Rehabilitation Techniques for Shoulder Dislocation and Humeral Fracture

Rehabilitation methods for shoulder dislocation combined with humeral fracture?

Dear Dr.
Yeh,
In your reply, you mentioned that rehabilitation should begin three weeks after the injury.
I have since returned for a follow-up appointment, and the X-rays show no significant issues.
The doctor has advised that I can move freely.
It has been five weeks now, but I can only raise my arm to 45 degrees, and I still cannot move it in all directions as I used to.
I did not undergo surgery; I only had a reduction performed.
Could you please advise on which rehabilitation exercises I can do and what the limits of these movements should be? How often should I schedule follow-up appointments? Thank you.
Sincerely,
Doctor Q&A Teams
November 3, 1992

Xiao Mei, 40~49 year old female. Ask Date: 2003/11/03

Dr. Ye Qingnian reply Orthopedics

Bend at the waist, rotate the arms, bend at the waist again, swing the arms, and face the wall.
Gradually climb the arms upward, recording the position each day, and progressively increase the height of the arm lift daily.

Reply Date: 2003/11/03

More Info

Rehabilitation after a shoulder dislocation and humeral fracture is crucial for restoring function and alleviating pain. Given your situation, where you have been advised to engage in rehabilitation exercises five weeks post-injury, it is essential to approach this process with care and a structured plan.

Rehabilitation Techniques
1. Range of Motion Exercises: Start with gentle range of motion (ROM) exercises. These can include:
- Pendulum Exercises: Lean forward and allow your arm to hang down. Gently swing your arm in small circles, which can help improve mobility without putting too much strain on the shoulder.

- Wall Crawls: Stand facing a wall and use your fingers to "crawl" up the wall. This helps in gradually increasing the range of motion in a controlled manner.

2. Stretching Exercises: Once you have gained some mobility, incorporate stretching exercises to improve flexibility:
- Cross-Body Stretch: Use your unaffected arm to pull the affected arm across your body gently. Hold for 15-30 seconds.

- Sleeper Stretch: Lie on your side with the affected shoulder down. Use your other arm to gently push the affected arm down towards the floor, feeling a stretch in the back of the shoulder.

3. Strengthening Exercises: As you progress and gain more range of motion, begin strengthening exercises:
- Isometric Exercises: These involve contracting the muscles without moving the joint. For example, press your hand against a wall or a sturdy surface without moving your shoulder.

- Resistance Band Exercises: Use resistance bands to perform external and internal rotation exercises, which are vital for shoulder stability.

4. Functional Activities: Gradually incorporate functional movements that mimic daily activities. This can include:
- Reaching for Objects: Practice reaching for items on a shelf or table to improve functional mobility.

- Light Weightlifting: Once cleared by your physician, you can start with light weights to build strength.

Limitations and Goals
The extent of your movements will depend on your healing process. Initially, your goal should be to increase your range of motion gradually. You mentioned being able to lift your arm to 45 degrees; aim to increase this incrementally. It’s essential to listen to your body and avoid pushing through pain, as this can lead to setbacks.

Frequency of Follow-Up Appointments
Regarding follow-up appointments, it is generally recommended to see your physician or physical therapist every 4-6 weeks during the rehabilitation process. This allows for monitoring of your progress and adjustments to your rehabilitation plan as needed. However, if you experience increased pain, swelling, or any concerning symptoms, you should seek medical advice sooner.

Conclusion
Rehabilitation after a shoulder dislocation and humeral fracture is a gradual process that requires patience and consistency. Focus on gentle range of motion exercises initially, progressing to strengthening as your mobility improves. Regular follow-ups with your healthcare provider will ensure that you are on the right track and help you achieve the best possible recovery. Always consult your physician or physical therapist before starting any new exercise to ensure it is appropriate for your specific condition.

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