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Recovery after humerus fracture

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I broke my humerus the 3rd of January 2012. I had surgery(nailing) and I was put in a sling for about 3 weeks. It is about 7 weeks post op now. I have been doing physiotherapy but I have still a lot of pain and limited movements. My arm is weak and extension and abduction movements are difficult...In extension I can manage 45 degrees on the front and side, but I cant lift my arm above my head. Is this normal at 7 weeks post op? t is very frustrating, as the recovery is very slow and my shoulder seems frozen. I am doing pendulum exercises, stretching and pulley exercises about 3 times per day for half an hour every time. Is this enough? Shall I maybe increase the number of exercises and do them every hour?could this be dangerous for my recovery?Is there any risk I may not recover my range of movements?
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First Helper User Profile Gaelic
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replied March 3rd, 2012
Especially eHealthy
Laura,

First, how is the union of the humerus going? You are now about 7 - 8 weeks out. In one study of humerus fractures treated with IM nailing, the range to union was 6.3 to 16.7 weeks, with 9.5 weeks being the average. Is the bone healed yet?

Are you using a co-apt, or clam shell, brace when doing your therapy?

Until the bone is united, you will probably still have some pain at the fracture site when you apply a large bending moment to it. It has been found that IM nailing of humerus fractures provides torsional and bending stiffness of only 20-30% of normal. So, until the bone us basically healed, even trying to lift the weight of the arm, may be too much stress. If you are not wearing the clam shell during therapy, you may want to, just for some extra external support.

It is a little difficult to determine exactly what is causing the problems from your description. You do say, at one point, that you think you have a frozen shoulder. But, at other places, it is difficult to figure out if it is the pain that is keeping you from moving or if it is objective weakness (without pain) that is keeping you from moving.

It is most likely a combination of the above, and is different in the various locations. So, pain, weakness, and stiffness are all coming into play. The problem over the internet, without an examination, it is difficult to give detailed instructions.

It is known that loss of shoulder motion (all the way to a frozen shoulder) is a complication of IM nailing of a humeral shaft fractures. The following is taken from the Wheelees Textbook of Orthopedics, out of Duke University.

Complications following IM nailing of humerus fractures may include:

LOSS OF SHOULDER MOTION:
---- may occur in up to 1/3 patients with antegrade nailing;
---- may be a consequence of rotator cuff damage at insertion site;
-------- note that many IM nail designs do not have large diameters because that would cause a larger hole through the rotator cuff; but, it still causes a hole in the rotator cuff;
---------try to use deltoid splitting incision, then incise the rotator cuff by dividing the supraspinatus in line with its fibers, just posterior to the bicipital tuberosity;
---- also, even a slight prominence of IM nails causes impingement & resultant loss of shoulder motion.




As to the weakness you are having, that should be fairly easy to take care of, once the fracture is completely healed. Once you are allowed to place full stress across the fracture site, it is then just a matter of doing some weight lifting.


But, it is the pain and stiffness that need to be addressed now. If the pain is coming from an incompletely stabilized fracture, then it needs to be stabilized. If there is not yet enough bone to stabilize the fracture (remember the nail only provides 20-30% bending and rotational strength of a normal bone), then some external support is needed, such as a clam shell brace. Or, by using lighter weights.

If the pain is coming from the stiff joints, well then, the stiffness needs to be worked on, and two problems will be helped.



But, you are going to need help with the stiffness. Though patients can often do a lot to help themselves with stiff joints, sometimes they need a professional physical therapist. You may benefit from some friction massage and ultrasound, to break up the scar tissue.

The therapist also knows how far he/she can stretch and push a joint. Sometimes, it takes some passive motion from a therapist to get an adequate stretch on a frozen shoulder. There is some risk with passive range of motion, if it is done by an untrained person. So, it is usually best to let the PT do the passive ROM.



You need to jump on frozen shoulders as soon as possible. As they say, the best treatment for a frozen shoulder is prevention. They are very difficult to treat, so try not to develop one in the first place.


As to the pain in the various locations, you need to see your surgeon. Is it coming from an unhealed, unsupported humerus fracture, or is it coming from a proud nail impinging on the rotator cuff, or is it due to the damage to the rotator cuff when the nail was put in through it.

Is the weakness just from the pain, or is it due to the damage to the rotator cuff? When will you be allowed to advance your activities? So, that the weakness can be reversed, so that you can rebuild your strength?



Again, jump on the frozen shoulder as soon as you can.

Good luck. Keep working.

Wishing you the best.
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