Physiotherapy Treatment of Shoulder Fractures

 

Fractures of the humerus are common, accounting for approximately five percent of all bone fractures. Of these, 80 percent are minimally displaced or remain non-displaced. Osteoporosis is a major contributing factor in these injuries, and a fracture in the arm on the affected side is a common manifestation. Damage to nerves or arteries resulting from the fracture is a significant concern, though it is not a common occurrence. The most common sites for these fractures are the upper part of the arm (the neck of the humerus—often referred to as a "shoulder fracture") and the mid-shaft of the humerus. For proper recovery and rehabilitation, consulting a Physiotherapist in Paschim Vihar is highly recommended.

The most common cause of a humerus fracture is falling on the hand, arm, or directly onto the shoulder. Due to the numerous muscles attached to the upper part of the humerus, significant force is generated during a fall, which determines the extent to which the bone is displaced from its position. Humerus fractures are generally more common among the elderly, with an average age of approximately 68 years. In younger individuals, such fractures typically result from severe injuries, such as those sustained in motor vehicle accidents or sports.

If a fracture has occurred without any significant force, an underlying abnormal cause—such as cancer—should be suspected. During a physiotherapy examination, movement of the shoulder or elbow will elicit pain; swelling and palpable lumps may be present; blood flow may appear diminished due to bone displacement; and shoulder mobility may be severely restricted. Sensory deficits involving the radial nerve are rare in fractures of the proximal humerus, whereas they are common in shaft fractures, potentially leading to wrist drop, weakness in the muscles of the wrist and fingers, and, to some extent, difficulty in supination. Early diagnosis and guidance from a Physiotherapist in Paschim Vihar can help manage these complications effectively.

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Management of Humeral Fractures

Following a fracture, a patient's activities are often restricted, and adequate rest is provided to ensure their safety. If the displacement is minimal or negligible, the management approach is non-operative; however, if the greater tuberosity is fractured, an associated injury to the rotator cuff should be suspected. This complication is more prevalent in injuries resulting from severe impact—particularly in elderly patients or when the humerus has sustained extensive damage. Fractures of the humeral neck can be stabilized using a collar-and-cuff sling, allowing the elbow to hang freely; conversely, the management of humeral shaft fractures is typically more challenging but can be effectively accomplished with the aid of a brace.

Open Reduction Internal Fixation (ORIF) is frequently performed for displaced fractures involving three or four fragments—a procedure more commonly undertaken in younger patients—whereas humeral head replacement is performed in older patients to prevent shoulder pain and stiffness. For shaft fractures, nailing or plating is utilized as needed; however, these typically heal without surgical intervention. Complications associated with humeral fractures may arise, including injury to the radial nerve in fractures at the base, frozen shoulder, and necrosis of the humeral head resulting from compromised blood supply. Although the typical recovery period spans 6 to 8 weeks, elderly patients may never fully regain a normal range of shoulder motion.

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Treatment of Shoulder Fractures Through Therapy

Initially, the physiotherapist assesses the arm and inquires about the patient's pain levels—as these can vary significantly—while also examining the arm for any inflammation or injury. Subsequently, the physiotherapist evaluates the available range of motion in the shoulder, elbow, forearm, and hand. Any signs of muscle weakness or sensory disturbances are noted, as these may indicate nerve damage. If surgery has been performed, the arm remains immobilized; however, if the fracture is not overly painful or severe, the physiotherapist initiates early-stage exercises. Pendulum exercises—performed by bending forward at the waist—are crucial during the initial stages, as they allow the shoulder joint to move without placing excessive stress on it.

Bone healing typically begins in earnest three weeks after the fracture occurs; at this stage, the physiotherapist guides the patient through a routine of self-assisted exercises—utilizing the uninjured arm for support—to minimize strain on the injury site. As the arm gains strength, unassisted exercises constitute the next phase, enabling the patient to perform lateral and medial rotation, as well as flexion movements. Two months post-injury, the bone is typically fully healed; consequently, the physiotherapist can then progress to more vigorous activities involving resistance training, along with subtle end-range stretching exercises. Regular follow-ups with a Physiotherapist in Paschim Vihar ensure optimal recovery and long-term mobility.