Rehabilitation protocol for reverse shoulder arthroplasty. Scapular fracture aftercare instructions what you need. Shoulder fracture aurora clavicle fracture treatment denver. Increase movement as shown in the stage 2 exercises. Rehabilitation protocol for total shoulder arthroplasty.
The bone positioning is no longer in its correct, anatomical position displacement 3. Rehabilitation programs for operative and nonoperative shoulder. The term scapula literally means skapulare to dig, because the greek anatomists who named it thought that the shoulder blade looked like a spade. Passive stretching exercises need to be continued until the shoulder has complete range of motion in it. Rehabilitation programs for orif humeral fractures with locking plate dr. Denards rehabilitation protocols open shoulder surgery these rehabilitation protocols are based on current studies detailing healing time and the risk of stiffness after open shoulder surgery. Orif of extraarticular scapular fracture has been rare owing to the belief that the shoulder girdles wide range of motion sufficiently allows maintenance of activities of daily living despite. Scapula fractures represent less than 1% of all broken bones and many of them can be treated without surgery. Post fracture proximal humerus rehabilitation guidelines r l humerus fracture. Surgery for a scapular fracture may be recommended when. Your collarbone, arm bones, lungs, or chest may also be affected. Background o the scapula is the base of support to shoulder joint and all movements of the upper extremity o poor scapular stabilization can contribute to a variety of upper quadrant syndromes such as. The angle of the bone causes a deformity in the limb angular deformity 3 the bone positioning is no longer in its correct, anatomical position displacement 3 the glenoid socket is fractured, causing instability of the ball and socket joint.
A fracture of this bone is termed as a scapula or broken shoulder blade. Non displaced 2 part fracture good alignment does not involve an articular surface. Dec 05, 2018 as the name suggests a scapula fracture is a fracture of the scapula or the shoulder blade. The scapular plane is defined as the shoulder positioned in 30 degrees of abduction and forward. Nonoperative proximal humeral fracture rehabilitation protocol.
Highspeed vehicle accidents are the most common cause. Scapular stabilization university of california, san francisco. Scapula shoulder blade fractures the shoulder blade scapula is a triangularshaped bone that is protected by a complex system of surrounding muscles. Although formerly felt to be rare, scapula fractures have been shown to occur with a rate of 0. Once the fracture begins to heal it is important to keep the shoulder moving. Rehabilitation programs for nonoperative humeral fractures.
The scapula is sturdy and located in a protected place, so it rarely breaks. Rehabilitation following total shoulder arthroplasty. You will be advised at your fracture clinic when you may discard the sling and return to normal light activities using. A scapula fracture usually occurs due to a direct blow to the shoulder blade, such as a motor vehicle accident, a hard ball impact in sports such as cricket or hockey, or a heavy collision with another player in contact sports such as rugby or football. Highenergy, blunt trauma injuries, such as those experienced in a.
Nonoperative proximal humeral fracture rehabilitation protocol general principles. Harold schock iii, md rotator cuff repair rehabilitation protocol the following document is an evidencebased protocol for arthroscopic rotator cuff repair rehabilitation. Normal shoulder motion involves a coordinated rhythm between movement of the shoulder blade on the chest wall and movement of the ball in the shoulder socket. Jul 26, 2018 famous physical therapists bob schrupp and brad heineck present. Increase rom while protecting the fracture site you can be slightly more. You may note that these protocols are more conservative than you have seen in your experience or heard from friends. Fractures of the scapula may occur in the body, neck, supraglenoid tubercle, spine, or glenoid cavity. Normally, the scapula is pretty well protected by a web of muscles and it is very rare that the scapula sustains a fracture, but if there is a scapula fracture then it gives an indication that the shoulder must have been injured with a significant amount of force coupled with significant trauma to the chest.
Bony healing occurs usually within 6 to 8 weeks in adults 2. Nonoperative proximal humeral fracture rehabilitation. The protocol is both chronologically and criterion based for advancement through four postoperative phases. There was variability in our rehabilitation protocol involving the time to rom exercises which in. When a scapular fracture was identified, a ct scan with coronal, sagittal, and threedimensional reconstructions was performed to further evaluate the fracture. Dr adam seidl offers treatment for shoulder fractures and clavicle fracture in denver and aurora. It is estimated that scapula fractures account for 3 %5 % of all fractures about the shoulder girdle, with the most frequent fractures encountered occurring in the. It is no means intended to be a substitute for ones clinical decision making. Rehabilitation programs for orif humeral fractures with. Proximal humeral fracture postsurgical rehabilitation. Rehabilitation protocol for total shoulder arthroplasty and.
Fracture rehabilitation considerations o usually nonoperative care is selected for those patients o thopae ic institute of ohio samir patel, who are medically unfit for surgery or have a minimally to nondisplaced fracture o depending on the severity of the fracture the best outcome may. Outcomes of nonoperatively treated displaced scapular body. Rehabilitation protocol considerations why is the scapula important. Outcomes of nonoperatively treated displaced scapular body ncbi. Reverse shoulder arthroplasty rsa shows a growing number of implantations and is a valuable option to improve shoulder function and decrease pain. Aggressive scapular stabilization and eccentric strengthening begin plyometric and throwingracquet program, continue with endurance activities cyclingrunning okay at 12 weeks or sooner if given specific clearance phase iv 45 months full and painfree none maintain rom and flexibility progress phase iii activities, return to full. Bony healing occurs usually within 6 to 8 weeks in adults 3. The shoulder blade has a ridge going along it known as the spine of the scapula. Physioadvisors detailed physiotherapy information on a scapula fracture includes. Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. However, there is no consensus concerning the rehabilitation protocol following surgery. Highenergy, blunt trauma injuries, such as those experienced in a motorcycle or motor vehicle collision or falling from a significant height, can cause a scapula fracture. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making.
Nonoperative care is usually chosen when the fracture is stable, minimally displaced or the patient is not a good candidate for surgery. This to ensure no further displacement and accurate nonoperative management. Reestablish dynamic shoulder and scapular stability. A successful outcome from orthopaedic shoulder surgery requires a multidisciplinary approach from our surgeons to physiotherapists. Article pdf available in physiotherapy theory and practice. Due to the potential of an acromion stress fracture one needs to. Rehabilitation following reverse shoulder arthroplasty. Rehabilitation programs for nonoperative humeral fractures dr. Thus, scapula fractures occur at rates approaching those of distal tibia and humerus fractures. Specific interventions should be based on the needs of the individual and. Treating a scapula fracture the physician may recommend working with a physical therapist for rehabilitation.
Rehabilitation guidelines for standard reverse total. Physical therapy protocols boston shoulder institute. Postsurgical orif clavicle fracture or nonunion rehabilitation protocol phase 1. Specific interventions should be based on the needs of the individual and should consider exam. Arthroscopic anterior stabilization rotator cuff repair arthroscopic rotator cuff repair protocol arthroscopic rotator cuff repair faqs and postoperative guidlines rehabilitation after rotator cuff repair. Devinder completed his medical qualifications from the university of melbourne and is a fellow of the royal australasian college of surgeons and the australian orthopaedic association. Feb 03, 2020 a scapular fracture is a break in your shoulder blade scapula.
Immobilized at all times day and night off for hygiene and gentle exercise only 04 weeks. Orif clavicle fracture spo twin cities orthopedics. In certain cases, surgery to repair a broken scapula is necessary. Post fracture proximal humerus rehabilitation guidelines. Scapular body 50% to 60% of patients scapular neck 25% of patients glenoid acromion coracoid symptoms the most common symptoms of a scapula fracture include. Displaced scapular body fractures most commonly are treated. Proximal humerus fracture nonoperative jason dieterle, do considerations. Famous physical therapists bob schrupp and brad heineck present. Rehabilitation protocol for reverse shoulder arthroplasty this protocol is intended to guide clinicians and patients through the postoperative course after a reverse shoulder arthroplasty. A scapular fracture is a fracture of the scapula, the shoulder blade.
General principles of rehabilitation for fractures treat the patient not the fracture move all joints that are not immobilized prevent disuse atrophy use gravity to assist in mobilizing a joint be aware of peripheral nerve palsy signs. Restrict motion to 90 fe in the scapular plane 0 er at side ir to stomach. Rehabilitation protocol for total shoulder arthroplasty and hemiarthroplasty this protocol is intended to guide clinicians and patients through the postoperative course after a total shoulder arthroplasty tsa and hemiarthroplasty. The intent of this rehabilitation protocol is to provide the physical therapist with a guidelinetreat ment. Gentle er in scapular plane to available prom as documented in. This normally takes between 612 weeks to unite heal. Scapular fracture aftercare instructions what you need to. However there is conflicting evidence in the literature regarding the outcomes owing to retrospective design of studies, different classification systems, and diverse outcome tools. Latarjet protocol the intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone a latarjet procedure for anterior stabilization. Depending on the severity of the fracture, the patient. These fractures account for less than 1 percent of all broken bones. Please follow the management rehabilitation plan shown below weeks since injury rehabilitation plan 03 wear the sling all the time even at night in bed.
Protection phase weeks 06 goals protect the surgical reconstruction. A sudden increase of deltoid activity during rehabilitation could lead to excessive acromion stress. Rehabilitation programs for operative and nonoperative. Orthopaedic consultant bone specialist and fracture care specialist. Fracture of the scapula or shoulder blade scapular fracture fracture of the clavicle or collar bone clavicular fracture fracture of the humerus or upper arm humeral fracture little league shoulder is a fracture of the proximal shoulder at the growth plate, usually from over head throwing. Harold schock iii, md rotator cuff repair rehabilitation. Below you will find links to physical therapy protocols for various surgical procedures. Frequency of inoffice visits 1 to 2 visits over first six weeks to monitor patient compliance and understanding shoulder range of motion. Bony healing occurs usually within 6 to 8 weeks in adults. The shoulder blade scapula is located in the upper back, and sits on top of the ribs. If you have not received the appointment within one week of receipt of this letter please contact the fracture care team on the details provided above. You have sustained a fracture to your scapula shoulder blade. Pdf rehabilitation of a patient with floating shoulder and. Due to the potential of an acromion stress fracture one needs to continuously monitor the exercise and activity progression of the deltoid.
Other major injuries often accompany scapular fractures, such as fractures in the shoulder, collarbone and ribs, or damage to the head, lungs, or spinal cord. When it does, it is an indication that the individual was subjected to a considerable amount of force and that severe chest trauma may be present. Rehabilitation guidelines for proximal humerus fracture nonoperative 2 p a g e phase ii continued precautions dc sling x 3 weeks if cleared by md aarom to 90 degrees forward flexion and 40 degrees er suggested therapeutic exercises arom cervical, elbow, wrist and hand pendelums gripping exercises scapular pnf. Return to normal function and motion may require 4 months 6 months. A scapular fracture is a break in your shoulder blade scapula. Scapula fracture shoulder blade fracture physioadvisor. The scapula or the shoulder blade is a triangle shaped bone which is surrounded by a complicated web of muscles. Horses with fractures of the neck or body of the scapula are usually non. Standard course patients will typically follow a standard postfracture rehab course if their fracture is. Clavicle fracture rehabilitation protocol created date. Proximal humeral fracture postsurgical rehabilitation protocol. Treatment algorithm for progressing the rehabilitation program for a patient that has had a total shoulder arthroplasty.
Return to normal function and motion may require 3 to 4 months overall goals. Therefore, the purpose of this paper is to provide a sciencebased clinical reasoning algorithm with practical guidelines for the rehabilitation of scapular dyskinesis in patients with chronic complaints in the upper quadrant, in particular shoulder and cervical spine disorders. The angle of the bone causes a deformity in the limb angular deformity 3. Any surgery poses some risk, such as nerve and blood vessel damage, bleeding, or infection. Aggressive scapular stabilization and eccentric strengthening begin plyometric and throwingracquet program, continue with endurance activities cyclingrunning okay at 12 weeks or sooner if given specific clearance. Displaced scapular body fractures most commonly are treated conservatively. Jan 23, 20 furthermore, progressive deformity of the scapular fracture during the early postinjury phase is a concern, and serial upright radiographs should be obtained on a weekly basis for up to 3 weeks if nonoperative management is to be undertaken. Rehabilitation guidelines for proximal humerus fracture nonoperative 2 p a g e phase ii continued precautions dc sling x 3 weeks if cleared by md aarom to 90 degrees forward flexion and 40 degrees er suggested therapeutic exercises arom cervical, elbow, wrist and hand pendelums gripping exercises scapular pnf progress to full. Extension and internal rotation not performed until 6 weeks 4. Patients with a concomitant repair of a rotator cuff tear andor a tsahhr secondary to fracture or cuff arthropathy should be progressed to the next phase. A scapular fracture is a break in the continuity of the cortex of the scapula bone. Nondisplaced means less than 1cm of displacement and less than 45 of angulation 2.
Devinder garewal is an orthopaedic shoulder specialist. Navigate to learn more about shoulder fracture protocol. Rehabilitation guidelines for standard reverse total shoulder. Our team of australian trained surgeons will work will formulate a comprehensive plan to ensure a successful treatment outcome to get you back to living life to the fullest. Pdf the scapula plays a critical role in the association between the upper extremity. Denards rehabilitation protocols open shoulder surgery. May begin scapular retraction and depression sling arm in sling at all times for 2 weeks except for exercises and bathing includes nighttime other continue cryotherapy incision mobilization and desensitization modalities to decrease pain and inflammation. Begin normal light activities with the arm and shoulder. Scapular fractures are uncommon, and displaced glenoid fractures are. Mobile, triangular and protected by an intricate system of surrounding muscles, the scapula isnt broken all that often. Strengthen scapular musculature to allow for proper scapulohumeral rhythm. Other major injuries often accompany scapular fractures, such as fractures in the shoulder, collarbone and ribs, or. As the name suggests a scapula fracture is a fracture of the scapula or the shoulder blade.
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