Fracture of the surgical neck of the shoulder( humerus)
Fracture of the surgical neck of the shoulder occurs due to a fall or any other physical impact on this area. Most often, such damage occurs in the female half of the population who are in old age. In this category of patients, various diseases of the musculoskeletal system develop over time, against which the bones become more fragile. They are damaged as a result of insignificant physical impact on the shoulder region, and when the upper limbs are held in an incorrectly chosen position for a long time.
Such fractures can be of the following types:
by adduction, occur when a person falls on a bent upper limb;
abduction, occur when falling on a limb taken to the side.
Shoulder fracture with bias
With a fracture of the surgical neck of the shoulder, a specialist can palpate the displaced bone fragments by palpation. In some cases, they can be seen visually, since they protrude from under the skin. Such patients almost instantly have a hematoma and severe edema in the area of injury. The strongest painful feelings cause painful suffering for the victims, so when they enter the medical institution they are immediately anesthetized. If there is a suspected fracture of the humerus with displacement, x-rays in several projections are mandatory, thanks to which the specialist will be able to determine the real picture of the problem and choose the correct treatment technique. Sometimes there are cases in which, during a fracture of the surgical neck of the shoulder, bone fragments begin to exert pressure on the neuromuscular bundle.
This often results in severe complications:
with a strong swelling of the upper limb;
by the necrosis of the injured limb;
, the appearance of an aneurysm, etc.
Fracture of the shoulder without bias
To date, fracture of the surgical neck of the shoulder is not so common, in 7% of all cases of damage to the bones of the musculoskeletal system.
Patients may show a fracture in any part of the humerus:
in the distal;
in the middle;
in the proximal.
During a fracture of the humerus without displacement of debris, a hemorrhage occurs in patients in the area of injury. In all cases, without exception, there is edema, which over time increases greatly. In patients, the mobility of the injured upper limb is completely impaired, and with a slight movement, they begin to experience strong pain sensations. If the fracture is classified as punctured, the patient will be able to perform passive hand movements. On the background of such a trauma, deformity of the shoulder joint may occur, therefore, it is necessary to immediately seek medical help from a qualified specialist.
Treatment of the fracture of the surgical neck of the shoulder
The patient, who suffered a fracture of the surgical neck of the shoulder, experiences severe pain, and also observes loss of mobility of the upper limb. These symptoms force him to go to a medical facility for qualified help. At the reception specialist in the first place will conduct a personal examination of the patient, will collect an anamnesis of the disease.
To obtain a more accurate clinical picture, the physician will prescribe to the patient an additional examination, which provides for a number of diagnostic measures. In most cases, this category of patients is immediately directed to radiography, through which it is possible to determine the type of fracture.
If the X-ray did not give the doctor a complete picture of the disease, the patient is given computer or magnetic resonance imaging, which can detect damage to the muscular tissue in the area of the injured shoulder belt.
Patients can be treated on an outpatient basis if a fracture of the surgical neck of the shoulder is detected. The specialist chooses the method of treatment individually, depending on the complexity of the fracture. With the usual fracture, the upper limb of the patient is fixed in a certain position, after which a gypsum langette is superimposed on it and on the trunk. To wear such bandage from gypsum follows for 4-8 weeks, depending on the complexity of the fracture.
In the case when there is a displacement of bone debris at a fracture, the patient is repositioned in a hospital. This manipulation is accompanied by a strong pain syndrome, so patients are injected with local anesthesia. In very complex fractures, treatment is possible only surgically. During the surgical intervention, the patient is immersed in general anesthesia, after which he performs an open reposition and fixation of bone debris.
As a fixator surgeons use special designs made of special medical alloys that are not subjected to oxidation. Their main purpose is to bring together bone fragments( in which holes are pre-drilled) and their reliable fixation. With a qualitatively performed operation, the patient can do without external immobilization. All metal retainers are dismantled their bones 4 months after their installation.
Repeated surgical intervention is performed only when the specialist is satisfied that the splicing of the bone fragments has been successful. The functions of the injured shoulder and upper limb will be restored gradually, after the patient has completed the full course of rehabilitation.
Immobilization for shoulder fracture
For fracture of the shoulder, patients need complete immobilization, for which a thoracobronchial bandage is used, for the application of which specialists use the traditional technique:
. The patient should be on a hill in a sitting position( high stool or table can be used).
Injured upper limb should be set in a certain position:
at an angle of 70-80 degrees - with fractures of the upper third of the humerus;
at an angle of 45 degrees - with fractures of the lower third of the humerus.
The damaged shoulder must be bent( the angle should not be in the range of 45 to 80 degrees).
A cotton wool is placed around the body of the patient( the area of the shoulder, on the crests of the iliac bones, as well as the elbow, shoulder, wrist joint), which is fixed by bandage or gauze.
On the sides of the trunk and injured limb, plaster langets are superimposed, while the healthy shoulder is not fixed at all and remains completely free and movable.
To prevent damage to the corset between it and the plastered upper limb, a special spacer is installed, the functions of which can be performed by an ordinary wooden stick.
In complex( abduction) fractures, accompanied by the displacement of bone fragments, the patients, after repositioning, are superimposed with the Whitman-Gromov dressing. In the event that a fracture occurred in the lower third of the humerus, a gypsum dressing is applied to the injury site, which covers the upper limb of the patient as a gutter.
LFK with fracture of the shoulder
In patients with fractures of the surgical neck of the humerus, patients are prescribed a course of therapeutic physical training. The patient will be able to perform special exercises for 2-3 days from the moment of receiving such an injury.
This course of exercise therapy is divided into several periods:
The first period of curative physical training( lasts for 2 weeks) includes a set of exercises that patients must perform by tilting the trunk toward the injured upper limb. All exercises are based on flexion and extension of the hands, performing various movements.
The second period of of physical therapy( on average, it lasts 4 weeks) includes exercises that involve the torso of the trunk, various movements of the upper limbs( mahi, breeding, etc.), the use of sports equipment, etc. The third period of exercise therapylasts for 3-4 weeks. During the implementation of the complex of exercises, patients use various sports equipment and shells: balls, dumbbells, maces, sticks, etc. For such a category of patients, it is very useful for occupational therapy, during which they can do household chores, work in the garden,
The third course of LFK includes exercises, during which the patients make mahi, flexion and extension of hands, and strength exercises. Patients are advised to visit the swimming pool, as water procedures have a positive effect on the musculoskeletal system in general and help restore the body after injuries. After performing each approach, the patient must relax the muscles and do respiratory gymnastics. Thanks to a specially developed complex of exercises in patients who have suffered a fracture of the surgical neck of the humerus, the amplitude of movements is fully restored and they can lead an active lifestyle. Muscular tissues in the area of the injured limb come in a tone and can function fully as before.
On the topic: 12 folk methods for home treatment
Rehabilitation for shoulder neck fracture
After carrying out a constructive treatment of fracture of the neck of the shoulder, patients need a fairly long rehabilitation. The program of rehabilitation measures begins with the restoration of physical activity of patients. For them a special set of exercises is developed, separately for the upper and lower extremities.
It is mandatory for this category of patients to perform:
complex of exercises for fingers;
movement of the upper limbs in different planes;
strain the muscles of the shoulder girdle, etc.
Patients can go through rehabilitation both at home and in medical institutions, where there are specially equipped classrooms for study. Each exercise should be repeated 8-10 times, while carefully listening to your own body and immediately stopping your workout if pain occurs. The complex of physical exercises must be performed daily. It is recommended to do 3-4 approaches, each of which lasts at least 15 minutes.
In addition to physical education, rehabilitation includes a complex of physiotherapeutic procedures, which can be described as:
visiting the swimming pool, etc.
Massage of this category of patients should be carried out by well-trained professionals who use modern techniques in their work, based on intermittent vibrations. For these purposes, the masseur uses either fingers or a wooden hammer, the purpose of which is to perform light taps on the plaster bandage of the patient, in the area of the fracture.
Over time, patients are encouraged to increase physical activity, especially in the area of the injured shoulder. Daily exercises, the time which should be increased to 40 minutes, the patient should perform only after a thorough warm-up, during which all joints of the upper limbs and shoulder girdle are worked and heated. After the first course of exercise, you should perform a set of breathing exercises, the purpose of which is to relax the muscles.
The final phase of rehabilitation includes a complex of more complex exercises aimed at restoring the coordination, strength and dexterity of the patient. The daily physical education course includes throws and catching the ball, transferring it to a partner, etc. After completing the rehabilitation, patients completely restore their professional and household activities.
Author of the article: Aleksandr Sergeevich Kaplan, Trauma Physician, orthopedist
LFK after fracture of humeral bone
Damage to the humerus is a serious trauma. It can be of the following character: a rupture of the knoll, anatomical and surgical fractures of the cervix. Damage to the neck of the shoulder leads to the necrosis of the broken head, so in such cases, surgical intervention is indicated.
A long-term patient should avoid any work that causes pain in the broken arm, including lifting weights and the actions accompanying the raising of the upper limb.
Ignore the physical therapy during this period, in no case it is impossible, even if it will cause painful sensations, since the bone callus can grow very slowly.
Exemplary set of exercises
• compress and unclench fingers without lifting the brush;
• strike each finger on the palm of a healthy hand;
• raise, rotate the brush, keeping your fingers straight.
Movement is performed at least 5-6 times.
• to make forearm rotational movements in both directions;
• withdraw and bring the shoulder, helping the second hand;
• lean your fingers on a healthy arm and slowly move the injured limb upwards;
• hold your hand on the weight( a few seconds).
Movements are performed 8-10 times.
If the treatment procedures are carried out regularly and correctly, the movements are restored already on day 20, which can not be said about muscle strength, so after the tire is removed, the training gymnastics should be continued.
Exercises after tire removal:
• Mill exercise;
• raise and lower your hand up and down.
The shoulder joint works actively if you do this work: dress and take off your clothes with a sleeve, try on your headgear, comb your hair, get books off the shelf and put them in place, clean shoes, iron the iron, wash the windows.
In addition to exercise therapy, therapeutic massage and physiotherapy procedures are additionally prescribed to restore operability and motor functions of the hand after injuring the humerus. Only comprehensive, regular treatment can give an expected, effective result.
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The development of the hand after a fracture of the humerus is an important stage for those who have encountered this trouble. In order to return to the habitual state as soon as possible, normalizing the functioning of the hand, one should know about the main methods of development, which are the most effective for this ailment.
General principles of hand rehabilitation
Fracture is a serious trauma, the treatment of which takes some time. The process is complicated by the presence of a bias. Recovery should be comprehensive, include physiotherapy, special exercises and massage. The main goal is to normalize the condition of the muscles and joints, which should be quite delicate, because for the first time after treatment all tissues in the damaged area are sufficiently vulnerable.
Physiotherapy is prescribed, usually about 3 weeks after injury to the shoulder. Usually this is an ultrasonic effect. Often an ultraviolet irradiation of damaged parts of the bone is prescribed, which can significantly reduce pain, promote rapid recovery. The doctor may recommend electrophoresis procedures( calcium or phosphorus).All of the above procedures can be performed with a plaster cast. After removing the gypsum, special applications( paraffin, therapeutic mud) and baths with turpentine, sage, iodine can be used. Physiotherapeutic procedures are usually recommended to be applied no more than 10 times.
As a rule, the humerus is fully restored after several months( up to six months with rehabilitation).
The use of exercise therapy is permissible only 3 days after the application of gypsum, but the first time loads must be very insignificant. Only after removal of gypsum should you start active movements with your hands when the bone has already grown together.
It is not uncommon for patients to exercise extremely hard. Causes can be complex fractures, hampering any action and causing pain. Often this is due to insufficient load during the long wear of the cast. In these cases, massage will be irreplaceable, which will break off the shoulder and elbow joints, increase blood supply and allow you to perform the exercises soon enough.
It is important to understand that the timing is directly related to the complexity of the fracture, the type of injury, the age of the patient, and also the characteristics of his bone tissue. In any case, a properly selected course of rehabilitation will speed up the process and bring the period of full recovery closer. It should be noted that if pain, numbness or other discomfort occurs in the area of damage after removal of gypsum, consult a specialist immediately to avoid possible complications.Back to the table of contents
The first stage of exercise therapy
This method of recovery is the most important, especially since it should be started a few days after injuring the humerus. While wearing gypsum, you must give some load to the muscles, but you should do it carefully.
The first step to restore the working capacity of the damaged limb and to prevent the occurrence of complications due to gypsum will be active finger movements. This will normalize the flow of blood, will keep the muscles in a tone, improve the patency of blood vessels.
Approximately 7 days after the delivery of medical care, the patient should strain his shoulder while maintaining his immobility. Exercises of this type are called isometric. It's quite easy to master them, but you should try it first on the other hand. Per day, the optimal performance of about 8-10 exercise approaches is 20 times. Isometric strains perfectly tone up muscle tissue, increase blood supply to the damaged area, and therefore accelerate recovery.
Special breathing exercises can be used that contribute to the overall strengthening of the body, the flow of oxygen into the tissues, and other exercises for the waist and elbow joints.
The second stage of therapeutic physical training
When the cast is removed, exercise exercises need to continue, but now they must be slightly different:
- pendulum rotations of both hands can contribute to the development of the joints of the shoulder and elbow, with the legs being placed and the body tilted;
- of rotation in a circle in the same position of the trunk;
- hand spreading in different directions is an important exercise that can be quite problematic at first, in this case it is necessary to help yourself with your fingers, rearranging them on the wall;
- rotation with your hand in front of you;
- putting your hands in the castle in front of you, and then straightening;
- Elbow joint development by hand bending;
- placement of forelimbs behind the head;
- using a special gymnastic stick.
There are special devices that allow you to gently but effectively develop your hands. For example, rubber balls, which should be compressed alternately with both hands. Do not do this too much and too often to avoid overexertion. After the hands are already a little stronger, you can go to a special expander.
Exercise exercises should be done 13-15 times 3 times a day, interrupted by the appearance of pain or discomfort. In a few weeks after the removal of gypsum, you can use dumbbells( only not heavy) to increase the load and increase the effectiveness of training. If there is a bad mobility of the joints even after a few weeks, you should go to special rehabilitation centers where patients are helped with the help of devices. To engage in active sports, swimming should only after full recovery and return to normal functioning of the hand.
Types of fractures of the humerus and principles of treatment
The humerus is long enough, and a fracture can occur on any part of it:
- anatomical neck of the shoulder( intraarticular fracture);
- surgical neck of the shoulder( extraarticular fracture);
- diaphysis of the shoulder( the main part of the bone);
- distal part( closer to the elbow).
The fractures of the surgical neck of the humerus are especially dangerous, since they can lead to damage to the neurovascular bundle, and hence to hemorrhage and possible paresis in the future.
Treatment of fracture of the humerus is usually conservative( reposition of fragments, plastering and observation), but in some cases surgical intervention may be required. The beginning of treatment usually coincides with the rehabilitation period.
The main goal of rehabilitation is to restore the full amplitude of movements. The complex of exercises is adjusted by the attending physician and the physician of physiotherapy exercises individually for each patient. LFK promotes muscle relaxation, correct comparison of bone fragments, reduces pain syndrome, activates regeneration and adaptation processes.
Immobilization stage( first 3 weeks after fracture)
The whole complex should be performed 6-8 times a day for 30 minutes( 6-10 repetitions for each exercise).The starting position is standing with the inclination forward.
- Breathing exercises.
- The hand should always be in a bandage( except for occupations).
- Active movements( rotation, flexion / extension, pronation / supination) in the elbow, wrist joints, brushes stimulate blood circulation in the hand, reducing edema and reducing the risk of thrombus formation.
- Rotations by hand clockwise and counterclockwise.
- Pendulum movements with hands. This exercise perfectly helps to remove pain syndrome at any time. It is enough to take the sick arm out of the bandage and in the standing position with a forward tilt make a few pendulum swings with a relaxed limb.
- Drawing and bringing the arm or just the elbow to the torso.
- Cotton in front of the chest, and then behind her.
- Cross arms in front of the chest.
- Torso rotations with hands locked into the lock in front of the chest.
Physiotherapy procedures include cryotherapy to reduce pain syndrome, reduce edema and inflammation.
The patient receives a list of exercises on discharge. Continue to study it is necessary, otherwise it will be impossible to restore the mobility of the hand.
Functional stage( 3-6 weeks)
During this period, the fracture is already considered fused, which is confirmed by X-ray images. The purpose of rehabilitation at this stage is to restore the former volume of passive and active movements. The complex of exercises expands, the original position remains the same. The patient should strive for a gradual extension and performing the exercises without standing forward. The frequency of exercise is 4-6 times a day up to 6-10 repetitions.
- Raising a straight hand in front of you.
- Active use of block simulators: raising and lowering of the diseased limb, raising hands to the sides.
- Makhi hands forward, back, to the sides. The starting position is standing with a slight inclination forward.
- Retracting the arms behind the back with blades. The starting position - the arms in front of the chest are bent at the elbows.
- Water procedures. While visiting the pool, you should perform exercises that simulate swimming with breaststroke and freestyle, crossing your arms in front of your chest, various movements of your limbs. Staying in water gives an additional load on the muscles, which improves blood circulation in them, increases the effectiveness of training.
Physiotherapy procedures include magnet, massage, balneotherapy. Courses for 10-12 procedures.
Training stage( 7-8 weeks)
It is believed that by this time the patient almost completely restored the functionality of the injured arm and shoulder. Exercises are carried out to strengthen the muscles, complete recovery of the amplitude of movements. Training should be held 3-4 times a day for 10-12 repetitions.
- Raising a straight hand in front of you. The starting position is standing straight.
- Exercises for the withdrawal, reduction, pronation, supination, rotation of the hand. Vis on the crossbar or the Swedish wall, resting on the hands and push-ups, manipulation with medbola and dumbbell weighing not more than 5 kg. Continue exercise is necessary to strengthen the deltoid muscle and the rotator cuff, which are the muscular framework for the shoulder joint. It should be borne in mind that exercises that require heavy workload should not be prescribed to elderly patients.
- Stretching exercises."Walking" with your fingers on the wall up and to the sides, the establishment of a towel or gymnastic sticks behind your back. The above manipulations can achieve a complete restoration of mobility in all directions.
- Swimming pool - swimming is a comfortable style.
Physiotherapy still includes a magnet, massage, balneotherapy.
With a rationally chosen scheme of rehabilitation, a full recovery of the patient occurs after 2-3 months. Only after this, it is necessary to perform exercises designed to develop physical strength, stretching, endurance. It is necessary to take vitamin complexes and special supplements, and also to ensure that there is enough calcium in the food( dairy products).
Video "Rehabilitation after a fracture of the humerus"
LFK with a fracture of the
Should a person fall on the right arm or elbow, a fracture of the upper end of the humerus can occur, namely, a fracture of the head, the neck of the humerus, the separation of the large tuber. When the shoulder falls or the shoulder strikes, a diaphyseal fracture is noted, that is, a fracture of the humerus body.
In the event that the fracture was nested or causing the , the injured arm should be placed on a bean-shaped shaft for the axillary region, which is fixed by the neck and trunk with a gauze bandage. The forearm and the brush are placed at an angle of 35-45 degrees to the serpentine bandage EF Dreving( wide gauze bandage, quilted with cotton wool), the dressing should be double wound around the lower third of the forearm, wrist and hand.
In the case of the outgoing fracture of the upper end of the humerus, a triangular tire trimmed with gauze and cotton wool is inserted into the axillary area such that the shoulder is located on the flat side of the tire and its vertical side is attached to the trunk. The forearm is also fixed by EF Dreving's bandage. Overlapping the tire helps to relax the muscle of the injured arm, so that the fragments are connected correctly. This type of fracture is the only one in which only specific exercises are performed in a certain sequence.
In the course of treatment, it is necessary to give due attention to exercise therapy for fracture and dislocation of the shoulder, which is prescribed in the first period of treatment, its duration is about 10-14 days. Physiotherapy and therapeutic gymnastics with fracture and dislocation of the shoulder contribute to maximum relaxation of the muscles of the shoulder and shoulder for proper comparison of fragments, as well as removal of pain, resorption of bleeding, restoration of blood and lymph circulation and normalization of metabolism in the injured limb. In order to achieve the above described results, the patient is assigned the following set of exercises that are part of the exercise therapy for fracture of the shoulder.
Complex of special exercises for fracture of the upper end of the humerus in the first period:
1) IP - standing. The leg, with the same name to the injured arm, is pushed forward a step, with the trunk tilted forward toward the sick arm. It is necessary to take a sick hand out of the kerchief with a healthy hand( if this is done without leaning forward towards the sick arm, a sharp pain will appear in the fracture region).In this position, perform the pendulum swing of the relaxed patient with his arm forwards and backwards. Run 6-10 times.
2) IP is the same. Perform circular motions clockwise and counterclockwise in the horizontal plane. Run 6-10 times.
3) IP is the same. Throw your arm forward and behind the trunk back. Run 6-10 times.
4) IP is the same. Fingers of the hand to clench into a fist( once the thumb should be outside, another time - inside), then straighten. Run 6-10 times. Due to this exercise, there is a resorption of the extensive hemorrhage, which is observed with fractures of the shoulder and forearm.
5) IP is the same. Bend arm in elbow joint by weight, then straighten. Run 6-10 times.
6) IP is the same. Hand put in a kerchief, while bending it at the elbow joint at a right angle. Move the hand from right to left and vice versa, then move forward and lead to the torso in front of the chest. Run 6-10 times.
7) IP is the same. With your hand, take the lining of the neck, move the elbow forward, then press the elbow against the body. Run 6-10 times.
8) IP is the same. Hand put in a kerchief, straighten up, then raise the shoulders and lower. Blades reduce and dilute. Run 6-8 times.
All this set of exercises must be performed at least 8-10 times a day.
In order to avoid pain in the area of fracture during sleep or lying down, you need to take a medium-sized pillow, one corner of it to bend inward and into the recess that formed, place the elbow of a sick arm. In this position, you can lie on your back and on a healthy side. If suddenly from an awkward turn in a dream there is a pain it is necessary to rise and execute 15-20 times pendular swinging by hand forward and backward. Then the pain immediately subsides.
The second period of treatment includes physical exercises with a fracture of the shoulder, which are performed synchronously with both hands: both sick and healthy. The task of exercise therapy in the fracture and dislocation of the shoulder is the restoration of movement in the shoulder joint of the injured arm in all directions.
Complex of special exercises for fracture of humerus in the second period:
1) IP - standing, legs shoulder-width apart, body tilted forward, arms hanging along the trunk. Perform pendulum movements with your hands forward and backward. Make 10 times.
2) IP is the same. Perform circular movements with your hands clockwise and counterclockwise( in the horizontal plane).Make 10 times.
3) IP is the same. Hands move to the right, then to the left and vice versa. Run 10 times.
4) IP is the same. Hands "to throw" forward, then behind the trunk back with cotton and without cotton. Repeat 10 times.
5) IP is the same. Perform cross-flap movements with your hands in front of the chest( hands should alternate - then right, then left above).Repeat 10 times.
6) IP is the same. Hands knit in the "lock", then bend them in the elbows, bring to the chin and lower, then - to the forehead and lowered. Then put your hands on the parietal part of the head in such a way that a right angle is formed between the shoulder and the body, then lower the arms. Run 10-12 times. When the patient can freely put his hands on his head, he can do exercises 7-12.
7) IP is the same. In the lowered hands - a stick. Carry out various movements of the hands in all directions. Run 10-15 times.
8) IP - standing at the wall, feet shoulder-width apart, hands along the trunk. Move your hands on the wall up and down, while you can not remove the sick arm from the wall, without lowering it beforehand on the wall downwards, otherwise a sharp pain will appear in the shoulder joint. In the case of pain, it is necessary to quickly perform exercise 1 from the complex of the first period. This exercise will help to remove the pain.
9) IP - standing, feet shoulder-width apart, in the lowered arms of the ball. Throw the ball and catch with both hands. Repeat 10-15 times.
The following exercises 10 to 12 are performed on the block. At home, the unit is made as follows: a coil without threads and a long nail is taken, this peg is pierced with a square piece of cardboard so that the nail head does not slip into the coil hole. Then the nail, with the coil hanging on it, is driven into the lintel of the door opening, and a cord with two hinges is pushed onto the spool. And, thanks to the rotation of the coil, this cord moves.
10) IP - standing, holding hands with the cord loops. Raise and lower the sore arm. Do 10-15 times.
11) IP is the same. Bend your arms in front of you, then take your bent arms back. Run 10-15 times.
12) IP is the same. Hands spread apart, then return to the starting position. Run 10-15 times. Also in this period of LH( therapeutic gymnastics) with a fracture of the shoulder, general development exercises are recommended, which include movements in the shoulder joint in all directions.
The whole complex of exercises of the second period should be performed at least 4-6 times a day.
In the third period , the task of exercise therapy and LH with shoulder fracture is the final restoration of the function of the shoulder joint of not only the injured limb, but also the entire body. Depending on the age in this period, the most varied loads are applied to the injured arm: the arms, visas on the gymnastic wall, exercises with dumbbells, stuffed balls( weight 3-5 kg), as well as swimming and sports games such as volleyball, basketballetc. But if the patient is elderly, then such exercises in the daily complex should not be included.
Complete recovery and recovery of the of the injured person's ability to work in the fractures described above, occurs approximately 1.5-2 months after the injury.
A fracture of the humerus body requires conservative treatment, in some cases surgery is necessary. After the fragments are corrected( regardless of the method of treatment), the arm should be placed on the outgoing tire for 4-5 weeks.
The first period of treatment of ( on the outgoing bus) includes a set of exercises of exercise therapy and LH with a fracture of the shoulder, which is performed against the background of general development and breathing exercises, and consists of all sorts of finger movements( these exercises are similar to those included in the exercise therapyfracture of the collarbone).
After the tire has been removed, in the second and third periods of treatment, the exercises are conducted in the same way as in the fracture of the upper end of the humerus. In addition, in the complex of physiotherapy exercises, fractures in the shoulder include exercises in the water.
Complex exercises in the water:
1) IP - sitting or standing in the water. Perform movements that mimic swimming styles "krol" and "breaststroke".
2) IP - lying in the water on the stomach. Carry out circular movements with your hands in the water and cross movements with your hands in front of your chest.
3) IP - lying on the side of the damaged arm. Damaged arm bend at the elbow joint, then straighten. Then perform a bent hand circular movements in the shoulder joint clockwise and counter-clockwise.
4) IP - squatting in the water. Perform hand movements with your hands in the water forwards and backwards and crosswise( that's right, then the left hand on top).
These exercises can be performed not only in the pool, but also at home in the bath, provided that the bath is large and the water is poured to the top. In all periods of exercise are performed 6-10 times, and the whole complex - at least 4-6 times a day.
If the exercises included in the complex of exercise therapy and LH with a fractured shoulder, performed regularly, then the full restoration of movements and disability comes about 2-3 months after the injury.
In the case of transverse fractures of the of the humerus, in some cases, the treatment is performed with the aid of the GA Ilizarov apparatus, in which movements are performed in all joints with a full or limited amplitude. Sometimes, with transverse fractures of the humerus, surgical intervention is necessary, an operation is performed that involves the insertion of a long metal nail, while the arm bent at the elbow at right angles is placed in the gypsum longe from the shoulder joint to the base of the fingers of the wrist.
Before removing the joints of , during the practice of exercise therapy, the plaster bandage is bandaged to the elbow joint and the patient performs various exercises for the fingers and wrist joint. Also, the patient can perform flexion and extension of the arm in the elbow joint, which are done within the limits of the imposed gypsum.
Exercises for the shoulder joint are performed in a bandaged plaster bandage, with a healthy arm supporting the affected arm. Exercises include: flexion and extension, sidetracking, circular movements in the shoulder joint, which are performed clockwise and counterclockwise. Each exercise should be performed at least 6-10 times in a row, and the entire complex - 4-6 times a day.
After the seams have been removed , during the exercises of exercise therapy with a fracture of the shoulder, the hand is removed from the longi and movements to the elbow joint are added to the exercises described above, namely: turning the palm up and down, circular movements. Movements in the shoulder joint are performed with a full amplitude, but the place of the fracture must be fixed with a healthy hand.
The time when it will be possible to remove the gypsum longtite, remove the nail, and also remove the apparatus of GA Ilizarov, is determined by the doctor after the X-ray image has been prepared( in each case individually).
As for the dislocation of the ( injury) of the humerus, it usually occurs when it falls on an elongated forward or sideways arm. As a rule, with a dislocation of the shoulder, stretching and rupturing of the joint bag is observed, as well as a sharp deformation of the shoulder joint and the absence of movement in it. The head of the humerus can be shifted forward, backward and downward. Depending on this displacement, shoulder dislocations are divided into three groups: anterior dislocation, posterior and lower. After the dislocation is corrected, the shoulder and forearm should be fixed with a Dezo bandage or gypsum bandages.
On the second day after the trauma, the patient can start exercise therapy with a shoulder dislocation. The first period of training includes special active movements for the fingers, brushes( exercises similar to those included in the complex LFK at fracture of the clavicle), as well as isometric exercises, which represent the tension of the muscles of the hand, this is done so that to the immobile humeraland ulnar joints went impulses. These exercises are performed against the background of general development and breathing exercises, they are repeated 10-15 times, and the entire complex must be performed at least 4-6 times a day.
After the bandage is removed, in the second and third periods, the same sessions are held as those that occur when the upper end of the humerus fractures.
As a rule, if there are no complications, and if all the exercises included in the complex of exercise therapy for fracture and shoulder trauma are performed systematically, then full recovery in the shoulder joint occurs 2.5-3 months after the injury.
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