Do You Need Rehabilitation After a Shoulder Fracture Surgery?

Fracture rehabilitation

Hello, I would like to ask about a shoulder crush fracture from a bicycle fall.
After surgery and the insertion of a steel pin, is rehabilitation necessary? Or will it heal on its own without rehabilitation? My family consulted two hospitals; the first surgeon said rehabilitation is not needed, while the second doctor, after reviewing the X-rays and medical history, said there is no issue with the surgical site and that rehabilitation should begin.
Why would there be differing opinions regarding the need for rehabilitation for the same symptoms? Isn't rehabilitation a normal part of recovery from an injury? How can a doctor say that rehabilitation is unnecessary and that it will heal on its own?

AA, 20~29 year old female. Ask Date: 2015/12/21

Dr. Shi Guozheng reply Orthopedics

The purpose of rehabilitation is to restore the range of motion and function of the shoulder joint to what it was before the fracture.
If the condition is good and the range of motion is satisfactory after surgery, there is no need to intentionally go to a rehabilitation department for therapy; self-directed activities are sufficient.
You can perform movements such as flexion, extension, elevation, internal rotation, and abduction of the shoulder joint.

Reply Date: 2015/12/21

More Info

After a shoulder fracture surgery, rehabilitation is generally considered an essential part of the recovery process. The need for rehabilitation can vary based on the severity of the fracture, the type of surgical intervention performed, and the individual patient's overall health and activity level. In your case, having sustained a comminuted fracture (粉碎性骨折) and undergoing surgery with the insertion of screws or plates, rehabilitation is typically recommended to ensure proper healing and to restore function.

Importance of Rehabilitation
1. Restoration of Range of Motion: After surgery, the shoulder joint may become stiff due to immobilization. Rehabilitation exercises help to gradually restore the range of motion, which is crucial for regaining full functionality of the shoulder.

2. Strengthening Muscles: Rehabilitation focuses on strengthening the muscles around the shoulder joint. This is important not only for recovery but also for preventing future injuries.

3. Pain Management: Physical therapy can help manage pain through various modalities, including manual therapy, ultrasound, and electrical stimulation.

4. Functional Recovery: Rehabilitation aims to help patients return to their daily activities, whether that involves lifting objects, participating in sports, or simply performing routine tasks.

Why Different Opinions?
The differing opinions from the two doctors you consulted may stem from several factors:
- Variability in Treatment Philosophy: Some surgeons may adopt a more conservative approach, believing that certain fractures can heal adequately without formal rehabilitation, especially if the patient is young and healthy. Others may advocate for rehabilitation as a standard practice to ensure optimal recovery.

- Assessment of the Injury: The first doctor may have assessed your specific case and determined that the fracture was stable enough to heal without rehabilitation. In contrast, the second doctor might have considered the potential for stiffness and weakness post-surgery and recommended rehabilitation as a precaution.

- Patient Factors: Individual factors such as age, activity level, and overall health can influence the decision. For instance, younger patients might recover more quickly and may not need as intensive rehabilitation as older patients.

Recommendations
1. Follow-Up with a Physical Therapist: Regardless of the opinions you've received, it would be beneficial to consult with a physical therapist who specializes in post-surgical rehabilitation. They can provide a tailored rehabilitation program based on your specific needs and recovery goals.

2. Monitor Symptoms: Pay attention to any pain, swelling, or changes in your shoulder's range of motion. If you experience any concerning symptoms, it's important to communicate these to your healthcare provider.

3. Gradual Progression: If you do start rehabilitation, ensure that you follow a gradual progression of exercises. This typically begins with passive range of motion exercises and progresses to active range of motion and strengthening exercises as tolerated.

4. Educate Yourself: Understanding the rehabilitation process can help alleviate concerns. Ask your healthcare providers about the expected timeline for recovery and what milestones you should aim for during rehabilitation.

5. Stay Active: While you may need to limit certain activities initially, staying as active as possible within the guidelines provided by your healthcare team can aid in recovery.

In conclusion, while some doctors may suggest that rehabilitation is not necessary, it is generally advisable to engage in a structured rehabilitation program after shoulder surgery, especially following a significant injury like a comminuted fracture. This approach not only promotes healing but also helps ensure that you regain full function of your shoulder. Always consult with your healthcare providers to make informed decisions about your recovery plan.

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