proximal humerus fracture exercises pdf

Immediate Post-Injury Care and Phase 1 Rehabilitation

Immediate care involves immobilization with a sling, pain management using ice, and initiating gentle exercises like pendulum movements and grip strengthening. Avoid heavy lifting and overhead activities for the first 6 weeks to protect the fracture site and ensure proper healing. Early passive exercises focus on maintaining mobility in the elbow, wrist, and hand while minimizing shoulder movement. This phase emphasizes rest, protection, and controlled exercises to prevent complications and promote optimal recovery.

1.1. Use of Sling and Immobilization

A sling is essential for immobilizing the arm after a proximal humerus fracture, protecting the injury and reducing pain. Wear the sling at all times except during hygiene or prescribed exercises. Proper fit is crucial to avoid discomfort or nerve compression. The sling should hold the arm across the body, with the elbow slightly bent. Immobilization typically lasts 2-4 weeks, depending on the fracture severity. This period allows initial healing and minimizes displacement. Regular follow-ups with a healthcare provider ensure the sling fits correctly and the fracture progresses as expected.

1.2. Pain Management Strategies

Pain management post-proximal humerus fracture focuses on reducing discomfort while promoting healing. Ice is recommended to minimize swelling and inflammation during the initial phase. Prescribed pain medications, such as NSAIDs or opioids, are often used to control pain effectively. Gentle exercises, like pendulum movements, are introduced cautiously to avoid aggravating the injury. Physical therapy modalities, including ice and electrical stimulation, may also be employed. It’s crucial to balance pain relief with gradual mobilization to prevent stiffness. Avoiding overexertion and adhering to a structured rehabilitation plan are key to managing pain and ensuring proper recovery.

1.3. Early Passive Exercises and Activities

Early passive exercises focus on maintaining mobility without active muscle engagement. Pendulum exercises, performed while leaning forward, help prevent shoulder stiffness. Elbow, wrist, and hand exercises, such as flexion, extension, and grip strengthening, are encouraged to maintain dexterity. These activities are done 4-5 times daily, with a focus on gentle, pain-free movements. The goal is to promote healing, reduce stiffness, and prepare for more advanced exercises in later phases. Supervised physical therapy ensures exercises are performed safely, avoiding complications and supporting the recovery process effectively.

Phase 2 Rehabilitation (2-6 Weeks Post-Injury)

This phase focuses on gradually increasing shoulder mobility and strength while protecting the healing fracture. Gentle exercises like pendulum movements and passive range of motion are introduced. Patients begin supervised physical therapy, incorporating activities that promote flexibility without overloading the shoulder. Restrictions on heavy lifting and overhead movements remain in place to ensure proper healing. The emphasis is on controlled exercises to improve joint mobility and muscle function, preparing for more advanced rehabilitation in later stages.

Pendulum exercises are introduced in Phase 2 to gently promote shoulder mobility without stressing the fracture site. Patients are instructed to lean forward, bending at the waist, and let the affected arm hang freely. Small, controlled circles (both clockwise and counterclockwise) are performed for 5-10 repetitions, 4-5 times daily. These exercises rely on gravity to assist movement, making them low-stress for the healing fracture. The goal is to improve joint lubrication, reduce stiffness, and maintain passive range of motion. Supervised by a therapist, pendulum exercises are a cornerstone of early shoulder rehabilitation, ensuring gradual and safe progress. Pain-free movement is emphasized to avoid complications.

2.2. Passive Range of Motion (PROM) Exercises

Passive range of motion exercises are initiated in Phase 2 to gradually restore shoulder mobility without active muscle engagement. A therapist or caregiver gently moves the injured arm through controlled motions, focusing on forward elevation and external rotation. These exercises are performed pain-free, ensuring no stress on the healing fracture. PROM is essential for preventing stiffness and maintaining joint function. Progression is slow, with goals to achieve 90 degrees of forward flexion by week 4. Consistency and proper technique are crucial to avoid complications and promote a full recovery. Supervised sessions ensure safety and effectiveness in this critical phase of rehabilitation.

2.3. Gentle Strengthening Activities

Gentle strengthening activities are introduced in Phase 2 to gradually improve shoulder and scapular stability without overloading the fracture site. Isometric exercises, such as shoulder shrugs and scapular squeezes, are performed to maintain muscle tone and strength. Sub-maximal isometric exercises for the rotator cuff and scapular muscles are also incorporated to prevent atrophy. These exercises are done in a pain-free manner, focusing on controlled contractions and avoiding any heavy resistance. Progression is slow, ensuring no stress on the healing fracture. Consistency and proper form are emphasized to promote strength and stability, laying the foundation for more advanced exercises in later phases.

Phase 3 Rehabilitation (6-12 Weeks Post-Injury)

Phase 3 focuses on advanced strengthening, resistance training, and functional activities. Prone exercises and resistance bands are introduced to enhance shoulder mobility and strength. The goal is to restore full shoulder function and prepare for daily activities and sports.

3.1. Advanced Strengthening Exercises

At 6-12 weeks post-injury, advanced strengthening exercises are introduced to restore shoulder function and prepare for daily activities. Prone exercises, such as shoulder flexion and abduction, are commonly used. Resistance bands or light weights are incorporated to target the rotator cuff and scapular stabilizers. Progression includes increasing resistance and repetitions as strength improves. Emphasis is placed on proper form to avoid reinjury. These exercises aim to enhance dynamic stability, improve endurance, and restore full mobility, enabling a gradual return to pre-injury activities and sports.

Resistance training is gradually introduced to enhance shoulder strength and endurance. Light weights or resistance bands are used to target the rotator cuff and scapular muscles. Exercises include seated rows, lateral raises, and internal/external rotations. Progression is based on patient tolerance and strength gains. Emphasis is placed on controlled movements to avoid strain. Resistance training helps improve dynamic stability, preparing the shoulder for functional activities and reducing the risk of future injuries. This phase ensures a balanced strengthening approach, promoting long-term recovery and return to normal activities.

3.3; Functional Activities and Mobility

Functional activities focus on restoring the shoulder’s ability to perform daily tasks, such as reaching, lifting, and dressing. Gentle, controlled movements are emphasized to improve mobility without risking re-injury. Patients progress to light functional exercises, including simulated activities like carrying light objects or reaching overhead with support. Mobility exercises, such as seated forward reaches and wall slides, enhance flexibility and coordination. The goal is to gradually reintroduce the shoulder to real-world movements, ensuring strength and stability are sufficient for independent living. This phase bridges the gap between rehabilitation and returning to normal, injury-free function.

Role of Physical Therapy in Rehabilitation

Physical therapy begins early to reduce stiffness and pain, incorporating modalities like ice and gentle exercises. It progresses to strengthen muscles and restore full shoulder function gradually.

4.1. Modalities Used in PT Sessions

In physical therapy for proximal humerus fractures, modalities like ice therapy are commonly used to reduce inflammation and pain. Electrical stimulation may be applied to maintain muscle activity and prevent atrophy. Heat therapy can also be introduced to improve tissue flexibility and comfort. These modalities complement exercises by enhancing relaxation, reducing stiffness, and promoting blood flow to the affected area; They are typically used in the early stages of rehabilitation to support healing and prepare the shoulder for progressive exercises, ensuring a safe and effective recovery process.

4.2. Structured Home Exercise Programs

Home exercise programs for proximal humerus fractures are tailored to promote healing and restore function. They include gentle exercises like pendulum movements, wrist, and hand rotations, and isometric shoulder exercises to maintain strength without strain. Patients are often instructed to perform these exercises 4-5 times daily, focusing on controlled movements and avoiding pain. Progression to more dynamic exercises, such as scapular stabilization and passive range of motion, occurs as healing advances. Adherence to these structured programs ensures steady recovery, with regular monitoring by healthcare providers to adjust routines as needed and prevent setbacks.

Precautions and Restrictions During Recovery

Avoid heavy lifting, overhead movements, and extreme shoulder abduction or external rotation to prevent disrupting the fracture site. Patients should abstain from activities that cause pain or strain.