How to develop a hand after a fracture of the humerus

A fracture of the humerus is accompanied by damage to soft tissues of varying severity. During treatment at the stage of callus formation, restoration is prescribed. They include several stages with temporary immobilization and subsequent normalization of the functional state. The prognosis after a fracture of the humerus depends not only on treatment, but also on high-quality rehabilitation.

Types of fractures of the humerus

The humerus has a fairly high strength. Fractures occur mainly during falls on the elbow, as well as after direct excessive mechanical impact (impact) with a frequency of up to 2.9% of all injuries. According to the localization of damage, fractures of the upper, middle and lower thirds of the humerus are distinguished. In relation to the shoulder joint, injuries are intra-articular (supra-tubercular) and extra-articular (sub-tubercular). Depending on the severity of the injury, fractures are:

• Incomplete - a crack or break occurs in the bone
• Complete - there is a violation of the integrity of the bone tissue with or without displacement of fragments.

If damage to the skin and soft tissues occurs at the same time, then an open fracture occurs, if not, a closed one. Severe injury is often accompanied by the development of the following complications (complicated fracture):

• traumatic shock;
• fat embolism;
• wound infection with the subsequent development of osteomyelitis (purulent bone damage) or sepsis (blood poisoning);
• bleeding of varying severity (damage to the brachial artery can be life-threatening).

A closed incomplete fracture usually proceeds without complications, and subsequent rehabilitation measures do not last long. The choice of treatment tactics is carried out by the doctor based on the type of fracture of the humerus. Diagnosis is based on visualization of changes using radiography.

Principles of treatment

Bone tissue regenerates well, so almost any fracture heals. To fully restore the functional state of the hand, complex treatment is prescribed, which includes several main stages:

• Ensuring conditions for the correct union of bone fragments - with a complete fracture with displacement, the fragments are repositioned, the anatomical shape is given to the bone. Poor quality of the primary stage leads to improper fusion, change in the shape of the shoulder and disruption of its functional state. If the fracture is not displaced, then reposition is not performed.
• Immobilization - ensuring the immobility of bone fragments, due to which conditions are created for their speedy fusion. In most cases, a plaster cast, splint is used. At the stage of immobilization, the implementation of rehabilitation measures begins. Simultaneous medications are prescribed. If necessary, non-steroidal anti-inflammatory drugs are used. The diet includes the intake of a variety of foods rich in proteins, vitamins and mineral salts, which are necessary for the full restoration of tissues.
• Functional recovery - activities are scheduled after the removal of the plaster cast. They are necessary for the adaptation of the bone to increasing loads.

Therapeutic measures and rehabilitation are determined by the type of fracture, localization and severity of changes.

Stages of rehabilitation

Rehabilitation after a fracture of the humerus is a complex event that includes 2 stages:

• Immobilization.
• functional recovery.
• Training stage.

Immobilization (immobilization) is necessary for bone fusion and regeneration of damaged soft tissues. The stage begins immediately after the treatment (reposition of fragments with a complete fracture with displacement). Functional recovery is carried out after the removal of the plaster immobilization bandage and includes physiotherapy, massage and physical therapy exercises (exercise therapy). In the future, active exercises are carried out to adapt the bone to increasing loads.

Immobilization stage

After the main stage of treatment of a fracture of the humerus, which includes the reposition of fragments or osteosynthesis, if necessary, immobilization is performed. It is carried out with the help of a plaster bandage and diverting splints, which must necessarily immobilize the joints above and below the fracture. The duration of the stage depends on the type and severity of the fracture, on average it varies from 3 to 8 months. During the immobilization stage, exercises are performed aimed at preventing complications, these include:

• Breathing exercises - alternate deep breaths and exhalations.
• Performing rotation in joints that were not immobilized by an immobilization bandage, which improves blood circulation in tissues and accelerates regeneration processes.
• Pendulum movements of the hands, helping to reduce the severity of soft tissue edema and pain.
• Abduction and adduction of the elbow to the body.
• Turns of the torso with hands clasped in a “lock” in front of you.

Exercise for at least half an hour a day. If after the start of exercise therapy the pain intensifies, then the classes are stopped. When physical therapy exercises are not performed, the hand in a plaster cast should be free in a physiological position (tied up with a scarf). If necessary, physiotherapy procedures are additionally prescribed. How to develop a hand after a fracture of the humerus at the stage of immobilization is selected by the attending physician individually, which depends on the type and severity of the injury.

What does functional recovery include?

The rehabilitation stage of functional recovery begins after the removal of the immobilization bandage after X-ray confirmation of the overgrowth of bone fragments. The exercise therapy complex for fracture rehabilitation is expanding, it includes the following exercises:

• Raise your arm in front of you, while it does not bend at the elbow joint.
• In a standing position, swing your arms back and forth and to the sides.
• Abduction of straightened arms with simultaneous reduction of the shoulder blades.
• Performing exercises using block simulators (bringing arms to the side, lifting and lowering with a load).
• Exercise in the water - the movement of the hands that imitate breaststroke swimming, freestyle.
• Crossing your arms in front of you on your chest.

At the same time, physiotherapy is prescribed, which is a therapeutic effect on tissues by certain physical factors:

• Magnetotherapy - a magnetic field stimulates the processes of regeneration (healing) of tissues.
• Massage - stroking, rubbing, kneading soft tissues improves blood circulation in them, stimulates the course of metabolic processes.
• Balneotherapy - the use of local hand baths, common baths filled with mineral waters.
• Electrophoresis - the impact of an electric current of a certain strength and frequency on tissues contributes to the rapid accumulation of drugs. The procedure is prescribed if it is necessary to use anti-inflammatory drugs, drugs that stimulate tissue regeneration.
• Laser therapy - procedures have a stimulating effect on tissue regeneration.
• Infrared radiation - local effect of heat on tissues provokes an increase in the intensity of metabolic processes, increases blood circulation in tissues and stimulates the speedy recovery of damage, subsidence of the inflammatory process.
• Ozokeritotherapy - applications are performed with a mixture of hydrocarbons (paraffin).

The choice of measures is carried out by the attending physician. Rehabilitation after a shoulder fracture at the stage of functional recovery lasts on average from 3 to 6 weeks after the injury. Classes are held 4-6 times a day, their duration is not less than half an hour. Each exercise must be done in 6-8 sets.

Training stage

The last stage, during which the arm is developed after a fracture of the humerus under conditions of increasing loads. This is necessary for the adaptation of the bone and soft tissues of the area of ​​the trauma to full functioning. Physical therapy exercises include:

• Raising a straight arm in front of you in a standing position (feet shoulder-width apart), as a result of which the load on the shoulder joint and the upper third of the bone increases.
• Hanging on the crossbar or "Swedish" wall.
• Abduction, adduction of the arm, supination (outward rotation), pronation (inward rotation) of the arm with dumbbells. The weight of the dumbbell must not exceed 5 kg.
• Performing exercises aimed at “stretching” the tendons and ligaments - “walking” with the fingers of the hand on a horizontal or vertical surface, imitation of playing the piano, putting a towel or gymnastic stick behind the back.
• Pool - a person can swim in any style convenient for him.

Physiotherapy procedures are prescribed only on an individual basis, usually after a severe fracture of the humerus with displacement. They include electrophoresis, balneotherapy, magnetotherapy. If the activities were chosen rationally, then the last stage lasts about 2-3 months. Exercises after a shoulder fracture are performed 3-4 times a day, each of them requires 8 to 10 approaches. After this period, all structures of the upper limb are restored in full.

For people who are engaged in professional sports, accompanied by loads on the upper limbs, the duration of the training session is longer. At the same time, the number of exercises increases, since better adaptation of bone tissue, muscles, ligaments and tendons to high loads is required.

Features of rehabilitation for different types of fractures

The duration and volume of activities depend on the type of injury. Rehabilitation after a fracture of the humerus with displacement is long. If the immobilization of bone fragments requires osteosynthesis (fastening with metal staples, knitting needles), then the recovery period lasts about a year. Before removing the needles, staples or the Ilizarov apparatus, physical exercises are practically not performed. To prevent tissue infection, antiseptic treatment is performed, antibacterial agents are prescribed. Then, as the bone fragments coalesce, physiotherapy exercises are prescribed with a gradual increase in static and dynamic loads.

Rehabilitation after a fracture of the large tubercle of the humerus is prescribed after surgical treatment with open reposition of fragments, its average duration is 3 months. Physical therapy exercises are more aimed at developing the shoulder joint and preventing the development of stiffness. To gradually increase the load, pulling up on the horizontal bar is recommended.

After a closed incomplete fracture without displacement, rehabilitation measures last about 1 month. They include general exercises with a uniform load on the elbow and shoulder joint. In the presence of an inflammatory reaction, physiotherapeutic procedures are simultaneously prescribed.

Rehabilitation after a shoulder fracture at home is possible at the stage of immobilization, subject to the disciplined implementation of all prescriptions and recommendations. At the same time, periodic monitoring of the effectiveness of the doctor at the reception is mandatory. The specialist, if necessary, makes a correction in the duration of classes, selects other sets of exercises.

How to develop a hand after a fracture of the humerus, the attending physician determines on an individual basis. The direction and duration of measures depend on the type of injury, localization and severity of damage. In general, the prognosis depends not only on the quality of the treatment, but also on rehabilitation, which makes it possible to fully restore the functional state of the upper limb.