Rehabilitation Complex Humeral Fracture Fixation

  • 0 - 6 weeks


    This information is general and may vary from case to case. Your physiotherapist will guide you through the process. There are many different exercise and therapy regimes.
    • After humeral fracture fixation surgery it is important for the repair site to remain reasonably still to promote healing.
    • Therefore limited gentle range of motion is allowed at first and then built up
    • Strengthening the arm is avoided until healing has occurred (12 weeks after surgery)
    • Take some painkillers about 30min before you do your exercises
      Ice should be applied (wrapped in a cloth NOT APPLIED DIRECTLY TO THE SKIN) for 20 minutes every 2 hours in the first 2 weeks.
    • Do 10 of each exercise 4 times per day.
    • Do not push through the pain barrier or try and do extra repetitions

    DAY 1-14


    Posture:
    Shrug your shoulders then roll them backwards and downwards, pinching your shoulder blades together.
    Hold for 5 seconds
    Try to maintain this position throughout the day
    Hand & Wrist:
    Keep your arm in the sling and move your hand up and down at the wrist. Clench and unclench your fist.
    Squeezing a soft ball can help.
    Forearm:
    With your arm in the sling and the elbow bent at your side, turn the hand to face the ceiling and then the ground.
    Elbow:
    With your arm out of the sling bend and straighten the elbow.
    Stacks Image 418028

    Fig 1

    Pendulum shoulder flexion: see fig 1
    Undo waist strap of sling
    Bend forward at your waist. Let your (operated) arm relax and hang straight down
    Use your good arm to bring your operated arm back in
    Then slowly release and let the operated arm hang forward again
    Stacks Image 418066

    Fig 2

    Stacks Image 418071

    Fig 3

    Assisted shoulder external rotation to neutral: see Fig 2 and Fig 3
    Lie on your back
    Bend your elbows and keep them tucked in to your sides
    Using your good arm push rotate your operated hand outwards until the operated
    hand is pointing to the ceiling

    WEEK 2-6


    Your first post-operative visit is at two weeks
    Ice can be discontinued
    Continue the posture and elbow wrist and hand exercises
    Stop the pendulum shoulder flexion exercises and substitute the following instead
    Continue the assisted external rotation to neutral exercises
    Stacks Image 418112

    Fig 4

    Stacks Image 418117

    Fig 5

    Passive forward elevation to 90: see Fig 4 and Fig 5
    Lie on your back. Lock the fingers of each hand together.
    Use your good arm to pull the other hand up towards and then above your head
    Then straighten your elbow
    Hold for 5-10 seconds
    Bend your elbows and then gently return to the start position
    As pain improves this exercise can be performed in the sitting position
    0 - 6 weeks
  • 6 weeks - 6 months


    This information is general and may vary from case to case. Your physiotherapist will guide you through the process. There are many different exercise and therapy regimes.

    6-12 weeks


    The focus of this phase is to regain range of motion.
    The following are useful examples that can be used initially using your good arm to drive the movement and gradually using the
    operated side more.
    Do 10 of each exercise 4 times per day
    Do not push through the pain barrier or try and do extra repetitions

    Information for your physiotherapist in this period:
    Self-passive, active assisted progressing to active range of motion exercises are allowed.
    No therapist-performed passive capsular stretching.
    Patient self-passive stretching only.
    No strengthening until 12 weeks
    Stacks Image 4513213

    Fig 1

    Stacks Image 4513218

    Fig 2

    Combined internal and external rotation lying: see Fig 1 and Fig 2
    Lie on your back, grasp a stick with both hands, shoulder width apart,
    Rock the bar as far as you can from side to side
    This exercise can be done sitting with your elbows resting on a table
    Stacks Image 4513227

    Fig 3

    Stacks Image 4513232

    Fig 4

    Flexion in lying position with bar: see Fig 3 and Fig 4
    Lie on your back, grasp a stick with both hands, shoulder-width apart
    Start with stick resting across your hips,
    Lift your arms over your head keeping them straight
    Stacks Image 4513241

    Fig 5

    Stacks Image 4513246

    Fig 6

    Shoulder extension standing: see Fig 5 and Fig 6
    Stand holding a stick behind your back with both hands
    Lift the stick backwards away from your back
    Stacks Image 4513255

    Fig 7

    Stacks Image 4513260

    Fig 8

    Internal rotation standing: see Fig 7 and Fig 8
    Hold a stick behind your back as shown with your good arm at the top
    Use your unaffected arm to pull your operated arm up your back as far as possible
    Stacks Image 4513269

    Fig 9

    Pulleys: see Fig 9
    Sitting position.
    Hold the pulley handles in each hand and use the unaffected arm to pull the affected arm up

    12 weeks – 6 Months


    12 weeks: The focus of this phase is to continue to gain range of motion and to start strengthening your shoulder

    Information for your physiotherapist in this period: Continue ROM - capsular stretching is allowed.
    Open chain long lever exercises can now be incorporated, Isometric exercises can start in neutral and progress to through range, then add
    Therabands
    Stacks Image 4513281

    Fig 10

    Stacks Image 4513286

    Fig 11

    Isometric exercises in neutral External rotation: Sit with or without your arm supported on
    a table and with your elbow bent to 90. Place a rolled up hand towel under your armpit. Place
    the unaffected hand on the outside of the forearm at wrist level and push against it, to 30% of
    maximum resistance
    Abduction: Sit with or without your arm supported on a table. Keep your elbow by your side,
    place the hand of the unaffected arm on the outside of the upper arm and push into it, to 30%
    of maximum resistance
    Internal rotation: In sitting with or without your arm supported on a table. Place a rolled up
    hand towel under your armpit. Place the unaffected hand on the inside of the forearm at wrist
    level and push against it, to 30% of maximum resistance.
    Stacks Image 4513293

    Fig 12

    Shoulder flexion: see Fig 12
    Stand on the band
    Grasp the band with arm at side
    elbow straight, thumb up
    Raise arm in front over-head, keeping elbow straight
    Slowly return to starting position
    Stacks Image 4513300

    Fig 13

    Shoulder abduction: Fig 13
    Stand on the band
    Grasp the band with arm at side
    elbow straight, thumb up
    Raise arm upwards to the side, keeping elbow straight
    Slowly return to starting position
    Stacks Image 4513307

    Fig 14

    Shoulder extension: see Fig 14
    Secure band at waist level around a door handle or rail
    Grasp band and pull backwards keeping elbow straight
    Slowly return to starting position
    Stacks Image 4513314

    Fig 15

    Internal rotation: see Fig 15
    Secure band at waist level around a door handle or rail
    Stand with operated side to band
    Elbow bent to 90 degrees arm at side
    Grasp elastic and pull inwards across the body
    Stacks Image 4513321

    Fig 16

    External rotation: see Fig 16
    Secure band at waist level around a door handle or rail
    Place pillow between elbow and body
    Stand with operated away from band
    Elbow bent to 90 degrees arm at side
    Grasp elastic and rotate arm outwards
    Stacks Image 4513330

    Fig 17

    Stacks Image 4513335

    Fig 18

    Combined external rotation and flexion in sitting: see Fig 17 and Fig 18
    Sit in a chair
    Clasp both hands behind your head
    Push both hands up to the ceiling
    Shoulder blade retraction / rows
    Secure band at waist level around a door handle or rail
    Grasp band in both hands, elbows bent to 90 degrees, thumbs up
    Bring arms out 45 degrees from body
    Pull band backwards, pinching your shoulder blades together in a rowing type action,
    Hold shoulder blades together for 5 seconds
    6 weeks - 6 months

PHONE
(02) 9587 4720

Sydney Orthopaedic Trauma and Reconstructive Surgery
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Kogarah NSW 2217

Orthopaedic & Arthritis Specialist Centre
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