on, a sling will begin, and if the injury is not too uncomfortable or serious, the physiotherapist will recommend early exercises. In the early stages, pendular exercises, with the patient bent over at the knee, are necessary since they enable the shoulder joint to function without much effort.
Three weeks after the broken bone recovery is well under way then the physiotherapist can advise the patient to use the other arm in self-assisted activities to help relieve tension on the injury. Unassisted movements are the next step to perform lateral and medial rotation and flexion, as the arm gets stronger. Within six weeks the bone would be scientifically stable enough that the physio will continue through pressure and mild end-range stretching through more aggressive motions. Joint mobilizations may be helpful in transforming the slipping and gliding motions of mutual work and restoring and mutual range function with Theraband persisted.