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Fractures of the humerus are common and make up about 5% of all fractures, with 80% of them either undisplaced or just minimally displaced. More common in people suffering from osteoporosis, it is common to have a forearm fracture on the same side. Damage to the nerves or circulatory system is possible from these fractures but not often seen. Common areas of fracture are the neck of humerus at the top of the arm(fractured shoulder) and the mid shaft of the arm bone.

A fall onto the outstretched hand, onto the elbow or onto the shoulder itself is the most common cause of a fractured arm. Since many of the arm muscles insert onto the humeral head, when the injury occurs the muscular action involved can displace the fragments and complicate the management. 65 years old is the peak incidence for this kind of fractured humerus and if younger patients suffer this fracture the likely cause will involve high forces such as traffic accidents or sports injury.

A forceful incident is normally required to fracture the humerus and if there is no history of this the physician will suspect a cause such as cancer. The physio examination will show significant pain on attempted movement of the shoulder or elbow, reduced movement of the shoulder, widespread bruising or swelling in the whole arm and in shaft fractures some arm shortening is possible. Checking for nerve damage is important as the radial nerve can be injured especially in shaft fractures, impairing control of wrist and thumb muscles.

Management of Arm Fractures

After the fracture the patient’s movements are kept restricted and sufficient analgesia provided to keep them comfortable. With little or no displacement the management is non-operative but if the greater tuberosity is fractured then it is important to suspect rotator cuff injury. This is more common in injuries with high forces, when the patient is older or the tuberosity is displaced significantly. Humeral neck fractures can be kept in line with a collar and cuff, allowing the elbow to hang free, while shaft fractures are difficult to manage but can be braced.

Displaced three or four part fractures typically require surgery, referred to as ORIF (open reduction internal fixation) and this is more likely in younger people. Older people may have a poorer result in terms of pain and movement so may have surgical replacement of the head of the arm bone. Plating and nailing is usually unnecessary for shaft fractures as they heal well normally. The side effects of humeral fractures include nerve injury in shaft fractures, adhesive capsulitis and avascular necrosis of the head of the humerus. Healing occurs in six or eight weeks and older people may never regain full movement of the shoulder.

Shoulder Fracture Treatment by Physiotherapy

Initially the physio assesses the arm, asking the patient about their pain level as this varies greatly, examining the swelling and bruising of the arm. The physiotherapist then checks the available range of movement of the shoulder, elbow, forearm and hand. Any muscle weakness and sensory loss is noted as this may denote nerve damage. If not operated on, a sling is continued with and if the fracture is not too painful or severe, early exercises are started by the physiotherapist. Pendular exercises, with the patient bending over at the waist, are important in the early stages as they allow movement of the shoulder joint without much force.

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.

Tags: Health & Fitness //