Up to 5 percent of fractures are of the humerus so this is a common presentation at Emergency Departments, with up to 80 percent of fractures either not displaced or displaced minimally. As older people suffer mostly from this fracture, there is a relationship with osteoporosis and people often have a fractured forearm on the same side. These fractures occur mostly at the upper arm, known as the humeral neck (shoulder fractures), and at the middle of the arm bone, with artery or nerve damage possible but not common.
The usual cause of a humeral fracture is a direct fall on the arm, either on the hand, elbow or directly onto the shoulder itself. Due to all the muscles that attach to the upper humerus, there can be a lot of muscular force at the time, dictating how much the bones are pulled into a displaced position. Humeral fractures are more common in the elderly with an average age of fracture of around 65 years and younger people usually have a history of forceful trauma such as motor accidents or sport.
Humeral fractures usually occur with great force and if this has not happened then a serious condition such as cancer must be considered. When the physio examines the arm they may find very limited shoulder movement, severe swelling and bruising, some shortening in shaft fractures and pain on movement of the elbow or shoulder. The radial nerve, which supplies the extensors of the wrist and fingers and thumb extensors and abductors, can be damaged but this is more common in shaft fractures and less so in fractures of the humeral neck.
Management of Humeral Fractures
Acutely the patient is kept still and given adequate analgesia to relieve the initial pain. Fractures of the upper part of the arm bone can mostly be managed without operation if there is little or no displacement but rotator cuff injury could occur if the greater tuberosity is fractured, especially if it is displaced any distance, great force was involved or the patient is older. A collar and cuff sling allows upper humeral fractures to traction themselves straight and in line, while shaft fractures can be braced but are difficult to control.
Fractures with three or four parts plus displacement often need surgical treatment, with open reduction surgical fixation (ORIF) more often required in younger patients. In older people the humeral head may be replaced as the fracture may not heal or give an acceptable pain or movement result. Shaft fractures usually heal without surgery (plating or nailing) and are managed in a functional brace. Complications include frozen shoulder, avascular necrosis of the humeral head in multi-part fractures and nerve injury in shaft fractures. Six to eight weeks is typical healing time with older people often suffering a permanent reduction in shoulder movement.
Shoulder Fracture Treatment by Physiotherapy
Initial physiotherapy assessment consists of assessing the patient's pain levels as these can vary hugely, the joint ranges of motion of the elbow, hand and wrist and the tissue swelling and bruising in the arm. Muscle strength is tested in the forearm as this may indicate an injury to the radial nerve, as may loss of sensory discrimination. The patient may stay in the sling for 2-3 weeks with the physio exercises beginning early if pain is reasonable and the fracture stable. The aim is to maintain the range of motion of the shoulder joint while the fracture heals, by performing bent over pendular exercises to counteract gravity.
The fracture will have started to heal at the three week point so the physio will start auto-assisted exercises, the patient assisting the movement of the fractured arm with the healthy one. Progression from here it to unassisted exercises where the affected arm does the movement alone, practicing flexion, medial and lateral rotation. Healing time for the humerus is six weeks so the physio will increase the force behind the exercises, gently stretching the joint to increase the available movement. Joint mobilisation techniques can be uses to free up the accessory movements and Theraband used to perform strengthening exercises and maintain gains in movement.
Article Source: http://www.alltopinfo.com
Jonathan Blood Smyth is a Superintendent Physiotherapist at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Leeds.
Please Rate this Article
Not yet Rated
Additional Articles From -
Home |
Fitness 
