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Questions and Answers
What is the initial phase of rehabilitation for a fracture shaft of the humerus focused on?
What is the initial phase of rehabilitation for a fracture shaft of the humerus focused on?
Which of the following conditions would indicate a need for operative treatment of a humerus shaft fracture?
Which of the following conditions would indicate a need for operative treatment of a humerus shaft fracture?
In the treatment of supracondylar fractures of the humerus in children, which type of fracture is more common?
In the treatment of supracondylar fractures of the humerus in children, which type of fracture is more common?
What type of cast is utilized as part of conservative management for a humeral shaft fracture?
What type of cast is utilized as part of conservative management for a humeral shaft fracture?
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What is the primary goal during Phase II of rehabilitation following a humeral shaft fracture?
What is the primary goal during Phase II of rehabilitation following a humeral shaft fracture?
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What is the generally recommended time frame for clinical union to be achieved in clavicle fractures in adults?
What is the generally recommended time frame for clinical union to be achieved in clavicle fractures in adults?
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Which of the following is NOT an indication for surgical management of a clavicle fracture?
Which of the following is NOT an indication for surgical management of a clavicle fracture?
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What type of immobilization is usually recommended for undisplaced clavicle fractures?
What type of immobilization is usually recommended for undisplaced clavicle fractures?
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At what stage of rehabilitation should strengthening exercises typically begin for clavicle fractures?
At what stage of rehabilitation should strengthening exercises typically begin for clavicle fractures?
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Which physical therapy exercise is usually recommended at the beginning of rehabilitation for clavicle fractures?
Which physical therapy exercise is usually recommended at the beginning of rehabilitation for clavicle fractures?
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What is the recommended duration of immobilization in a sling for undisplaced fractures of the clavicle?
What is the recommended duration of immobilization in a sling for undisplaced fractures of the clavicle?
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What precaution should patients take during forceful coughing or sneezing post clavicle fracture?
What precaution should patients take during forceful coughing or sneezing post clavicle fracture?
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What is the purpose of using a figure-of-eight brace during the healing of clavicle fractures?
What is the purpose of using a figure-of-eight brace during the healing of clavicle fractures?
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What is the primary mechanism used in the Hippocratic method for shoulder reduction?
What is the primary mechanism used in the Hippocratic method for shoulder reduction?
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In which position is the patient placed during Stimson’s gravity method?
In which position is the patient placed during Stimson’s gravity method?
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What is a common indication for operative treatment of shoulder dislocation?
What is a common indication for operative treatment of shoulder dislocation?
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What is the primary immediate goal of non-operative treatment for shoulder instability?
What is the primary immediate goal of non-operative treatment for shoulder instability?
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If the subscapularis was cut during surgery, what should be avoided in the early rehabilitation phase?
If the subscapularis was cut during surgery, what should be avoided in the early rehabilitation phase?
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Which of the following is NOT a target in rehabilitation after shoulder reduction?
Which of the following is NOT a target in rehabilitation after shoulder reduction?
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Which clinical finding is most indicative of an anterior shoulder dislocation?
Which clinical finding is most indicative of an anterior shoulder dislocation?
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What specific precaution should be taken regarding external rotation after surgical intervention?
What specific precaution should be taken regarding external rotation after surgical intervention?
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Which imaging view is essential for diagnosing posterior shoulder dislocation?
Which imaging view is essential for diagnosing posterior shoulder dislocation?
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Which muscle group is primarily targeted for strengthening during rehabilitation after a shoulder reduction?
Which muscle group is primarily targeted for strengthening during rehabilitation after a shoulder reduction?
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Which statement regarding the management after shoulder reduction is accurate?
Which statement regarding the management after shoulder reduction is accurate?
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What is a common consequence of anterior shoulder dislocation related to peripheral nerves?
What is a common consequence of anterior shoulder dislocation related to peripheral nerves?
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What is the typical duration for performing Stimson’s technique for reduction?
What is the typical duration for performing Stimson’s technique for reduction?
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What is the primary characteristic of a posterior shoulder dislocation?
What is the primary characteristic of a posterior shoulder dislocation?
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Which condition is also known as luxatio erecta?
Which condition is also known as luxatio erecta?
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What symptom may indicate an axillary artery injury in a patient with a shoulder dislocation?
What symptom may indicate an axillary artery injury in a patient with a shoulder dislocation?
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What is the ideal timeframe for reducing a shoulder dislocation to prevent complications?
What is the ideal timeframe for reducing a shoulder dislocation to prevent complications?
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Which mechanism commonly leads to posterior shoulder dislocation?
Which mechanism commonly leads to posterior shoulder dislocation?
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What is an observable sign that suggests anterior shoulder dislocation?
What is an observable sign that suggests anterior shoulder dislocation?
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What description best fits the condition of the arm during inferior dislocation?
What description best fits the condition of the arm during inferior dislocation?
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What is the primary reason for placing the arm in external rotation after a Bankart lesion?
What is the primary reason for placing the arm in external rotation after a Bankart lesion?
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What is the typical duration of sling immobilization for individuals under the age of 40?
What is the typical duration of sling immobilization for individuals under the age of 40?
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During the immobilization period after dislocation, which activity should be focused on?
During the immobilization period after dislocation, which activity should be focused on?
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In which phase is the goal to restore adequate motion, specifically in external rotation?
In which phase is the goal to restore adequate motion, specifically in external rotation?
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What should be avoided until full range of motion is achieved in rehabilitation?
What should be avoided until full range of motion is achieved in rehabilitation?
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Which musculature should strengthening exercises focus on after achieving full range of motion?
Which musculature should strengthening exercises focus on after achieving full range of motion?
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What exercise might be incorporated during the immobilization period?
What exercise might be incorporated during the immobilization period?
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What is an important focus when stretching is permitted in the rehabilitation process?
What is an important focus when stretching is permitted in the rehabilitation process?
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What is the focus of functional exercises during later phases of rehabilitation?
What is the focus of functional exercises during later phases of rehabilitation?
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What should be the primary approach to managing posterior dislocation?
What should be the primary approach to managing posterior dislocation?
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Study Notes
Clavicle Fracture
- Early union occurs in 1-2 weeks in children and 3-6 weeks in adults.
- Consolidation takes 12 weeks.
- Callus formation is visible and palpable.
- Conservative management involves immobilization with a sling or figure-of-eight brace for 2-4 weeks.
- Surgical management is indicated for displacements greater than 2cm, severe displacement, open fracture requiring debridement, associated neurovascular injury, or non-union.
- Surgical management includes open reduction and internal fixation with plates and screws or intramedullary fixation.
General Guidelines For Clavicle Fracture Rehab
- Gentle motion exercises, like pendular exercises, are started at 2-4 weeks.
- Strengthening exercises begin at 6-10 weeks.
- Full activity, including sports, is allowed around 3 months after fracture.
- Proper shoulder position and body mechanics are crucial to prevent future problems.
Anterior Shoulder Dislocation
- Dugas test: inability to touch the opposite shoulder with the affected hand.
- Presenting symptoms:
- Arm held in abducted and externally rotated position.
- Difficulty with internal rotation and adduction.
- Loss of deltoid contour.
- Humeral head palpable anteriorly.
- Pain and limited movement.
- Palpable fullness below the coracoid process and towards the axilla.
- Clinicians evaluate for axillary artery injury by checking for reduced pulse pressure or transient coolness in the hand.
- Peripheral nerve injuries are common due to proximity of the brachial plexus .
Posterior Shoulder Dislocation
- Rare and often missed, occurs more frequently in epileptics and individuals experiencing electrocution.
- Caused by an external blow to the front of the shoulder, which forces flexion, adduction, and internal rotation.
- Lateral and axillary views are essential for diagnosis, looking for the "light bulb sign".
- Presenting symptoms:
- Arm adducted and internally rotated.
- Difficulty with external rotation.
- May or may not have loss of deltoid contour.
- Posterior prominence of the humeral head may be noticeable.
- Possible tear of the subscapularis muscle.
Luxtio Erecta
- Also known as inferior dislocation of the shoulder.
- Caused by severe hyper abduction of force.
- Arm presents in an abducted position.
- Reduction is achieved with in-line traction and gentle adduction.
Management Of Shoulder Dislocation
- It's an emergency, reduction should be performed within 24 hours to prevent avascular necrosis of the humeral head.
- Reduction can be closed or via open surgical reduction.
Methods Of Anterior Shoulder Closed Reduction
- Hippocratic method
- Stimson’s gravity method
- Kocher’s method
Hippocratic Method
- Involves holding the patient's affected arm at the wrist and applying traction at a 45-degree angle.
- Counter-traction is applied by placing a foot on the patient's chest or having an assistant wrap a sheet around them.
Stimpson’s Technique
- Patient is placed in a prone position on the bed.
- Affected shoulder is supported, and the arm hangs over the edge of the bed.
- Weights are attached to the elbow or wrist, starting with 2 kg and increasing up to 10 kg.
- Gravity stretches the muscles, and reduction occurs over 15-20 minutes.
- Gentle internal humeral rotation may be applied.
Operative Treatment
- Indications: irreducible shoulder, displaced greater tuberosity fractures, glenoid rim fractures larger than 5mm, recurrent dislocations (3 or more in a year), dislocations occurring at rest or during sleep.
- Immediate goals in non-operative treatment: decrease pain and edema, protect static stabilizers, and strengthen dynamic stabilizers.
- Ultimate aim: increase overall shoulder stability through exercises that enhance joint proprioception and address kinetic chain deficits.
- Strengthening the rotator cuff and scapular muscles (lower trapezius and serratus anterior) is the main focus in any program.
Rehabilitation
- Immobilization after reduction (closed or open) is performed with external rotation, opposing traditional internal rotation immobilization.
- Duration of immobilization in a sling ranges from 3-6 weeks for individuals under 40 and 1-2 weeks for those over 40.
Phase 1 (Up to 6 Weeks)
- Goal: maintain anterior-inferior stability.
- Focus on active range of motion (AROM) of the elbow, wrist, and hand, along with pain reduction.
- Incorporate isometric exercises for the rotator cuff and biceps musculature.
- Codman Exercises (Pendulum exercises)
- AAROM for external rotation (0-30º) and forward elevation (0-90º).
Phase 2 ( 6-12 Weeks)
- Goal: restore adequate motion, particularly in external rotation.
- AAROM to achieve full range of motion
- Passive stretching of the posterior joint capsule using joint mobilizations or self-stretching.
- Strengthening and repetitive exercises are delayed until full range of motion is achieved.
Phase 3 (12-24 Weeks)
- Goal: successful return to sports or physical activities of daily living.
- Begin strengthening exercises, initially pain-free and focused on stability.
- Progression: rotator cuff musculature and scapular stabilizers (trapezius, serratus, levator scapulae, and rhomboids) followed by larger muscles (deltoids, latissimus dorsi, and pectorals).
- Introduce functional exercises, including proprioceptive training.
Posterior Dislocation Management
- Follows the same progression as the anterior protocol with the following modifications:
- No resisted internal rotation for 4-6 weeks if subscapularis was cut.
- External rotation limited initially to 30 degrees and then 45 degrees at 6 weeks.
- Avoid provocative positions that increase the risk of recurrent anterior shoulder dislocation:
- External rotation
- Abduction
- Distraction
- Extension
Fracture Shaft of the Humerus
- Conservative treatment preferred: closed reduction in an upright position followed by application of a U-shaped slap of plaster of paris (POP) or a cylinder cast (coaptation splint).
- Functional brace may be used initially in stable fractures or a few weeks after initial casting.
Operative Treatment
- Indications: inadequate reduction, nonunion, open fractures, segmental fractures, associated vascular or nerve injuries.
- Most commonly treated with plates and screws, but intramedullary nails can also be used.
Rehabilitation
Phase I (0 to 6 Weeks)
- Encourage range of motion (ROM) of the neck, shoulder, elbow, wrist, and hand.
- Pendulum exercises (30-minute sessions, 3-5 times per day).
- Begin passive self-assisted exercises.
Phase II (6 to 12 Weeks)
- Early active, resistive, and stretching exercises can begin.
- Therabands are used for strengthening internal rotators, external rotators, flexion, extension, and abduction (3 sets of 10-15 reps each).
- Flexibility and stretching exercises are progressed for increased ROM in all directions.
Phase III ( > 12 Weeks)
- Initiate isotonic exercises using rubber tubing, progressing to weights for strengthening.
- Focus on rotator cuff and scapular strengthening.
- Weights start at 1lb, progressing in 1-lb increments with a maximum limit of 5 lbs.
- Discontinue weights if pain persists after exercise.
- Progress to overhead exercises and maximum ROM.
Supracondylar Fracture of Humerus
- Most frequent fracture in children, with peak incidence between ages 5-8.
- Most commonly caused by a fall on an outstretched hand (FOOSH).
- Types:
- Extension type (98%): posterior displacement of the distal fragment.
- Flexion type (2%): anterior displacement of the distal fragment.
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Description
This quiz covers essential information regarding clavicle fractures, their healing timelines, and rehabilitation protocols. Learn about conservative and surgical management options, as well as recommended exercises for recovery. This content is crucial for understanding shoulder injuries and enhancing recovery practices.
