Nondisplaced means less than 1cm of displacement and less than 45 of angulation 2. The head, greater tuberosity, lesser tuberosity, and shaft make up the four possible fragments as described by neer 35. While nondisplaced fractures can be managed conservatively, displaced. Rehabilitation is central to addressing the problems caused by the fracture. Increase rom while protecting the fracture site you can be slightly more. It may seem like a severe enough break to require surgery, but, in reality, most humerus fractures can be treated by nonsurgical means. These devices provide varying degrees of constraint. The most useful rehabilitation protocol is the threephase system. This book is distributed under the terms of the creative commons. Hemiarthroplastyorif proximal humerus fracture protocol general principles of rehabilitation for fractures treat the patient not the fracture move all joints that are not immobilized prevent disuse atrophy use gravity to assist in mobilizing a joint be aware of peripheral nerve palsy signs. Proximal humerus fractures pediatric orthopaedic society. A patients guide to adult proximal humerus shoulder fractures compliments of. Heal a humerus fracture without surgery the jackson.
Proximal humerus fractures pediatric orthopaedic society of. Proximal humeral fracture twin boro physical therapy. Fractures of the proximal humerus are the third most common type of fracture. Maintain rom without displacing the proximal humerus fracture. Greater tuberosity fractures are a unique type of proximal humerus fractures. Oct 28, 2014 proximal humerus fractures includes everything the orthopedic surgeon needs to know about the clinical management of these common shoulder injuries. Depending on the type of fracture, it may be treated with or without a surgery. Oct 11, 2019 the profher proximal fracture of the humerus. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder.
A patient s guide to adult proximal humerus shoulder fractures. Proximal humerus fracture rates will continue to increase with the aging population 57,58 and the concomitant rise in osteoporosis. Famous physical therapists bob schrupp and brad heineck present. Proximal humerus fractures are generally classified by fracture type. Immediate physiotherapy following a proximal humerus fracture results in faster. The muscles and tendons of the rotator cuff, the acromion, and ligamentous attachments, such as those between the coracoid process of the scapula and the acromion, stabilize the glenohumeral. Most proximal humeral fractures do not require reduction as remodelling is extremely effective in the proximal humerus. Although no definitive phf rehabilitation protocols exist, physical therapy pt. Proximal humerus fractures are the third most common fracture in elderly patients.
Proximal humerus fractures includes everything the orthopedic surgeon needs to know about the clinical management of these common shoulder injuries. Early home physical therapy for my humerus fracture youtube. Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. If a fracture or fracture repair is stable, then therapy should be started early. Popkin, 2015 the proximal humerus is a common site of overuse injuries that mimic fractures. Sep 02, 20 the incidence of proximal humeral fractures lies between 105 and 342 per 100 000 persons per year. Oct 12, 2008 fractures of the proximal humerus are the third most common type of fracture. Surgical treatment options for proximal humerus fractures phfs include osteosynthesis and arthroplasty. Proximal humerus fracture statpearls ncbi bookshelf. Proximal humerus fractures evaluation and management lynn. There may be a decreased ability to move the arm and the person may present holding their elbow. Jun 30, 2015 trying to break my fall, my right outstretched arm took most of 226 pound weight fracturing the top of my humerus bone leaving me laying in the street moaning in pain. Greater tuberosity fractures may occur due to trauma or shoulder dislocation, and represent a boney disruption to the rotator cuff. In some cases, the broken proximal humerus must be surgically repaired or replaced.
Fractures of the distal humerus in the adult comprise 2 % of all fractures and approximately 30 % of all humeral fractures, with an incidence of 5. Shoulder manipulation under anesthesia rehabilitation protocol. Physical therapy new york knee surgery shoulder surgery. Non displaced 2 part fracture good alignment does not involve an articular surface. Outcome analysis following removal of locking plate. Proximal humerus fractures monograph series american. Use the video or information below to gain a better understanding of your injury and what can be done to maximise your recovery. A proximal humerus fracture is a crack or break in the top of your upper arm bone. A myriad of nonsurgical and surgical treatment options exist for these injuries, including shortterm immobilization and early physical therapy, percutaneous fixation, plate osteosynthesis, intramedullary nailing, hemiarthroplasty, and reverse shoulder arthroplasty.
Nov 18, 2019 proximal humeral fractures can be treated conservatively with an arm sling, pain management, and supportive care. Oct 01, 2010 an analysis of the literature reveals few published series on the results of surgical treatment for nonunions of the proximal humerus. Extension and internal rotation not performed until 6 weeks 4. Due to variable stability of the fracture, check for specifications and precautions ordered by the orthopedist. A physical therapy program after a proximal humeral fracture can help you return to normal activity quickly and safely. Around the world, this type of fracture remains a major challenge for treating surgeons. Maintain range of motion rom without displacing the proximal humerus fracture. These fractures have an annual incidence from to 14. In a child less than 3 years of age who presents with a proximal humerus fracture the treating physician should consider nonaccidental trauma.
Greater tuberosity fractures simcoe muskoka orthopaedics. Due to variable stability of the fracture, check for specifications and precautions ordered by the. Shoulder rehabilitation protocols shoulder surgery avon. Improve your ability to assess and successfully manage challenging proximal humerus fractures. Each book in the series is organized anatomically, so the surgeon can quickly access. Hemiarthroplasty has been the treatment of choice in patients with bone quality and fracture patterns not. Pediatric humeral fractures can occur in several locations including the proximal humerus, shaft diaphysis, or the distal humerus supracondylar ridges, medial and lateral epicondyles.
The proximal humerus is one of the bones in your shoulder joint. The information contained in these standards of care or protocols is not intended in any way to be used as primary medical advice or to replace medical advice offered by physical, occupational, speech therapists or other health care professionals. Rotator cuff repair protocol rotator cuff strengthening exercises scapular dyskinesis shoulder impingement phase i exercises shoulder impingement phase ii exercises slap repair stable proximal humerus fracture subacromial decompression, distal clavicle excision throwing program total shoulder arthroplasty unstable proximal humerus fracture. Stable proximal humerus fracture after surgical fixation. Proximal means it is the end of the bone that is closest to the body. The most common mechanism for these fractures is a fall on the outstretched hand from a standing height. Jul 26, 2018 famous physical therapists bob schrupp and brad heineck present. When the blood supply is damaged, the fragment may not heal and may actually collapse or fall apart. Mar 03, 2019 proximal humerus fractures often happen to elderly individuals due to osteoporosis and weakened bones. A sling and swath, or velpeau with an axillary pad should be used when not doing physical therapy.
Proximal humerus fractures phfs are common, particularly among older. If the bone cannot be surgically repaired, the ball of the shoulder may be replaced. Rehabilitation after proximal humeral fractures request pdf. Surgeons may use nails, plates, and screws to secure pieces of bone together. Phase i 0 to 21 days begin elbow, wrist and hand active rom. Proximal fractures are classified into one of four types of fractures based on the displacement of the greater tubercle, the lesser tubercle, the surgical neck, and the anatomical neck, which are the four parts of the proximal humerus, with fracture displacement being defined as at least one centimeter of separation or an angulation greater.
A humerus fracture is a break of the humerus bone in the upper arm. These fractures tend to occur in older patients who are osteoporotic. Although some people refer to them as shoulder fractures, we prefer to avoid that term as there are many bones around the shoulder. Emphasizing the importance of sound clinical assessment, the respected authors set out to help.
Physical therapy standards of care brigham and womens. Proximal humerus fracture family practice notebook. A patient s guide to adult proximal humerus shoulder. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. Although the appropriate management of displaced or unstable proximal humeral fractures remains a controversial, open reduction and internal fixation orif using fixedangle interlocking plate seems to be a promising. Proximal humeral fractures can be treated conservatively with an arm sling, pain management, and supportive care. I recently fractured my left humerus and found that reading humerus fracture recovery blogs has been helpful in anticipating the healing process. Although the appropriate management of displaced or unstable proximal humeral fractures remains a controversial, open reduction and internal fixation orif using fixedangle. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. Stable proximal humerus fracture after surgical fixation rehabilitation protocol. The usual treatment for this fracture is immobilisation of the shoulder in a sling, body swathe or shoulder immobiliser. The proximal humerus articulates with the glenoid of the scapula to form the glenohumeral shoulder joint figure 1 and figure 2 and figure 3. In the elderly and adult population osteopenic bone can fracture from minimal trauma or as the result of a shoulder dislocation.
The treatment of proximal humeral fracture in adults. These fractures can result from a direct hit or a fall onto an. Proximal humerus fractures may be treated nonoperatively with an initial period of immobilization followed by early motion. Fracturing the bone of your upper armmedically known as a humerus fracturecan be a painful and frightening experience, especially because the most common cause of this type of fracture is a bad fall. Nonoperative proximal humeral fracture rehabilitation protocol.
Patients should be seen in the fracture clinic or by an interested gp within 7 days for followup with x. Although nonoperative treatment techniques are addressed and can be used in less severe circumstances, this book focuses mainly on the current operative treatment techniques for proximal humerus and tuberosity fractures, malunions and nonunions. Such stiffness often requires physical therapy to help get back to normal motion. Most proximal humerus fractures can be treated without surgery. Trying to break my fall, my right outstretched arm took most of 226 pound weight fracturing the top of my humerus bone leaving me laying in the street moaning in pain. This protocol is for patients with nondisplaced proximal humerus fractures, or patients with proximal humerus fractures that have been surgically repaired. Humeral shaft fractures account for 1 to 3% of all fractures in adults 1, 2 and for 20% of all humeral fractures. Proximal humerus fractures often happen to elderly individuals due to osteoporosis and weakened bones. Little league shoulder is a proximal physeal overuse injury found in overhead throwing athletes. Nondisplaced means less than 1cm of displacement and less than 45. This information will guide you through the next 6 weeks of your rehabilitation.
Abstract the occurrence of proximal humerus fractures will continue to rise with the increasing elderly population. Treatment of the humeral shaft fractures minimally. Rehabilitation goals protect repair minimize pain and swelling maintain rom of surrounding joints prevent adhesive capsulitis. Nonoperative treatment is still the standard treatment for isolated humeral shaft fractures 6, 7, although this method can present unsatisfactory results, such as, nonunion and shoulder. One part fracture 80% of proximal humerus fractures. Greater tuberosity fractures may occur due to trauma or shoulder dislocation, and represent a boney disruption to the rotator cuff tendons around the shoulder. Proximal humerus fracture book twin cities orthopedics. Codman developed the original classification scheme in 1934 by devising a system based on the epiphyseal regions of the proximal humerus, creating four possible fracture fragments. Surgical treatment for a proximal humerus fracture. The shoulder is a ball and socket joint and you have fractured the ball part. Additionally, fractures of the shoulder can bring about nerve injuries or other nerve conditions such as carpal tunnel syndrome.
The incidence of proximal humeral fractures lies between 105 and 342 per 100 000 persons per year. Pdf rehabilitation of proximal humerus fractures a scoping. Electrotherapy or hydrotherapy does not enhance recovery. Bony healing occurs usually within 6 to 8 weeks in adults 3. Proximal humerus fractures almost always occur at the surgical neck of the humerus, dividing the proximal humerus into as few as two or as many as four parts. Nonoperative treatment typically consists of wearing a sling or shoulder immobilizer for one. Evaluation by randomisation trial a pragmatic multicentre randomised controlled trial evaluating the clinical effectiveness and costeffectiveness of surgical compared with nonsurgical treatment for proximal fracture of the humerus in adults. Proximal humerus fractures phf account for 56% of all adult fractures1. Complications may include injury to an artery or nerve, and compartment syndrome the cause of a humerus fracture is usually physical trauma such as a fall. Fractures of the proximal humerus are common, accounting for 5% of all fractures. Many patients with proximal humerus fractures have osteoporosis and have poor neuromuscular control mechanisms. The trial compares surgical versus nonsurgical treatment for these fractures and it is important to the validity of the trial that comparable physiotherapy is. Sling immobilization with or without closed reduction also has a role in the management of displaced proximal humerus fractures.
Proximal humeral fractures, which typically occur in elderly persons, are among the most common fractures. Initial immobilization may be achieved with a sling, a shoulder immobilizer, or a sling with an accompanying swathe. This portable reference offers a comprehensive discussion of current concepts in closed treatment, minimally invasive techniques, and traditional methods. A guide to proximal humerus shoulder fractures melbourne. Healy and colleagues 1 reported on the outcome of 25 proximal. Bony healing occurs usually within 6 to 8 weeks in adults 2. Replicate citations, books and retracted articles were removed and. Although nonoperative treatment techniques are addressed and can be used in less severe circumstances, this book focuses mainly on the current operative treatment techniques for proximal humerus and tuberosity fractures, malunions and. Pdf rehabilitation of proximal humerus fractures a. Nonoperative proximal humeral fracture rehabilitation protocol general principles. Fractures of the proximal humerus peter biberthaler springer. Fractures in the shoulder area can involve any of the bones that form the shoulder, including the humerus or upper arm humeral fracture.
The most common fracture of the humerus, and involves the proximal third of the humerus as a result of a direct blow to the anterior, lateral, or posterolateral aspect of the humerus, or from a fall on an outstretched hand foosh injury. Proximal humerus fractures sometimes result in stiffness of the shoulder, elbow, or hand. Outcome analysis following removal of locking plate fixation. Post fracture proximal humerus rehabilitation guidelines r l humerus fracture. Hemiarthroplastyorif proximal humerus fracture protocol. Rehabilitation guidelines for proximal humerus fracture nonoperative 2 p a g e phase ii continued precautions dc sling x 3 weeks if cleared by md aarom to 90 degrees forward flexion and 40 degrees er suggested therapeutic exercises arom cervical, elbow, wrist and hand pendelums gripping exercises scapular pnf progress to full. Post fracture proximal humerus rehabilitation guidelines. Return to normal function and motion may require 3 to 4 months overall goals. Although nonoperative treatment techniques are addressed and can be used in less severe circumstances, this book focuses mainly on the current. A 3fold increase in osteoporosisrelated fractures is expected in the year 2030 2, 3. Appointments begin physical therapy at 1 week post op, 2 xweek follow up with md 1014 days post op.
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