The shoulder blade scapula is located in the upper back, and sits on top of the ribs. Petre would like to thank the doctors at the steadman clinic and the staff at howard head sports medicine in vail colorado for the creation of this rehab protocol. Nov 16, 2009 proximal humeral fractures, which occur mainly in older adults, account for approximately 4 to 5% of all fractures. Uw health sports rehabilitation rehabilitation guidelines for type i and type ii rotator cuff repair and isolated subscapularis repair the anatomic configuration of the shoulder joint glenohumeral joint is often compared to that of a golf ball on a tee. Active horizontal abduction exercise posterior deltoid in prone lying position.
Approximately 40% of these fractures are displaced fractures involving the surgical neck. Progress to independent rehabilitation program by 10 weeks ube forward and retro. Evaluation and management of scapular dyskinesis in. This is because the articular surface of the round humeral head is approximately. The term scapula literally means skapulare to dig, because the greek anatomists who named it thought that the shoulder blade looked like a spade. Slin ive and passive range of motion of the neck, elbow, wrist and hand should beact. Shoulder rehabilitation western orthopaedic clinic.
Anterior shoulder dislocationsubluxation nonoperative treatment. Physiotherapeutic interventions and rehabilitation regimen of. Shoulder arthroscopy rehab protocol the stone clinic. Management of this group of fractures is often challenging and the outcome is frequently unsatisfactory. Johns hopkins shoulder rehabilitation protocol after capsular. Shoulder surgery postoperative care and rehabilitation protocol.
Treatment of glenoid fractures and injuries to the. The socket portion of the joint is not naturally deep. Shoulder rehabilitation protocol general shoulder rehabilitation exercises. Normally, the scapula is pretty well protected by a web of muscles and it is very rare that the scapula sustains a fracture, but if there is a scapula fracture then it gives an indication that the shoulder must have been injured with a significant amount of force coupled with significant trauma to the chest. For this reason the shoulder is the most mobile joint in the body. Return to normal function and motion may require 4 months 6 months. Latarjet protocol the intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone a latarjet procedure for anterior stabilization. Nondisplaced means less than 1cm of displacement and less than 45. Only about 10 percent of scapula fractures require surgery.
The start of this protocol is intended to start 46 weeks following rtsafor a revision andor in the presence of poor bone stock based on the surgeons assessment of the integrity of the surgical repair. Nonoperative treatments include the use of a sling or shoulder immobilizer, ice and pain medications. Rehabilitation programs for nonoperative humeral fractures dr. Posterior shoulder dislocationsubluxation nonoperative. Clavicle fracture rehabilitation protocol range of motion immobilizer exercises phase i 06 weeks 04 weeks. One high standard, three local partners for more information go to. Ankle fracture rehabilitation protocol home patient education ankle fracture rehabilitation protocol this protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. It is estimated that scapula fractures account for 3 %5 % of all fractures about the shoulder girdle, with the most frequent fractures encountered occurring in the clavicle or proximal humerus 2, 3. There is a body of evidence suggesting that patients with impingement symptoms and glenohumeral instability consistently show altered scapular kinematics. More than 90% of scapula fractures have minimal displacement, primarily because of the thick, strong support provided by the surrounding soft tissues. Scapula shoulder blade fractures the shoulder blade scapula is a triangularshaped bone that is protected by a complex system of surrounding muscles. Shoulder instability is a common pathology often seen in the orthopaedic and sports medicine setting. Nonsurgical shoulder impingement rehabilitation protocol ramin r.
Rehabilitation guidelines for standard reverse total. Physical therapy for clavicle fracture you may be referred to physical therapy three to four weeks after your injury. Use the information below to gain a better understanding of your injury and what can be done to maximise your recovery. Bony healing occurs usually within 6 to 8 weeks in adults. Your doctor will gradually add strengthening exercises to your program as your fracture heals. Conservative subscapularis repair protocol weeks one to two weeks two to four initial evaluation evaluate. Bony healing occurs usually within 6 to 8 weeks in adults 3. Shortterm immobilization in a sling and swathe bandage is provided for comfort. Nonoperative proximal humeral fracture rehabilitation protocol. Proximal humeral fracture postsurgical rehabilitation.
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. Medical treatment for a proximal humeral fracture most often includes a period of immobilization using a sling, with the arm slightly abducted. Direct trauma is usually the cause of most scapula fractures. Strengthen scapular musculature to allow for proper scapulohumeral rhythm. Perform the jumping drills listed in the appropriate phase of your rehab. Avoid excessive stress to the anterior joint capsule by limiting movement to no greater than 4550. More severe shoulder fractures may require surgery to realign and stabilize the injury. Sleep with arm out of sling, straight on pillows with arm elevated for edema reduction. Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. Fractures joint replacement sports medicine humerus fx orif protocol proximal, midshaft, or distal orif dr. Elbow placed in a hinged elbow brace locked last 3050 degrees of extension. Worn at all times taken off only for physical therapy sessions converted to hinged knee brace at first post.
Highenergy, blunt trauma injuries, such as those experienced in a. Non operative management of common fractures mr duy thai orthopaedic surgeon mbbs, fracs ortho, dip surg anat avhap educational talk 28 june 2011, duy thai. Soft tissue mobilization to surrounding tissues, effleurage for edema. Your physical therapist will take your history and do an assessment to see the specific ways she can help your rehabilitation. Displaced scapular body fractures most commonly are treated conservatively.
Scapular dyskinesis in relation to neck and shoulder pain. Clavicle fracture rehabilitation protocol dr justin griffin virginia. A scapula fracture usually occurs due to a direct blow to the shoulder blade, such as a motor vehicle accident, a hard ball impact in sports such as cricket or hockey, or a heavy collision with another player in contact sports such as rugby or football. Therapy programs typically start with gentle motion exercises. Rehabilitation guidelines for lumbar spondylolysisspondylolisthesis. The shoulder blade has a ridge going along it known as the spine of the scapula. As pain is often the best indicator of healing, physical therapy strategies that optimize active painfree functioning with adequate humeral head control are best suited to. Increase rom while protecting the fracture site you can be slightly more. Rehabilitation goals protect repair minimize pain and swelling maintain rom of surrounding joints. Orif patella fracture postoperative rehabilitation protocol. General rehabilitation guidelines orif proximal humerus fractures precautions. Bony healing occurs usually within 6 to 8 weeks in adults 2. How much movement should be restricted following the fracture will depend on the severity of the break. Scapula fracture shoulder blade fracture physioadvisor.
Posterior shoulder dislocationsubluxation conservative. Rehabilitation programs for operative and nonoperative. Broken collarbone rehab protocol frozen shoulder repair rehab protocol. The intent of this protocol is to provide the clinician with a guideline to establish and progress a patient through post operative rehabilitation. The scapula plays a critical role in the association between the upper extremity and the axial skeleton. Phase i 0 to 21 days begin elbow, wrist and hand active rom.
Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. Nonsurgical shoulder impingement rehabilitation protocol. Normal shoulder motion involves a coordinated rhythm between movement of the shoulder blade on the chest wall and movement of the ball in the shoulder socket. Calcaneus fracture repair physical therapy protocol pg 2 12 weeks progressive wb begins 12 week md visit. Marsh brook rehabilitation service wentworthdouglass hospital durham. Immobilized at all times day and night off for hygiene and gentle exercise only 04 weeks.
Keeping these muscles strong can relieve shoulder pain and prevent further injury. Thus, scapula fractures occur at rates approaching those of distal tibia and humerus fractures. The scapula, or shoulder blade, is the bone located in the back. Post fracture proximal humerus rehabilitation guidelines. Canner, mdt the treatment of posterior shoulder instability can be a frustrating experience for both the patient and the clinician. Shoulder immobilizers may have additional straps and cuffs for the arm, wrist, and fingers for. Stewart, md, mba orthopaedic surgeonsports medicine specialist 370 n. The glenohumeral joint allows tremendous amounts of joint mobility to function, thus, making the joint inherently unstable and the most frequently dislocated joint in the body. This information will guide you through the next 6 weeks of your rehabilitation. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. Maintain rom without displacing the proximal humerus fracture.
You will be advised at your fracture clinic when you may discard the sling and return to normal light activities using. Rehabilitation protocol considerations why is the scapula important. Dec 05, 2018 as the name suggests a scapula fracture is a fracture of the scapula or the shoulder blade. Calcaneus fracture repair physical therapy protocol. Acute shoulder injuries in adults american academy of. Although operative versus nonoperative treatment of. Specific changes in the program will be made by the. Physical therapy guidelines for ankle fracture with surgery. The plan of care should be based upon the patients clinical exam and individual. It has been updated and modified to accurately reflect the needs of dr. Nonoperative proximal humeral fracture rehabilitation protocol general principles. Distal biceps tendon repair postsurgical rehabilitation protocol 35 days postop 1. Rehabilitation guidelines for posterior shoulder reconstruction with or without labral repair phase ii begin after meeting phase i criteria, usually 38 weeks after surgery appointments rehabilitation appointments are 12 times per week rehabilitation goals full active rom in all cardinal planes, except shoulder internal rotation. Acute shoulder injuries in adults are often initially managed by family physicians.
Using a sling or shoulder immobilizer to prevent movement. All active exercises should be carefully monitored to minimize substitution or compensation. Physical therapyoccupational therapyteach you exercises to increase your strength, work with you on an exercise program, instruct you on the correct way to. Physical therapy prescription humerus fracture orif. Fractures in the scapula are uncommon as they require a large amount of force to break the bone. Fracture of the greater tuberosity of the humerus journal. Nonoperative rehabilitation for traumatic and atraumatic.
Jump and plyometric training boston sports medicine. Jun 15, 2018 most scapula fractures can be managed with closed treatment. Rehabilitation protocol adopted from the massachusetts. David lintner specializes in arthroscopic surgery of the knee and shoulder and is active in teaching orthopedic surgeons the latest techniques. Patients with a displaced hip fracture usually lie with the limb externally rotated. Fracture of the shoulder blade scapula the scapula shoulder blade is a flat, triangular bone providing attachment to the muscles of the back, neck, chest and arm. Passive range of motion in all planes as tolerated. Due to variable stability of the fracture, check for specifications and precautions ordered by the orthopedist. Scapula fracture shoulder blade fracture johns hopkins. Outcomes of nonoperatively treated displaced scapular body. Distal biceps tendon repair postsurgical rehabilitation protocol. Background o the scapula is the base of support to shoulder joint and all movements of the upper extremity.
The shoulder blade scapula is a triangularshaped bone that is protected by a complex system of surrounding muscles. Johns hopkins shoulder rehabilitation protocol after capsular shift with subscapularis splitting approach johns hopkins shoulder surgeons introduction. Shared care plan eastbourne 023 414928 conquest 01424 757576 email esht. Injuries to the shoulder girdle can range from clinically insignificant avulsion fractures or partial ligament disruptions, to markedly displaced or comminuted fractures that may predispose to longterm shoulder dysfunction. In particular it is not clear whether surgery gives better outcomes than nonsurgical. Pain, swelling and bruising are the most common symptoms. Fracture rehabilitation considerations o usually nonoperative care is selected for those patients o thopae ic institute of ohio samir patel, who are medically unfit for surgery or have a minimally to nondisplaced fracture o depending on the severity of the fracture the best outcome may. Open treatment of scapular fracture body, glenoid or acromion team orthobullets d trauma. Clavicle fracture broken collarbone a broken collarbone is also. General time frames are given for reference to the average, but individual patients will progress at different rates depending on their age, associated injuries, preinjury health status, rehab.
Rehabilitation protocol for reverse shoulder arthroplasty. In the case of a delayed start to physical therapy adjust below timeframes so that day 1 is the first day of physical therapy. Ankle fracture postop rehabilitation protocol this protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. Shoulder rehabilitation protocol brian waterman, m. Your fracture is stable and does not need an operation. The shoulder is a wonderfully complex joint that is made up of the ball and socket connection between the humerus ball and the glenoid portion of the scapula socket. In case of a scapula fracture or broken shoulder blade, more than one part of the scapula may get fractured. Strengthening the muscles that support your shoulder will help keep your shoulder joint stable. The anteriorposterior radiographic view in external rotation, essential for best visualization of the greater tuberosity of the humerus, 1 showed an incomplete nondisplaced fracture in the superior aspect of the greater tuberosity.
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. Postoperative protocols orif proximal humerus fractures general rehabilitation guidelines tuberosities are repaired and bony healing must occur before stress is applied to rotator cuff tendons. This protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance. The intent of this protocol is to provide the physical therapist with a guideline treatment protocol for the postoperative rehabilitation management for a patient who has undergone a reverse total. It is not intended to be a substitute for ones clinical decisionmaking. Scapula fractures represent less than 1% of all broken bones and many of them can be treated without surgery. If superior performed, deltoid activity is contraindicated and the rehab protocol may be delayed. Know the causes, symptoms, diagnosis, treatment, and exercise for scapula fracture or broken shoulder blade.
Xray ankle, subtalar, forefoot, toe aarom gentle stretch and isometrics. Extension and internal rotation not performed until 6 weeks 4. Physical therapy prescription clavicle fracture orif. Protocol for the profher proximal fracture of the humerus. This summary of the evaluation and rehabilitation of a patient who is being treated with a shoulder stabilization procedure is designed to guide the therapist and patient. Sean griffin weeks full time in sling avoid ir behind the back, lifting more than 12 lbs, and horizontal adduction. Kavanagh, pac this protocol provides general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. Rehabilitation protocol adopted from the massachusetts general hospital sports physical therapy program and the american academy of orthopedic surgeons for nonsurgical rehabilitation of clavicle fractures 7,15. Be sure to limit your total contacts or jumps to the suggested amount listed for each training session to prevent injury. Rehabilitation guidelines for lumbar spondylolysis. A sling and swath, or velpeau with an axillary pad should be used when not doing physical therapy.
The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation for the patients who undergo surgery for. Famous physical therapists bob schrupp and brad heineck present. Standard course patients will typically follow a standard post fracture rehab course if their fracture is. However there is conflicting evidence in the literature regarding the outcomes owing to retrospective design of studies, different classification systems, and diverse outcome tools. Physical therapy is a part of any treatment approach to proximal humeral fractures with few guidelines available as to staging of interventions to maximize range of motion, strength, and optimize activities of daily living. Appointments begin physical therapy at 1 week post op, 2 xweek follow up with md 1014 days post op. Fractures joint replacement sports medicine clavicle fracture orif protocol dr.
Avoid excessive stress to the posterior capsule by limiting movement from 45 degrees of. Rehabilitation guidelines for type i and type ii rotator cuff. Chairlevel exercises, such as active quadriceps exercises and. Shoulder surgery postoperative care and rehabilitation protocol dr. Surgery may be required if a fracture displaces bones, forcing them out of their normal positions. Rehabilitation protocol for reverse shoulder arthroplasty this protocol is intended to guide clinicians and patients through the postoperative course after a reverse shoulder arthroplasty. Sean griffin weeks 14 wear the sling full time for 2 weeks, and then only wear when outside the home for 4 more weeks. Proximal humeral fracture twin boro physical therapy.