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Proximal humerus fracture

Proximal humerus fractures usually verify at the level of the surgical neck of humerus.

Patients over 50 years old often find their traumatic mechanism in a simple fall, while younger people may reveal it after a violent trauma, fall from a higher point, car crashes and sports traumas. 

The symptomatology is characterised by intense pain beyond the area of the injury and immediate functional impotence. 
Pain worsens even after minor movements of the shoulder. X-rays are usually the means that helps diagnosis, together with a possible and following CT scan. 

When the dislocation is modest, fracture is compound and the suggested treatment is conservative adjoined by the immobilisation of the limb through brace for 20-25 days and a rehabilitation cycle: mobilisations and pendular exercises and for the recovery of the muscular strength ad proprioception.

Proximal humerus fracture - Surgery

The proximal fracture of the humerus occurs mainly (80% of cases) in women suffering from osteoporosis.

The type of treatment suggested is in the majority of cases is surgical and it consists in the stabilisation of fragments with Kirshner wires or Rush spike when dealing with osteosynthesis with screws and plate, or, in patients over 40 years old and a fracture in 4 parts, with an intervention of endoprosthesis (shoulder prosthesis). Regardless of the type of surgery undergone, it is indispensable to mobilise immediately the limb in order to prevent post-traumatic rigidities. The passive mobilisation is started as soon as possible in the arch free from pain.  Your case manager will always keep contacts with the surgeon to establish together times and way of the joint recovery. 

You will undergo frequent radiographic check-ups to verify the maintenance and stability of the synthesised fracture. A MRI scan will then be necessary to check which are the conditions of the bone of the humeral head that can lead to a necrosis in these cases. Starting from the third week from intervention, exercises of slow assisted mobilisation can be performed, privileging movements of elevation at the scapula level, paying a particular attention when rotating. 
Pendular exercises will then be prescribed together with exercises for the activation of the scapular stabilisers and massages for the shoulder girdle, superior trapezius and scapular elevator, that are usually heavily strained.
Rehabilitation in water is also extremely important, since it helps relaxing the muscle. From the sixth week post-surgery onwards it is possible to focus more on mobilisation, taking into consideration, however, the degree of pain and the level of scarring of tissues; the insertion of active exercises inside the protocol for the rotators cuff will be agreed with the surgeon in order to avoid decomposition of the fracture, which is possible throughout the first months from surgery. 
The phases of recovery of co-ordination and sportive technical skills can be carried about alternating sessions in the gym and in the field, where co-ordination between movements of the trunk and of the superior limb, and therefore of the whole kinetic chain, are analysed and properly restored. The treating period requires no less than 3-4 months of therapies to recover the whole range of motion and the complete functionality.

Proximal humerus fracture - Rehabilitation

In case of proximal humerus fracture, if the dislocation is modest, and the fracture is compound, the suggested treatment is conservative adjoined by the immobilisation of the limb through brace for 20-25 days and a rehabilitation cycle: mobilisations and pendular exercises and for the recovery of the muscular strength ad proprioception.
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