Post-Operative Care and Rehabilitation for Humerus Fractures: Key Insights

Postoperative care for humeral fracture?

I apologize, but Dr.
Chen has some questions to ask.
My mother (around 60 years old) was in a car accident in mid-September 2020, and she was taken to the emergency room and underwent surgery.
Currently, the doctor has advised aggressive rehabilitation and monitoring, and there is no need for further surgery to remove anything.
However, my mother’s rehabilitation progress seems to be slow; she is making gradual improvements, but the extent of improvement is not significant.
She still cannot lift her arm on her own and experiences pain when attempting to raise it, along with occasional sharp pain even when not in use.

1.
The X-ray image below was taken at the end of December 2020.
Does it appear normal? (For example: bone fracture, adhesion, nerve issues).
https://imgur.com/PmCcVC6
2.
Does this injury affect the front or the middle part? Is there any evidence of slippage? Is it confirmed that there is no need for further surgery to remove anything?
3.
The orthopedic and rehabilitation doctors currently treating her have instructed her to use her injured hand to climb up a wall to the highest point and perform lifting motions at various angles.
Are there any other suitable rehabilitation methods and exercises that can be done at home?
4.
After completing rehabilitation exercises, her hand is easier to lift, but after resting for a while, it becomes very stiff and difficult to raise.
Is this a normal condition?
5.
Are there any other aspects that need attention or recommendations? I am very concerned about my mother’s health, so I hope to hear various suggestions.
I apologize for the many questions, and thank you, doctor, in advance.

Jason, 30~39 year old female. Ask Date: 2021/02/08

Dr. Chen Yongxue reply Orthopedics

1.
The X-ray taken at the end of December 2020 shows a bone fragment in the shoulder joint, which likely corresponds to the attachment site of the supraspinatus muscle.
This could be a primary reason for the inability to raise the arm.
Such findings can occasionally be seen in patients with osteoporosis after surgery.

2.
This injury is located at the proximal end, with no evidence of displacement, and there is no need for surgical removal.
3.
The orthopedic and rehabilitation doctors currently recommend rehabilitation exercises that involve using the injured arm to climb up a wall to the highest point, as well as performing lifting motions at various angles.
I would like to know if there are additional suitable rehabilitation exercises and movements that can be done at home.

4.
It is normal for the arm to be easier to lift immediately after rehabilitation exercises, but it may become stiff and difficult to raise after resting for a while.

5.
Are there any other aspects that need attention or suggestions? I am quite concerned about my mother's health condition and would appreciate hearing different recommendations.
Thank you, doctor.

Reply Date: 2021/02/08

More Info

Post-operative care and rehabilitation for humerus fractures, especially in older adults, is crucial for ensuring optimal recovery and regaining function. Given your mother's situation, here are some insights and recommendations based on the information provided.

1. Understanding the X-ray Findings
While I cannot view the X-ray image directly, generally, an X-ray taken after a humeral fracture should show signs of healing, such as callus formation around the fracture site. If there are concerns about non-union (where the bone does not heal properly) or malunion (where the bone heals incorrectly), these would typically be assessed through both clinical examination and imaging. If the doctor has indicated that surgery is not necessary at this time, it suggests that the fracture is healing adequately. However, if there are persistent symptoms like pain or limited range of motion, further evaluation may be warranted.

2. Location of the Injury
The location of the fracture (whether at the proximal, mid-shaft, or distal humerus) can significantly influence rehabilitation strategies. Proximal humeral fractures, for instance, often require more careful management due to the potential for complications involving the shoulder joint. If there is any concern about displacement or "slippage" of the fracture fragments, this should be discussed with the orthopedic surgeon.

3. Rehabilitation Techniques
The rehabilitation approach you mentioned—using the wall to assist in raising the arm—is a common technique to promote range of motion. Here are additional exercises that can be beneficial:
- Pendulum Exercises: Lean forward and let the arm dangle, gently swinging it in circles to promote mobility without straining.

- Wall Climbing: Similar to what is being done, but can also include using the fingers to "climb" up the wall to gradually increase the height reached.

- Isometric Exercises: While the arm is supported, gently push against a wall or a stable surface to engage the muscles without moving the joint.

- Theraband Exercises: Once some range of motion is regained, using resistance bands can help strengthen the muscles around the shoulder.

4. Post-Rehabilitation Stiffness
Experiencing stiffness after rehabilitation exercises is common, especially after a period of immobilization. It is important to balance activity with rest. After exercises, applying heat can help relax the muscles and improve flexibility. If stiffness persists, gentle stretching should be incorporated into the routine.

5. Monitoring Progress and Concerns
It’s essential to maintain regular follow-ups with both orthopedic and rehabilitation specialists. If your mother continues to experience significant pain, or if her range of motion does not improve, further imaging or intervention may be necessary. Additionally, ensuring that she is following a comprehensive rehabilitation plan, including physical therapy, is vital.

Nutritional Support
Nutrition plays a key role in bone healing. Ensure that your mother is consuming adequate amounts of calcium and vitamin D, which are crucial for bone health. Foods rich in these nutrients include dairy products, leafy greens, fish, and fortified foods. Staying hydrated and maintaining a balanced diet will also support her recovery.

Conclusion
In summary, while your mother is on the right path with her rehabilitation, it is important to remain vigilant about her progress and any persistent symptoms. Encourage her to communicate openly with her healthcare providers about her concerns, and consider seeking a second opinion if you feel her recovery is not progressing as expected. With time, patience, and appropriate care, she can achieve significant improvements in her shoulder function.

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