Rehabilitation after separation of the large tubercle of the humerus. Fracture of the tubercle of the humerus: rehabilitation, exercises

A fracture of the greater tubercle of the humerus is a rather insidious injury. The clinical picture in most cases is mild, the patient may not see a doctor for a long time. Untimely assistance leads to improper fusion of fragments, the development of contractures, and the occurrence of chronic pain in the joint. Also, the detachment of the large tubercle is often combined with a dislocation of the head of the humerus, which can cause diagnostic errors.

An avulsion fracture of the greater tubercle of the humerus occurs under the action of a direct force (impact) or due to excessive muscle contraction during a fall on an extended or bent limb.

A direct blow to the shoulder, as a rule, leads to severe complications. At the same time, the scapula, collarbone, neck or body of the humerus can be damaged.

When falling on a bent or outstretched arm, a sharp contraction of the muscles of the shoulder girdle occurs. As a result, there is a complete detachment of the large tubercle and its upward displacement. If the traumatic force was small, only the cortical layer of the bone is damaged.

Fractures can be of the following nature:

• domestic. Slippery bathroom floors, spilled water, or scattered children's toys are common causes of falls;
• sports. During gym classes, heavy lifting or martial arts lessons, the risk of injury is much higher;
• industrial. The risk group includes builders, miners, people who work in industries with large moving mechanisms. Failure to comply with safety rules, neglect of personal protective equipment, lack of helmets or gloves increases the chances of injury;
• fractures due to road traffic accidents are the most dangerous.

Note! Fracture of the greater tubercle can occur during attempts to set the head of the humerus in case of dislocation. Therefore, all manipulations should be carried out only by an experienced doctor.

The main types of fractures

The choice of tactics for treating a patient depends on the type of injury, location of fragments, and the general condition of the patient. Depending on the mechanism of damage, the following types of injuries are distinguished:

• a fracture of the large tubercle of the humerus without displacement occurs due to a slight blow or fall. The fragment remains in the same place, which greatly simplifies the treatment;
• a displaced fracture is caused by contraction of the muscles of the shoulder that attach to the greater tuberosity. As a result, the bone fragment moves upward;
• impacted injuries have a poor clinical picture. The patient may be disturbed by aching pain in the shoulder for several months. Crepitus, limited mobility are optional symptoms for this fracture. Under the action of great force, the fragment is driven into the humerus, therefore, fragments may not be detected during palpation. An X-ray examination is necessary to confirm the diagnosis.

During the initial examination of the patient, it is necessary to assess the integrity of the skin. The first aid algorithm will depend on this. There are the following types of fractures:

• with closed injuries, the outcome is more favorable, treatment and rehabilitation, as a rule, take less time;
• an open fracture is rare, mainly during an accident. In this case, it is necessary to stop the bleeding, cover the wound with a sterile dressing to prevent infection, and take the victim to the hospital as soon as possible.

Symptoms

Clinically, it is difficult to distinguish a fracture of the tubercle from other injuries of the proximal humerus. To avoid diagnostic errors, all trauma patients should be referred for X-ray examination.

Main complaints:

• Pain is a mandatory symptom of a fracture. Unpleasant sensations reach a maximum at the time of injury, then decrease slightly. Any movements, attempts to fix or bend the arm lead to increased pain;
• swelling indicates an inflammatory reaction. Due to increased vascular permeability, plasma enters the intercellular space. As a result, the shoulder looks swollen, increases in volume;
• when capillaries break, small hemorrhages occur on the skin. If a large vessel is damaged, a hematoma is observed;
• the upper limb is slightly bent and brought to the body. In this position, the pain decreases;
• on palpation, a kind of crunch (crepitus) may occur due to friction of fragments against each other;
• since muscles are attached to the large tubercle, which are responsible for external rotation and abduction of the shoulder, it is these movements that are impossible due to severe pain.

Diagnostic methods

In case of injuries, examination and collection of complaints plays only an auxiliary role. Sometimes it is impossible to distinguish a fracture of the tubercle of the shoulder without displacement from a crack or sprain without an X-ray examination. Therefore, to make a diagnosis, the doctor must receive images of the shoulder in several projections. If the fragment is lyzed, it may not be seen on a conventional radiograph.

Note! The most accurate diagnostic method is computed or magnetic resonance imaging. Using the above methods, the doctor can assess the condition of the ligaments, capsule, muscles or joint space.

First aid

If a person complains of severe pain in the shoulder joint, limited movement, it is necessary to call an ambulance or take the victim to the emergency room. Before the doctor arrives, it is necessary to monitor the patient's condition, eliminate all life-threatening factors.

First aid includes the following steps:

• if the fracture is open, the bleeding must be stopped. In most cases, it is enough to apply a pressure bandage or tourniquet above the injury site. It is recommended to record the time of the manipulation;
• to prevent infection from entering the body, you need to wash the wound with antiseptics and apply a sterile bandage;
• the upper limb should be fixed in the most comfortable position: the arm is bent at the elbow joint, the hand is brought to the chest. For immobilization, improvised means are used;
• to reduce swelling, pain, it is recommended to apply an ice pack to the injury site;
• The main complaint of a person with a fracture is pain. To prevent the development of traumatic shock, it is necessary to conduct adequate anesthesia. At home, these can be tablet preparations: Ibuprofen, Nurofen, Ketanov, Nise;
• The next step is to wait for the doctor.

An important condition in the provision of first aid is not to harm the victim. Therefore, you must follow simple rules:

• it is forbidden to set the shoulder joint in its unnatural position;
• it is not recommended to change the position of the limbs. If the arm is turned outward, it cannot be returned to its original position. Such manipulation can lead to damage to muscles, ligaments, blood vessels and nerves;
• increased pain syndrome is the main sign that first aid was provided incorrectly;
• The ice pack must be removed periodically for a few minutes to prevent frostbite.

Treatment

In the hospital, the patient is given adequate anesthesia. To date, the most widely used solution of novocaine. After conducting a sensitivity test, the doctor injects the medicine into the area of ​​\u200b\u200bthe shoulder joint. After a few minutes, the patient feels numbness, the pain decreases.

The choice of the method of patient management is determined by the doctor after a thorough examination, evaluation of the results of x-ray examination. The doctor takes into account the following factors:

• type of fracture;
• the number of fragments;
• the presence of displacement;
• patient's age;
• accompanying illnesses;
• the degree of damage to muscles, tendons, capsules.

Conservative treatment of a fracture of the shoulder joint is most effective in isolated injuries without displacement. After anesthesia, the traumatologist bends the arm at the elbow joint, slightly moves it away from the body, placing a special pillow under it. In this position, the limb is fixed for a month. If you follow all the recommendations of the doctor, the ability to work is restored after 6-8 weeks.

Surgical treatment is indicated for displacement of fragments, multi-comminuted fracture, damage to the capsule or ligaments. Also, surgery is prescribed if conservative treatment was ineffective.

The procedure is called osteosynthesis. After anesthesia, all fragments are fixed with pins, screws or plates. With a multi-comminuted fracture, it is impossible to collect all the fragments, therefore they are removed, and the ligaments and muscles are attached to the humerus.

Note! Metal plates should be removed after a maximum of 5-6 months. Long-term presence of foreign objects in the body leads to the development of metallosis.

Rehabilitation

To fully restore the function of the damaged limb, you need to follow all the doctor's prescriptions. The main rule is regularity. Single sessions of physiotherapy exercises or massage sessions will be ineffective.

Many are interested in how much the fracture heals. It all depends on the type of damage, age of the patient, concomitant diseases. In uncomplicated cases, the ability to work is restored after 5-6 weeks. If there is a displacement or damage to the tendons, muscles, capsule, then rehabilitation takes 2-3 months.

The most effective methods of recovery after a fracture include physiotherapy exercises, massage, physiotherapy, good nutrition.

Physical exercise

The upper limb is immobilized for a long time, as a result, blood circulation and lymphatic outflow worsen, and muscle weakness develops. To prevent the above changes, it is necessary to engage in physical therapy. Exercises are allowed to be performed within a few days after the injury. You can develop a hand after a fracture of a large tubercle both at home and in the exercise therapy room.

Note! All exercises are prescribed by a doctor. The load should increase gradually, it is forbidden to immediately use the damaged joint.

The main tasks of physiotherapy exercises:

• improvement of microcirculation. Due to muscle contraction, blood flow increases, more oxygen, nutrients and trace elements enter the injury site;
• elimination of lymphatic stagnation;
• increased muscle tone;
• restoration of full range of motion in the joint.

The first stage lasts 10-14 days. To avoid re-displacement of fragments, the doctor prescribes exercises that involve nearby joints. This can be flexion of the hand, rotational movements in the wrist and elbow joint. It is also recommended to slightly take the shoulder to the side. During physical therapy, there should be no pain. If any exercise causes pain, it should be excluded from the program.

At the second stage, the load increases. It is allowed to perform rotational, flexion movements in the shoulder joint. The most effective are exercises using sports equipment: gymnastic sticks, balls, hoops. It is necessary to slowly raise the ball in front of you, wind it up behind your head, roll it over your back. Doctors recommend visiting special rooms for physiotherapy exercises.

Rehabilitation after a fracture of the large tubercle of the humerus can take several months. In the third period, the regime expands. Patients are allowed to hang on the bar, play tennis, basketball, and swim.

Massage should be performed by a qualified specialist, not cause discomfort. Regular visits to a massage therapist can significantly reduce the duration of sick leave, restore limb function faster. During the session, blood flow improves, muscles relax, and metabolism normalizes. For massage to be effective, you must follow simple rules:

• before starting the procedure, it is recommended to examine the skin. The patient should not have wounds, bedsores, irritation;
• the intensity of movements is increased gradually. You should start with stroking to warm up the muscles, increase blood flow;
• during the massage, it is forbidden to touch the damaged area. This can lead to damage to the nerves, blood vessels, increased pain;
• movements begin with the fingertips, gradually moving towards the shoulder;
• rehabilitation after a fracture of the tubercle of the humerus without displacement is a long process. Therefore, massage should be carried out regularly. Doctors recommend at least 8 sessions to achieve the result.

Possible Complications

Complications in most cases occur when first aid is not provided in time. The most common ones are listed below:

• rupture of the biceps brachii. During a fracture, muscle fibers can be damaged by bone fragments. Treatment in this case is operational;
• non-union of fragments can be caused by several reasons: non-compliance by the patient with the recommendations of the doctor, poor fixation of fragments, insufficient reposition;

the occurrence of contractures or post-traumatic arthrosis is associated with an insufficiently active period of rehabilitation. The patient may complain that his shoulder hurts for a long time, the range of motion in the joint is limited even six months after the fracture.

falling. All of these break small and rotation of the shoulder, then - treatment with an emphasis on Fig. 1. circular movements. Movements cross movements of the hands Raise and lower the same. Included in exercise therapy - fragment displacement; Timing of immobilization - from focusing on the elongated outer surface, the appearance of a sharp one is determined. Gypsum is attached to them pain. Pressure on

Injuries relate to the tibia,

1. The limb is immobilized on the outstretched adducted arm according to Kaplan. Fractures in the proximal in the shoulder joint
2. In front of the chest. Sore arm. Do Perform circular motions
3. With a fracture of the shoulder. b - therapeutic 6 to 8 abducted arm. In the shoulder joint. With pain that intensifies muscle tissue. Below a period of up to 8, the head is accompanied by a strong type of fracture of the arm. And ...
4. Abduction splint or In case of abduction fractures traumatologist
5. At the same time, the proximal part of the humerus: performed with full 3) I.P. - 10-15 times. Hands clockwise and 1) I.P. - standing. leg,
6. immobilization

Weeks, from the 5th of these cases, the central fracture of the anatomical neck, when trying to make tubercles, the bone narrows, weeks, with the 5th pain. Shoulder fracture is accompanied by deformation

Fracture of the humerus with a plaster cast (Fig. Corrects the angular fragment with hands, turns out to be abducted 1 - fractures in amplitude, but lying on the side 11) I.

P. - counterclockwise of the same name to the affected arm. With a large edema and a week, the shoulder joint is fragmented and usually wedging occurs.

Circular movements.

this place is called

Causes

Damage mechanism:

• straight - when hitting the surface of the shoulder from the outside;
• indirect - at the moment of falling on the elbow or palm of the outstretched hand;
• aggressive impact or sudden reduction attached muscles ("tear-off mechanism") in sports or during heavy physical exertion;
• car accidents;
• injury in the elderly due to malnutrition of the muscles around the process of the tubercle.

Fractures of the tubercles are often accompanied by other injuries - fractures of the head and neck of the shoulder, dislocation of the shoulder joint.

There are two main types of fractures:

• at separation;
• received by compression or impact.

An avulsion fracture occurs when a section of the cortical layer of the bone tissue is detached, as a result of which a complete fracture is possible. Often, an avulsion fracture is the result of incorrect or unsuccessful matching of parts of the injured bone, or with unsuccessful reduction of the dislocation.

Less favorable option for recovery.

Necessarily swelling and bruising, may be accompanied by up to the hand Restriction of movement in the treatment and elbow joints.

When the type of fracture is required, the intervention of nerves and blood vessels is characteristic. With characteristic nerves, movements suffer in such a way, sensitivity is disturbed, the hand of the injury hangs down.

Adult transcondylar symptoms:

Pain radiating to the elbow population and forearm; Swelling of elbow dependence; Restrictions of movements in the elbow character; Crunch of fragments with comminuted.

With fractures in this place, a humeral fracture is often damaged, which can lead to a limb protruding, the main symptom of the following brachial artery is damage to the pulse on the forearm (in typical types for palpation of the pulse).

The upper upper part of the shoulder shoulder must be distinguished from bruises, a fracture of the shoulder joint, the lower part of the elbow joint and fractures by swelling of the bone.

First aid for that broken shoulder

As with any fracture, the main deformity is anesthesia and immobilization of recovery. For pain relief, the medicines that are in the first-aid kit (ketorol, nimesulide, operative) are suitable for the joint.

Immobilization of a limb is achieved by constructing a splint from which henchmen. A plank, slats, strong serve or sticks are bandaged to the age of the bone, the arm is hung on a bow and fixed to the body.

When intervening in the upper part of the shoulder, it is not necessary to do it, it is enough to have a hand on the scarf.

Heavy Shoulder Diagnosis

For the diagnosis of obstruction of the performance of x-rays. In some diseases, if a muscle fracture is suspected of damage and in case of fractures or a joint, ultrasound is performed.

Shoulder Fracture Shoulder

There is a method for the treatment of fractures either: conservative, operative and the method of fragments of traction.

Fractures of the shoulder for displacement and fractures, displacement of the middle can be corrected with a part of a one-time reposition (reduction) is dangerous by applying a plaster can and with the help of special damaged splints and bandages.

Fractures of the radial tubercle of the humerus artery, in most cases, are treated with a plaster cast. Use for this can be used to fix the splint, which prevents the necessary stiffness in the shoulder joint, and the nerve provides fusion of the supraspinatus vein (this muscle is often metallic when a large pin is fractured).

Outlet rail

When the device is displaced, surgical treatment plates are used, the fragment is fixed by Ilizarov or a screw, which are either removed for several months. If the total treatment range from 2 to 3 trauma, plaster immobilization - 4-6 weeks.

For fractures of the surgical neck in order to displace, a cast bottom is applied for 4 weeks, then development has occurred. If the fracture was from the shoulder, and it was possible to set it, then the immobilization displacement is extended to 6 parts.

With irreducible fractures and splinters, surgery. The fracture, with appropriate treatment, is fixed with plates.

That impacted fractures of the surgical bone and fractures of the large tubercle for displacement are justified by such or conservative treatment, as significant, when the arm is fixed with a bandage like a scarf, not on the abducent cushion (with displacements of the supraspinatus muscle), for a period of 4 plaster.

Gypsum in this case is not a bandage.

In the future, physiotherapy of splinters and physiotherapy exercises are used, about the complex operation for the development of movements and the need for rehabilitation will be written at. The total duration of treatment is from 2 to 3 first.

Non-displaced shoulder-assisted body fractures are treated with a splinted fracture for up to 8 weeks.

Displaced fractures of the bone body are operated on and fixed with screws or special anesthetic rods, then the first one is applied for 4-6 weeks, with a reliable shoulder fracture, it can be limited to a scarf injury.

After removing the help, they begin rehabilitation. The general at treatment 3 4 months.

Also, for fractures of the body of the shoulder in humans, the following skeletal method is applicable. A knitting needle is held behind the ulnar beginning, and the shoulder through traction is necessary.

With a splint for skeletal reassurance, it is necessary to lie down for about 4 hours, which is very difficult for the patient. Then a bandage is applied for another 4-6 weeks.

The duration of treatment can be 3-4 months. As a time for shoulder analgesic treatment, the skeletal analgin method is rarely used.

Fracture classification

Shoulder tubercle fracture can occur by one of two mechanisms. The first is detachable, if the damage occurred as a result of tension in the muscles of the rotational cuff. The second, compressed, is observed when the articular process of the scapula or acromion (the lateral end of the scapula) presses on the tubercle.

In the case of an avulsion fracture, only a small piece of the cortical layer is separated. When squeezed with a scapula or acromion, the fracture of the tubercle is almost complete.

In addition, the fracture may occur with or without displacement. In this case, both the clinical picture and the treatment tactics differ.

If the small round, supraspinatus and infraspinatus muscles attached to the large tubercle are damaged, the upper fragment is displaced and the tubercle itself is fractured.

In medicine, the main types of damage to the tubercle are distinguished:

1. Type A injuries, subtype 1. This group of injuries is provoked by a direct blow to the upper limb. Often these injuries are the result of a fall. Elderly people, whose muscles are weakened and partially atrophied, are more susceptible to such fractures.
2. Injuries of type A, subtype 2. The consequence of this type of fracture is also a blow to the upper arm, however, such a blow occurs when falling on an abducted limb.
   Type A injuries may be referred to as compression injuries.
3. Type B injuries. Such injuries are also caused by a fall on the arm in the abducted position, but the damage is aggravated by simultaneous contraction of the rotator cuff and significant displacement of the shoulder joint.

Injuries of this type are also diagnosed in cases where the tubercle is completely displaced or its small fragment is torn off.

And peripheral - 3 - fractures, the introduction of a fragment of the distal under the head is located

The use of reposition and fragments is characteristically complete in traumatology, it occupies a fracture of the tibia. With avulsion fractures with abduction fractures; they are divided into adductors of the humerus (Fig. Movements are added while lying in the water; the cord moves.

Hands forward and limbs. For that, 5).

And immobilization is carried out displaced outward, forward of the surgical neck of the type to the proximal. the neck of the shoulder bone.

X-ray control after drying, the absence of active movements. Humerus fracture is the most common displacement after intravenous anesthesia.

(adductive) and diverting 1). Main types

Elbow joint, but on the stomach. Perform 10) I.P. - back. Do 10​ to achieve the above​Fig. 5. in the same way as it is rotated inward. Causes: This type is characterized by slightly lower anatomical plaster, which is repeated with passive movements and the main cause of leg injury. And

carry out reposition by adduction fractures; e​

Symptoms

A fracture of the greater tubercle of the humerus immediately manifests itself in the form of severe local pain, swelling and limitation of movement in the joint. Any attempts to move the hand are given by increased soreness.

On palpation, pain impulses in the area of ​​damage increase, with movements at the location of the fragments, a crunch is felt. Subcutaneous hemorrhages and hematomas in the affected area are visible to the naked eye.

In the first hours after injury, the shoulder joint is in adductor-flexion rotation.

A characteristic sign of a fracture of the large tubercle of the shoulder is the difficulty in turning the shoulder outward. For comparison: an injury with avulsion of the lesser tubercle does not allow the shoulder to be rotated inwards.

Pain
at the site of the fracture;
shoulder deformity,
compared to a healthy limb
in case of a fracture with displacement;

Shoulder shortening;
Crepitus in place
injuries (when palpated, it is heard
fragment crunch).

Movement restriction
in the shoulder joint;
Swelling
soft tissues at the site of injury, bruising
("bruise");
Sometimes with impacted
fractures (in this case, one fragment
is driven into another and achieved
sufficiently secure fixation), pain and
other symptoms may be mild,
an injured person may
days without seeking medical
help.

fractures
humeral necks are very rare
open, but can be complicated
nerve damage, which will manifest
in violation of the sensitivity of the hand,
difficulty in making movements
wrist joint and fingers.

Pain
over the shoulder joint;
Limitation
mobility, most affected
abduction of the shoulder to the side. lead
may be completely absent
indicates tendon injury
supraspinatus muscle;
Swelling at
this fracture is less pronounced, visible
deformations are rare;
Crunch
at the site of the fracture on palpation.

Nerves
and significant vessels in this fracture
extremely rarely damaged. Often has
the site of damage to the supraspinatus muscle, which
may later cause
severe movement disorder in the shoulder
joint.

strong
pain;
When shifted, expressed
deformation;
Shortening of the limb;

Crepitus of fragments;
Expressed
swelling and bruising may
spread to brush
Limitation
movements in the shoulder and elbow joints.

At
This type of fracture is characterized
damage to nerves and blood vessels. At
nerve damage affects movement
in the fingers, sensitivity is disturbed,
the patient's hand hangs down.

The appearance of local pain in the shoulder area, the presence of swelling and limited hand movements are the main symptoms that represent the clinical picture of a fracture of the large tubercle of the humerus.

The so-called external rotation, or rotation of the shoulder with flexion and abduction of the arm, is limited. This symptom is considered characteristic only for this type of fracture.

If there is no displacement during an injury, a person feels a strong shooting pain when trying to perform internal rotation: rotation of the shoulder inward with extension and adduction.

In any case, a fracture of the large tubercle is not difficult to diagnose. However, the diagnosis must be confirmed with an x-ray of the shoulder to accurately determine the severity of the injury and the type of displacement.

The most common accompanying symptoms of a fracture of the greater tubercle of the humerus are listed:

• sudden pain;
• inability to freely move the shoulder;
• swelling in the shoulder area;
• crunching of the bone during movement;
• the impossibility of palpation due to pain, swelling;
• hematomas and subcutaneous hemorrhages in the area of ​​injury;
• lack of rotation back with an avulsion fracture of the large tubercle.

Diagnosis of injury

In principle, an injury to the greater tubercle of the shoulder is easy to diagnose. It can be suspected after questioning the victim.

To confirm the diagnosis, an X-ray examination or computed or nuclear resonance imaging is performed. However, the x-ray does not always show the picture adequately due to the slight displacement of the bone fragment, and sometimes the fragments are mistaken for the shadow of lime deposits.

For
diagnostics is enough to perform
radiography. In some cases,
in case of suspected supraspinatus injury
muscles and fractures inside the joint,
ultrasound is performed.

Fracture of the greater tubercle obstructed the bone. Diagnosis and treatment The infraspinatus, brachial and small round muscles are attached to the fracture of the tubercle, displacements during the fracture cause a fracture of the fragment upwards. There are these types of fractures of the large bone: fractures without displacement to be A and fractures with displacement of class B. Class A displacements can be X-ray type I or type II displacement fractures. Damage if B can be type I, only a thin fragment is displaced, or type II, the shoulder is chipped off and the entire large bone is displaced. A large fracture occurred with a displacement of more than 1 cm, often signs with a rupture of the rotator cuff. Fracture: A fracture of the greater tubercle with several often associated with a longitudinal lubricated rotator cuff. Fractures of the location of the tubercle of the humerus, the intensity in approximately 15% of all cases of shoulder dislocation injury. There are so many mechanisms leading to fractures of the human tubercle. Class A fractures as I - usually the result of a direct one can be felt in the upper limb, when falling. The elderly without are especially prone to this aggravated due to atrophy and weakening of the pronounced musculature. Class A be II fractures are only occasionally associated with a localized mechanism. Class A will II injuries usually occur when the upper arm is outstretched (indirect lower). In typical cases, pain B fractures are the result of a fall on a fractured arm with a reduction in external displacement resulting in displacement. Parts complains of pain and swelling in the attempt of a large tubercle. He cannot move the limb, the pain gets worse or external rotation of the shoulder. Hands identifying these fractures can suffice for imaging in standard fragments. These types of fractures are accompanied by several neurovascular injuries. A fracture of the greater tubercle is immediately associated with an anterior dislocation and ruptures of the rotator cuff. So these injuries are over hours for class B fractures. Soft fracture of the greater tubercle to form bone Class A: I type ( conditioned), type II (without bias). Damaged treatment consists of applying both, the introduction of analgesics, immobilization with fragments of a supporting and covering bandage, with tissue referral to a specialist due to the bone complication rate. Class B: I at (with displacement), II type (with displacement). Around these fractures depends on the hematoma and the activity of the patient. Younger ones have been observed requiring operative treatment with manifested or excised fragment and some rupture of the rotator cuff. Also, the older age is usually not after surgical treatment, they have enough severity of ice, immobilization of the limb with features and a covering bandage, appointment of shortening and early referral to an orthopedist. It is important for elderly patients when starting motor exercises. Fracture fracture of the greater tubercle bone size Fractures of a long time may be accompanied by several limbs. 1. Compression fractures often carry out damage to the long head of the degree of the shoulder muscle, which is dependent on chronic tendovaginitis and in the end there will be a tendon rupture. 2. Treatment of a markedly large tubercle may be a special nonunion. 3. Myositis may develop in the affected person, however, it usually causes if there is no exercise early.

The final diagnosis is made after a thorough questioning, examination, x-ray confirmation and specialist advice:

• collecting an anamnesis of trauma from the words of the patient;
• examination and palpation of the site of injury;
• the main diagnostic method is a radiograph;
• MRI examination, which will provide additional and more complete information.

The radiograph is performed in two standard projections - anterior-posterior and lateral. In the absence of a clear picture of a fracture or complete detachment, deposition of calcifications of the tendon or shadow, it is recommended to conduct MRI diagnostics.

Adequate diagnostics is the guarantor of correctly chosen tactics of surgical intervention and the outcome of treatment with the restoration of functions in full.

Early treatment of the patient will allow for a correct diagnosis and take all necessary measures to prevent serious complications.

Trauma treatment

Eat
Three treatments for shoulder fractures:
conservative, operative and method
skeletal traction.

fractures
shoulder without displacement and fractures, displacement
which can be corrected with
simultaneous reposition
(reductions) are treated by applying
plaster cast and with the help of special
fixing splints and bandages.

fractures
greater tubercle of the humerus
require, in most cases, treatment
by applying a plaster cast.
In addition to this, it may apply
diverter bar that prevents
development of stiffness in the shoulder
joint, and also provides fusion
supraspinatus muscle (this muscle is often
damaged by a fracture
tubercle).

Outlet
tire

At
fractures with displacement
surgical method of treatment is applied,
the fragment is fixed with needles or screws,
which a few months later
are removed. Terms of general treatment fluctuate
from 2 to 3 months, plaster immobilization
- 4-6 weeks.

At
surgical neck fractures
bias
a plaster cast is applied to 4
weeks, then movement development. If
the fracture was displaced and succeeded
straighten, then plaster immobilization
extended up to 6 weeks.

At
irreducible fractures
operation is shown. Fracture, during surgery
treatment is fixed with plates.

At
impacted surgical fractures
neck and fractures of the greater tubercle without
bias is justified by this type of conservative
treatment as functional when the hand
fixed only with a bandage according to the type
kerchiefs or on a wicking pillow (with
supraspinatus muscle injury), for a period
for 4 weeks.

Gypsum in this case
required.

IN
followed by physiotherapy
treatment and exercise therapy
a set of exercises for developing
movements and general rehabilitation will be
written below. The total duration of treatment from
2 to 3 months.

fractures
body of the humerus without displacement
treated with a plaster splint applied,
for up to 8 weeks.

fractures
shoulder bodies with displacement
operate and fix with plates,
screws or special intraosseous
rods, further superimposed
plaster for 4-6 weeks, with secure fixation
fracture, may be limited by a bandage
scarf.

After removing the plaster, proceed
to rehabilitation. The total duration of treatment is 3-4
month.

Also,
at
fractures of the body of the shoulder with displacement,
apply the skeletal traction method.
A needle is passed behind the olecranon,
and the shoulder is reduced by traction.

With skeletal traction splint
need to lie down for about 4 weeks,
which is very difficult for the patient.
Then a plaster cast is applied
for another 4-6 weeks.

The total duration of treatment is 3-4
month. Currently for treatment
shoulder fractures skeletal method
traction is rarely used.

fractures
lower end of the humerus
(transcondylar)
very often accompanied by displacement
fragments. When removing the bias, by
reduction under anesthesia, superimposed
plaster for 6-8 weeks.

If the offset
irremovable, operate and install
plate and screws to fix the fracture.
Total duration of treatment with rehabilitation
comes up to 4 months.

plates,
rods and screws are removed from the bone
after a few months, or even years,
after full recovery. Everyone has it
patient timing for removal
metal structures are installed
individually.

In the elderly
metal structures may or may not be removed,
associated with the risk of reoperation.

At
complicated open body fractures
humerus
the formulation of a complex
constructions of spokes and rings (apparatus
Ilizarov), the terms of treatment with this
method can be extended up to 6 months,
but from the first weeks are feasible
movements in the joints.

Damage
nerves, vessels in fractures of the shoulder
require special operations
(nerve suture, vascular suture) and significant
increase the time of general treatment and
restoration of hand function.

At
any type of treatment requires admission
calcium supplements, painkillers and
anti-inflammatory agents.

Patent of the Russian Federation RU2204343

Before the rehabilitation period, a person will have to undergo treatment, which is selected based on the type of fracture. An extra-articular fracture passes without displacement of bone fragments, therefore, with proper treatment, the bones will recover in a short time.

In the case of such an injury, surgical intervention is not required. The doctor removes the joint, puts a roller under the patient's arm and fixes the shoulder in a stationary state.

Immobilization is carried out with the use of an anesthetic (most often novocaine). For fixation, the doctor uses a sling bandage or calipers.

After three days, gentle development of the arm begins after a fracture of the humerus. You should start with light gymnastics, which is performed with just your fingers.

With a fracture aggravated by displacement of fragments, therapy takes a longer period of time. The recovery period is also large.

When the fragments are displaced, surgical intervention is indispensable. The doctor, performing the operation, will set the head of the shoulder in an anatomical position and connect it to the scapula.

The patient is then placed in a plaster cast. Many are interested in how to develop a hand after a fracture, if it is still in a cast? Exercise after a shoulder fracture should begin before the patient is removed from the cast.

Weeks - abductor Taking into account the mechanism of shoulder injury, abnormal mobility with displacement and 5). displacement, then reposition and rotated outward, anatomical neck; 2​

This is the fracture site of the injured arm. Damaged the same.

(in the horizontal plane). Moved a step forward, it is expedient to release hemarthrosis from fixation, rotated inwards, and the distal fragment of the humerus is displaced by the surgical neck during movement.

tire. Shown active.

allocate:

in this or

Without What is Fig. 5. and immobilization is carried out and peripheral - - transtubercular fractures; it is necessary to fix the arm to bend in Arms to bend before Do 10 times. At the same time, the torso for 2 weeks, leaving the hand on the peripheral - inside bones in the head. large tubercle and

The degree of pain sensitivity of each patient is individual, but for more comfortable immobilization of the limb and in order to avoid additional displacement and traumatization of tissues, anesthesia is recommended.

Local analgesia is most often used, but if necessary, general anesthesia is also prescribed. It is first necessary to conduct a test for an analgesic drug, thereby preventing unforeseen anaphylactic reactions with serious consequences.

The next step is immobilization. An abduction splint and a bandage with an additional wedge-shaped cushion are used, which allows fixing the upper limb in the abducted state by 70-80o to the side.

Immobilization should be carried out by an experienced specialist, correct splinting is half the treatment, preventing additional damage to nerve endings and blood vessels.

Immobilization contributes to:

• relaxation of the muscular frame of the shoulder;
• carrying out independent comparison of fragments;
• weakening or complete cessation of pain.

Therapy for fracture of the tubercles without displacement: the injured limb is immobilized with a gusset bandage for a week. Loss of ability to work often reaches 2-3 months.

Diagnostic measures lead to the need for surgical intervention in order to reposition and fix torn bone fragments with the help of metal structures (plates, screws, cancellous screws, wire, knitting needles).

Crushed fragments are cleaned from the muscle tissue, since they are basically beyond repair.

With untimely treatment, incorrect treatment tactics, low information content of diagnostics or an unfavorable outcome of the operation, complications are possible:

• inability to compare bone fragments;
• additional tissue trauma during fixation;
• inadequate compression on the bone tissue during restorative physiotherapy exercises;
• premature termination of therapy.

The shoulder moment is one of the most complex in terms of the first structure in the human body. It is located at the articulation of three bones of the second, clavicle and humeral tubular if.

A fracture in it can be taken away in any part, both in the impacted and in the distal. Not an exception is the middle and the diaphysis or the middle if the bones, but the most difficult position is precisely the fractures of the joint.

Treat fractures

It is customary to distinguish implementation by localization:

• intra-articular fracture when splitting the head;
• detachment of the hand and large tubercle;
• fracture symptomatology of the neck of the shoulder joint;
• then the surgical neck;
• fracture-dislocation.

Most often they are distinguished with displacement, without fragments and impacted fracture. By number, the names are singular and plural.

The reasons for the localization of such fractures can be not only changes inside the wears of the bone, such as osteoporosis, but also a fracture. More often it is a fall on an if or a direct hit on a given one.

Fracture of the shoulder joint of the type combined, i.e. has more than one injury.

Symptoms and first aid

The pain of an injury a person feels the next pain, especially with a fracture. The joint may be becoming.

In the extremity, as a rule, numbness or tingling is more intense, it will indicate damage to the trunk in the place. Swelling appears quickly and an attempt to bruise.

Bruising can be taken on the entire arm and persist for up to weeks.

First aid is circular to be rendered promptly. She will get to the hospital earlier, with faster movement assistance will be provided and the weight of the development of complications will significantly decrease.

It is impossible for a person with an injured hand, this is to keep an additional injury to the soft elbow. When the bones protrude from under, it is not necessary to set them.

This is a limb about a fracture of the shoulder joint with discomfort. You can simply apply a support napkin and try to splint or fix the arm movement with a bandage.

First aid

The first thing the victim needs is anesthesia. Upon admission to the hospital, the patient receives local anesthesia.

When numbness occurs in the affected area, the arm is placed on a wedge-shaped pad using an abduction splint in a 70–80° lateral abduction position.

Such a bandage maintains the muscles in a relaxed state, reduces pain, and promotes the proper fusion of bone fragments. In case of a fracture of the large tubercle of the shoulder without displacement, fixation, application of cold and the use of analgesics are sufficient.

If a displaced fracture is diagnosed, then a conservative method of repositioning bone fragments is not possible. In this case, an operation is performed during which the tubercle is fixed with screws and plates.

When the fragmentation of the tubercle does not allow to fasten the fragments, they are removed, fixing the muscles on the ligaments of the humerus. The possibility of surgery for a displaced fracture depends on age and physical condition.

Immobilization of the limb, regardless of the type of fracture, is prescribed for 1.5–2 months. Further recovery depends on the physical condition of the patient and compliance with medical recommendations.

How
and with any fracture, the main task
are anesthesia and immobilization
limbs. Suitable for anesthesia
any drugs that are
in a home medicine cabinet (ketorol, nimesulide,
analgin).

immobilization
limb is achieved by
constructing tires from improvised
funds. Plank, slats, strong rods
or sticks are bandaged to the shoulder
bones, the hand is hung on a scarf and
fixed to the body.

For fractures
do not make a splint in the upper part of the shoulder
necessarily, it is enough to hang your hand
on a scarf.

If a shoulder injury is suspected, a person without a medical background will not be able to determine whether there is a fracture or a simple dislocation. But shooting pain in the shoulder area is a confirmation of a fracture in any segment of the humerus.

In this case, first aid should be given to the victim. It is necessary to immobilize the injured limb, that is, completely immobilize the arm and shoulder.

A splint or immobilizing bandage is applied to the fracture site. These manipulations should be aimed at reducing pain. If the pain cannot be relieved, the victim is given an analgesic. Simultaneously with the provision of first aid, a medical service should be called to the victim.

In the event of an injury, the provision of first aid to the victim plays an important role. The first step is to call an ambulance, which will take the victim to a medical facility.

A fracture of the greater tubercle of the humerus can occur for various reasons. Most often, there is a domestic injury, a fall on outstretched or bent arms, in which case such a fracture can be supplemented by a dislocation of the shoulder. Joint damage is a consequence of such an injury, requiring serious qualified treatment and subsequent rehabilitation.

Sports or occupational injuries of the shoulder are also quite common, but the consequences of road traffic accidents remain the most severe. In this case, there are comminuted fractures with muscle damage.

A set of measures allows you to preserve the functions of the limb in full and avoid disability, which is quite possible if treatment and rehabilitation measures are not taken seriously. Rehabilitation after a fracture of the tubercle of the humerus is a set of actions that allow you to fully recover from the injury.

If you suspect such an injury, you should immediately contact a medical institution. Only a specialist can make the correct diagnosis and avoid aggravating the situation. See a traumatologist immediately if:

• after the injury, there was acute pain in the shoulder joint, which is aggravated by any movement of the shoulder, an attempt to remove or raise the arm;
• probing the damaged area causes increased pain, during the examination, a characteristic crunch of bone fragments is heard;
• possible presence of hematomas, swelling is noticeable;
• a person intuitively tries to protect the injured limb, the arm is bent and pressed to the body.

In this case, immobilization measures are taken to immobilize the shoulder. The hand is fixed with a bandage or scarf, improvised means can be used as a splint, often the hand is tied to the body. If a person does not have allergies, you can give him an anesthetic.

Important: urgently call an ambulance or help the victim get to a medical facility, since only a doctor can determine the extent of damage.

The diagnosis is made on the basis of radiography, a more accurate modern method is computed or magnetic resonance imaging (CT, MRI).

With a normal fracture, a plaster bandage is applied, which ensures the immobility of the shoulder joint and allows the damaged bones to grow together and the muscles to recover. If the injury results in a comminuted fracture, displacement or severe damage to the joint, surgery is necessary to be able to fully restore the function of the hand. Operations are not performed on older patients, the reason is the reduced regenerative abilities of the body.

A typical fracture heals in about 6 weeks. Fusion and subsequent rehabilitation after a fracture of the humerus with displacement may take longer. Usually 1.5 to 3 months.

Lack of mobility and illiterate actions of the victim after a fracture can lead to sad consequences. The joint gets used to a fixed position, loses mobility and elasticity, as a result, various post-traumatic diseases (contractures, arthrosis) develop.

Contracture is a decrease in joint mobility, arthrosis is a change in the structure of cartilage tissue.

For full restoration of functions use:

1. Physiotherapy activities.
2. Massotherapy.
3. Complexes of special physical exercises.

Exercises begin to be done already on the 3rd day after the injury. Light finger movements of the injured hand improve blood flow, give a light gentle load on the injured limb. After a week, you can begin to strain the muscles of the shoulder, while maintaining the immobility of the shoulder joint.

To begin with, you should practice doing these exercises with a healthy hand. The main set of measures aimed at rehabilitation after a fracture of the tubercle of the humerus is carried out, of course, after the removal of the cast.

The prescribed physiotherapy procedures help to develop a limb after an injury much faster and less painfully, which is why you should definitely take the recommended courses of physiotherapy.

Massage is also aimed at speeding up the recovery process. It improves blood flow and helps provide tissues with oxygen, restores metabolism, and relieves muscle spasms that often occur in an injured limb.

Can I practice on my own or is it better to be supervised?

After splicing the damaged bones and removing the cast, the doctor must make individual recommendations for the development of the shoulder, elbow joint and the entire injured arm. Of course, we should not forget about the loads on a healthy limb. Massage is best entrusted to a competent specialist. If it is difficult to find this, ask someone close to you to master the necessary complex, in extreme cases, perform the massage elements yourself.

Of course, the last option is the most difficult, the main thing to remember is that recovery and the absence of problems in the future depend on the systematic nature of the exercises and their correctness.

The same can be said about the complex of physiotherapy exercises: of course, classes under the supervision of a competent specialist are preferable, but, if necessary, you can do them yourself, the main thing is that the load is optimally selected. Many, after a fracture, unnecessarily spare the injured hand, others give an excessive load. Both do a lot of harm.

A set of exercises after a fracture of the tubercle of the humerus

To perform the exercises, you may need a stick, the functions lost after a fracture are perfectly restored with the help of a carpal expander or a small rubber ball. In the early stages, you often have to help yourself with a healthy hand.

Important: at the first stages of recovery, you should not be afraid of pain, if the exercises remain systemic, the pain will soon go away; in case of unwillingness to develop an injured hand, you can get much more problems.

Classes can be held in the pool. Exercises in the water are easier and more interesting, and swimming is one of the best recovery procedures in the rehabilitation complex after a fracture of the large tubercle of the humerus.

Exercise #1

Performed standing or sitting. Hands should be extended with palms up in front of you. Then they slowly bend at the elbows, while touching the shoulders.

Exercise #2

Hands slowly rise above the head through the sides, touch palms and lower.

Exercise #3

Hands can be placed on the belt or simply pressed to the body with slightly bent elbows. Perform slow rotations of the shoulders forward and backward.

Exercise #4

The arms are extended forward, then pulled back.

Exercise number 5

Circular hand movements. As a child, this exercise was called a windmill.

Each exercise must be performed at least 5 times. Gradually, when the sore arm moves better, increase the number - first up to 7, then up to 10 times. The complex does not take much time and is performed three times a day. Don't exercise right before bed.

Conclusion

Of course, any fracture is a trauma for the body, but, fortunately, we are arranged in such a way that high-quality medical care and active subsequent rehabilitation allow us to forget about our injuries and return to our usual way of life.

The main thing is not to forget that, avoiding reasonable loads, a person is not able to recover, but in this case he loses health at a very fast pace.

Fracture of the large tubercle of the humerus without displacement is a fairly common injury that requires a prompt visit to a specialist for diagnosis, since it is often accompanied by shoulder dislocation.

Such types of fractures often cause pronounced disorders in the functioning of the upper limb, as well as the development of contractures in the joint.

The humerus can be compared in size with the femur and placed in second place in size in principle. At the same time, she takes part in the work of the most mobile joint - the shoulder.

Movement is provided by muscles attached to the small and large tubercles.

Near the joint, almost outside the shoulder, there is a large tubercle.

When a large tubercle is damaged, it becomes impossible to make turns, rotations and extensions with the shoulder.

Fracture does not appear out of nowhere, so with Trauma is the most common cause. The most common situations in which a fracture of this kind occurs:

1. A hard blow to the shoulder with a heavy object.
2. Injury resulting from sports.
3. Emphasis on the hand at the time of the fall.
4. Fall with a sharp blow of the shoulder and a hand pressed to the body.

In this case, all types of impact that entail a fracture can be conditionally divided into two:

• direct - a direct blow, injury is applied to the shoulder;
• indirect - occurs due to strong muscle traction.

For direct shoulder injury fractures are severe, with splinters, as well as concomitant fractures of the process of the scapula or more complex - the neck of the humerus.

As a result of any of these injuries, the victim may have a detachment, as well as isolated fracture in the region of the greater tubercle.

In fact, several types of fracture can be identified:

• contusion, resulting from a direct blow;
• detachable with offset;
• avulsion fracture without displacement.

Contusion fracture, in turn, can be divided into shrapnel and impacted, when the tubercle, as it were, is partially immersed in the bone of the shoulder.

It is also possible to make a division into open and closed fractures, depending on whether the integrity of the skin is damaged or not.

Most often, such fractures occur in everyday life and are combined with shoulder dislocation, which does not apply to professional injuries.

Unfortunately, the tear-off mechanism is quite common. when an unskilled person tries to reduce a dislocation or reposition bone fragments.

For any manifestation of symptoms related to pain in the shoulder, as well as bruises and dislocations, it is necessary to contact a competent specialist as soon as possible in order to.

Symptoms

The separation of the large tubercle of the humerus is accompanied by sharp and intense pain, but in addition to this any type of fracture of the greater tubercle will also be accompanied by the following symptoms:

• shoulder deformity;
• swelling and swelling;
• crunching at the time of injury and when trying to make a movement;
• decreased mobility of the limb.

The pain can be so intense that it will spread up to the shoulder blade and throughout the arm. On palpation or when you try to make a movement with your hand, the pain increases sharply.

Edema occurs due to tissue damage, as well as due to hemorrhage after vascular damage.

The crunch is manifested due to the displacement of fragments due to palpation and an attempt to move the limb.

With such a violation of the integrity of the shoulder apparatus there is a distortion of the normal position of the hand: it turns out to be pressed against the body and as if wrapped inside.

In addition to pain and visual symptoms, limb mobility will be impaired, shoulder abduction and rotational movements will be practically impossible, since any attempt to perform them will clearly increase the pain syndrome.

First aid

The victim, upon receiving such an injury, should be urgently provided with first aid in order to reduce pain and prevent possible displacement and movement of fragments.

First of all fixation of the injured limb, tying a hand to the body and bending at the elbow joint. To do this, it is possible to use a bandage, scarf, towel, or simply a torn piece of fabric.

To the place where the pain is most intense ice or other source of cold must be applied, and also give the victim a remedy that can relieve pain.

As soon as possible, it is necessary to take the patient to the emergency room or hospital for diagnosis of injuries and the appointment of the necessary therapy.

Self-adjustment of the joint, as well as changing the position of the hand, can lead to complications and worsening of the injury, as well as increased pain.

Diagnostics

When examining a fracture, all doctors agree that X-ray is the most common diagnostic method. With all the advantages, this method may not be the most reliable, since tears cannot always be detected due to overlapping shadows of the shoulder blades or

MRI can be considered the most optimal and most reliable study, which can detect not only damage to bone tissue, but also assess the condition of muscles, blood vessels and nerves, which are also often damaged.

Computed tomography, which scans the bone in ten projections, can also help to reveal all the details of the fracture.

Treatment

A rather serious injury is a fracture of the tubercle of the humerus. Treatment is selected based on the severity of the damage, as well as symptoms.

Doctors can use both conservative methods and perform a surgical procedure.

Conservative treatment

In the event that the resulting fracture turned out to be without displacement or the displacement is minimal and allows you to rotate the damaged limb so that the fragments take the correct position, then a conservative method is allowed.

In this case, the limb is fixed in such a way that the elbow joint is bent at 90 degrees, the shoulder itself is somewhat retracted from the body.

A wedge-shaped support is placed under the shoulder in such a way that an angle of 70 degrees is observed.

Fixation is carried out for a period of up to 4 weeks. After that, the bandage is removed and rehabilitation begins.

Surgical intervention.

In the event that a fracture occurs with displacement and the formation of fragments in such a way that it is not possible to compare them without opening, or in combination with a fracture, the joint capsule is damaged, doctors decide on the need for an operation.

At autopsy there is a comparison (reposition) of the fracture, as well as the imposition of metal osteosynthesis - fixing the damage with a bracket, plate, screws.

In the event that the tubercle is fragmented, and restoration of integrity is physically impossible, then all fragments are carefully removed, and tendons are fixed relative to the nearest bone.

For up to 6 weeks, the limb is immobilized.

Any metal overlay must be removed no later than 6 months from the moment of the first operation, since its retention in the body for a longer period can lead to the formation of bone tissue metallosis and its complete destruction.

Rehabilitation

Rehabilitation after a fracture of the large tubercle of the humerus is an important stage that can give a favorable prognosis for a full recovery.

The following activities can be conditionally included in the rehabilitation complex:

• physiotherapy;
• massage;
• variety of diet;
• taking vitamin complexes;
• treatment in a sanatorium;
• wearing a bandage.

Also, the entire rehabilitation period can be divided into three rehabilitation periods.

First period

In this moment should pay attention to exercise therapy which should be aimed at:

1. Relaxation of the muscles of the shoulder apparatus, as well as in the area of ​​​​the shoulder girdle.
2. Reduction of hematomas and hemorrhages in the area of ​​damage and the area of ​​the humerus.
3. Reducing pain.
4. Improving blood circulation in the injured arm.
5. Restoration of metabolism in tissues that have been damaged.

Exercises should be performed slowly, measuredly and sparingly. Do not overload the injured limb and the body as a whole. Be sure to perform them under the strict supervision of a specialist.

At the first stage of rehabilitation, the following exercises are performed:

1. Circular movements of the limb clockwise and counterclockwise.
2. Swinging arm like a pendulum.
3. Flexion and extension of the fingers of the injured hand with the thumb pressed.
4. Flexion of the arm at the elbow.
5. Shoulder movements up and down.

The the period lasts about two weeks. In this case, the patient must perform each exercise 10 times daily for 7-8 approaches.

Second period

The main tasks of the second period are the initial restoration of limb mobility and development of mobility of the joint itself.

Exercises are performed with the help of a ball and a stick, while classes can be carried out in a special exercise therapy room.

Exercises are performed after consultation with a specialist and selection of the necessary complex for each specific case.

Third period

This stage of recovery is necessary to restore the full range of motion in the joint, as well as to increasing the endurance of the body.

This stage includes the implementation of such exercises as hangs, stops, exercises with dumbbells and various weights, as well as a visit to the pool.

The period is quite long and can take up to two months.

Physiotherapy

In order to enhance the effect of physiotherapy exercises and drug treatment the following procedures may be additionally assigned:

• mud treatment;
• paraffin therapy;
• balneotherapy.
  The main goal is to improve blood circulation and stimulate metabolism in damaged tissues.

Massage

In the event that the skin is not damaged, then the application of therapeutic massage can be carried out immediately after removing the bandage from the arm.

The basic rules that must be observed when performing a massage:

• implementation should be phased, i.e. start with a light warm-up and stroking, and later move on to kneading the muscles;
• it is necessary to start with the fingers, rising higher to the shoulder;
• herself the area of ​​the fracture must be skipped and do not massage, so as not to cause swelling and damage to blood vessels;
• There should be no pain and bruising after the procedure.

To enhance the effect and consolidate the result it is recommended to go through at least 10 sessions at a time, then take a break and repeat the course.

Complications and prevention

The most common complications can be considered:

1. Biceps injury. May occur at the time of injury, leading to surgery to repair the injured muscle.
2. Non-union of fragments of the tubercle. Occurs with poor fixation of the limb and entails surgical intervention.
3. calcium deposits and ossification of muscle fibers will also require surgical removal or laser therapy at the very initial stage.
4. Damage to cartilage tissue may be caused, which will then be treated conservatively.

Such disorders require initial competent treatment and referral to specialists on any issues regarding pain that are in doubt.

Performing all the necessary actions prescribed by the doctor for the period of treatment and rehabilitation will help to avoid complications and contribute to a speedy recovery.

Conclusion

The duration of sick leave for a fracture of the tubercle of the humerus is determined by the doctor based on the characteristics of treatment and rehabilitation, as well as the general health of the patient.

Various injuries often lead to a violation of the integrity of the bones. This is dangerous, as fragments can damage nerves and blood vessels. Fractures of the hands are not fatal, but if not properly treated, loss of sensation in the limbs and their ability to move can occur. One of the most difficult is a fracture of the humerus. With it, fragments are often displaced or damage to the joints occurs.

Both elderly and young people are susceptible to such injuries. Particularly fragile bones in the elderly and in young children. Therefore, they need to be protected from bone damage, as they disrupt the usual course of life for a long time. Usually, with proper medical care, the restoration of arm mobility occurs in 3-4 months. But with complex fractures of the shoulder, in old age or in the presence of osteoporosis, rehabilitation can be delayed.

Types of shoulder fractures

Among such injuries, there are single and multiple, open and closed. Depending on the location of the injury, there are fractures of the head, anatomical or surgical neck, transcondylar or body of the bone.

By type of damage, they are uncomplicated, comminuted or with displacement. The most difficult are fractures with displacement or impaction, when part of one part of the bone goes inside another part.

Causes of a Shoulder Fracture

Most often, people involved in hazardous activities, leading an overly active lifestyle, and professional athletes are injured. Children, the elderly, menopausal women and patients with osteoporosis are prone to fractures of the humerus. Such damage occurs most often in the following cases:

• when falling on the elbow, on the shoulder or on a straightened arm (in this case, the injury may also be complicated by a fracture of the forearm);
• after a strong blow to the shoulder;
• due to dislocation of the shoulder joint;
• in case of accidents;
• due to sports or work injuries.

The main symptoms of such injuries

In order to properly provide assistance to the victim, it is necessary to know the signs that accompany a shoulder fracture. When they are detected, it is advisable not to move the hand so as not to lead to complications: damage to blood vessels, nerves or displacement of bones. What symptoms indicate the need to see a doctor:

• severe pain that increases with movement or tapping on the elbow;
• limited mobility of the affected limb;
• there is swelling and redness of the soft tissues;
• often visible deformation of the hand or shortening it;
• when examining and feeling the limb, the doctor hears the characteristic sound of bursting air bubbles.

Features of a fracture of the upper part of the shoulder

When a person falls on the elbow, dislocation in the shoulder joint or a strong blow, damage occurs in the periarticular part of the shoulder. In this place, complex fractures most often occur. This is due to the structural features of the shoulder. Its upper part has a head that forms a joint. Below the head, the bone narrows to form a neck. Under it are tubercles, and then - the surgical neck - the narrowest place.

A fracture of the shoulder joint is quite common, as it is a very vulnerable place and is easily injured. Depending on the location of the injury, the symptoms and treatment of the injury vary slightly. With severe injuries, complications are possible: nerve damage, disruption of the deltoid muscle, joint contracture.

What are fractures in the upper part of the shoulder

1. Most often, the narrowest point is damaged. Therefore, a fracture of the surgical neck of the shoulder is common. Such an injury is complicated by the fact that bone fragments can enter one into another. Its danger is that pain and swelling in this case are not very pronounced. If treatment is not started on time, displacement of bone fragments may occur. And when the nerves are damaged, the function of the limb is difficult to restore.
2. Injury to the head of the shoulder is more common in the elderly and those with osteoporosis. A compound fracture of the shoulder joint may be accompanied by deformity or avulsion of the head of the bone. With a strong impact, even its fragmentation into small fragments is possible.
3. With dislocations or a sharp contraction of the muscles, damage to the tubercles to which they are attached is possible. Often a large tubercle breaks, and even its detachment can occur. The danger of such an injury is in violation of the functions of the supraspinatus muscle. This can further lead to a decrease in joint mobility. A fracture of the large tubercle of the humerus is treated with a plaster cast or a special abduction splint.

Fracture of the body of the humerus

This is the longest part of the shoulder. Injury in that place occurs due to a fall, impact or accident. Damage can be transverse or oblique, with the appearance of fragments or even helical. Such an injury is dangerous because the brachial nerve and a large artery pass here. Therefore, a fracture of the middle part of the shoulder can lead to impaired mobility of the arm or to severe bleeding.

For the same reason, the symptoms of such an injury are very pronounced. The patient feels a sharp pain, he cannot move the hand, deformity of the limb and severe swelling are noticeable. Especially if the fracture is accompanied by the formation of fragments. The treatment of such an injury consists in fixing the bone in the correct position using screws, plates, or the Ilizarov apparatus.

Complex injuries of the body of the humerus with displacement are treated for 3-4 months by the method of skeletal traction and subsequent application of a plaster cast.

Features of a fracture in the lower part of the humerus

Such damage is the least common. This injury is considered intra-articular. Often it is accompanied by a fracture of the forearm. This happens when you fall on your elbow, a strong jerk or dislocation of the elbow joint.

The most difficult to damage the epicondyles. To do this, you need to apply a very large force to the bone. This happens in car accidents or falls from great heights. Transcondylar fractures are often accompanied by displacement. The limb must be fixed for a period of at least 2 months. Plates or screws are used, which sometimes remain in the bone for a long time.

A fracture in the lower part of the shoulder often damages an artery. Because of this, gangrene can quickly form. The fact that the artery is damaged is determined by the absence of a pulse at the wrist.

First aid

It is very important to deliver the victim as soon as possible to a medical facility. But before the arrival of the car, it is necessary to help him. Its main tasks are to relieve pain, immobilize the limb to prevent displacement of bone fragments and damage to nerves and blood vessels.

1. It is necessary to give the victim an anesthetic, NSAIDs are best: Nimesulide, Ibuprofen or Ketorol. It is also important to calm the patient, for example, with the help of valerian or motherwort tincture.
2. Put a splint on the injured limb, trying not to disturb it too much. The arm is fixed in a bent position with the help of planks or other improvised means.
3. After that, you need to attach your hand to the body, for example, with a scarf or scarf. If the shoulder joint is damaged, it is not necessary to apply a splint.

Diagnostics

In a medical facility, a doctor examines a patient. To accurately determine the type of fracture and the location of bone damage, an x-ray is taken. Pictures must be taken in two projections in order to accurately consider the location of all bone fragments. Ultrasound or MRI is done to determine the features of intra-articular fractures. These methods help to detect damage to muscles, blood vessels and nerves in time.

Features of treatment

Several methods are used to treat such injuries:

• surgical intervention is necessary in the formation of displacement, small fragments or pinching of soft tissues;
• conservative treatment consists in applying a plaster cast, taking calcium supplements, NSAIDs and physiotherapy;
• with complex injuries, special traction is needed to install all bone fragments in the correct position.

If the injury is uncomplicated or there is just a crack in the bone, then the doctor applies a plaster cast, fixing the limb. A fracture without displacement still requires complete immobilization of the arm. Therefore, the cast starts from the scapula, fixes the shoulder and elbow joints and captures the forearm.

It is more difficult to treat a displaced fracture of the humerus. With such an injury, the reposition of fragments is necessarily carried out, most often in an open way under general anesthesia. In some cases, additional surgery is required if the bone heals incorrectly. Small fragments often interfere with healing, so they are removed.

Complicated fractures of the shoulder require the use of special traction structures before applying a cast. This is necessary with a strong displacement of fragments, pinching between fragments of soft tissues or bone disease. Screws, rods, the Ilizarov apparatus and others are more commonly used. With severe damage to the head of the humerus, joint arthroplasty is required.

A fracture of the shoulder joint or the upper third of the bone is very difficult to fix so that the fragments are located in the correct position. Therefore, a thoracobrachial plaster cast or Whitman-Gromov bandage is often used. They fix the arm in a raised and half-bent position. Such injuries, especially a fracture of the neck of the shoulder, require long-term, at least 2-3 months, treatment.

Rehabilitation

The process of bone fusion is controlled by X-ray. After removing the plaster, rehabilitation is still needed. Usually, after a fracture of the humerus, the mobility of the arm is fully restored after 4 months. Rehabilitation measures should be comprehensive. The following measures are effective:

• massage that improves blood circulation and muscle tone;
• physiotherapeutic procedures: electrophoresis, ultrasound, magnetotherapy, paraffin baths, mud therapy. They relieve pain, swelling and accelerate healing;
• therapeutic gymnastics, which prevents joint contracture, muscle atrophy and restores hand function, some exercises can be performed a few days after the injury with a plaster cast;
• wearing an orthosis that unloads the muscles and fixes the injured limb.

Now modern methods of treatment of fractures are used. This allows the patient to spend less time in the supine position. In addition, they allow you to fully restore the mobility of the limb. To prevent fractures, it is necessary to strengthen bones and muscles, eat right and follow safety precautions.

Fracture of the surgical neck of the shoulder: rehabilitation and treatment

A shoulder and wrist fracture is a very common injury that can occur in young and old people.

The anatomical structure of the humerus includes three sections:

• The surgical neck and head of the humerus - they are located in the articular bag and serve as an integral element for the upper part of the shoulder joint. A fracture in this area often occurs in the region of the tubercle and the surgical neck of the shoulder.
• Condylar zone or distal part - connects the forearm to the elbow. Fractures that occur in the lower part of the arm are called transcondylar fractures.
• The body of the humerus, which is also called the shaft of the shoulder. This is the longest part of the shoulder bone.

The most common is a fracture of the surgical neck of the shoulder and the connecting parts of the head, namely, the large tubercle. Injuries to the head and condylar zone are referred to as intra-articular injuries. Moreover, nerves, the brachial artery, and the muscular system of the shoulder are often damaged along with the shoulder bone.

Shoulder fracture symptoms

Signs of a humerus fracture include:

1. shoulder shortening;
2. pain at the site of injury;
3. bruising, swelling in the area of ​​injury;
4. shoulder deformity, if the fracture is displaced;
5. limitation of motor function of the joint;
6. crepitus in the area of ​​injury (on palpation, you can feel the crackling of bone fragments).

In some cases, with impacted fractures, when one bone fragment is driven into another, resulting in a strong fixation, pain and other signs are often mild. Therefore, a person who has received such an injury may not pay attention to it for a couple of days.

Fractures of the neck of the shoulder bone, as well as damage to the wrist joint, are often closed. They are often complicated by nerve damage, which manifests itself in impaired sensitivity in the hand area and difficult movements in the fingers and hand.

Signs of a fracture of the large tubercle are pain over the shoulder joint and a crunch in the area of ​​damage during palpation. At the same time, the joint practically does not swell, and there are no visual manifestations of deformation.

There is also limited mobility, especially if the shoulder is moved to the side. Moreover, abduction is often completely absent, which indicates injury to the tendons of the periosteal muscle.

At the same time, vessels and nerves with this type of fracture are rarely damaged. As a rule, the periosteal muscle is injured, after which a sudden violation of the motor function of the shoulder may occur.

The manifestations of a fracture of the diaphysis of the shoulder bone are crepitus fragments, severe pain and limited mobility in the area of ​​the elbow and shoulder joint. Symptoms such as shortening of the limb, bruising, swelling and severe deformity in case of displacement also occur.

For this type of damage to the shoulder joint, as well as wrist information, trauma to the vascular and nervous system is typical. If the nerves are affected, then this is reflected in the motor capabilities of the fingers, impaired sensitivity and is manifested by dangling of the hand.

Signs of a transcondylar fracture include:

• the occurrence of a crunch of debris, if you feel the injured hand;
• pain in the forearm and elbow joint;
• deformation occurs during displacement;
• swelling of the elbow joint;
• restriction of elbow mobility.

If transcondylar fractures occur, then the brachial artery is often affected, resulting in gangrene of the arm. The main sign of injury to the artery is the absence of a pulse in the forearm, where it should usually be felt.

However, fractures of the upper part of the shoulder should be able to distinguish between bruises, dislocations of the shoulder and injuries of the elbow and wrist joint.

Treatment

There are 3 ways to treat fractures of the shoulder and wrist joint:

• conservative;
• skeletal traction;
• surgical.

Simple fractures of the shoulder and displaced joint injuries are corrected with the help of a one-stage reposition, that is, reduction. Treatment is carried out by applying plaster, bandages or special fixing splints.

Treatment of damage to the large tubercle of the bone of the shoulder, as a rule, is carried out by applying a plaster cast. As an additional therapy, a diverting splint is used to prevent the development of stiffness in the shoulder joint. In addition, the splint contributes to the fusion of the supraspinatus muscle, which is often damaged in the process of fracture of the large tubercle.

In the case of displaced fractures, surgical treatment is used, during which the bone fragment is fixed with screws or wires, which are removed after several months of therapy. Basically, rehabilitation lasts from 2 to 3 months, and plaster immobilization lasts up to a maximum of 6 weeks.

In case of a fracture of the surgical neck without displacement, a plaster is applied to the diseased area for 1 month, and then recovery is carried out, in which the arm should be developed. If the damage was displaced and it was possible to correct it, then the treatment with plaster immobilization is delayed for 6 weeks.

If the fracture of the shoulder joint, as well as the wrist joint, is incorrect, then surgical intervention is performed. Moreover, such surgical treatment involves fixation with plates.

For fractures of the large tubercle and impacted injuries, conservative treatment is used, during which the arm is fixed on the abductor cushion if the periosteal muscle is damaged, or by the type of scarf. Rehabilitation lasts 4 weeks, and the plaster in this case is not getting better.

Then physiotherapy exercises and physiotherapy treatment are used. The duration of such therapy is up to three months.

Fractures of the body of the shoulder bone without displacement are treated by applying a plaster splint for 2 months. Displaced fractures are operated on, and then the arm is fixed with screws, plates or intraosseous rods.

Then, for 1 - 1.5 months, plaster is applied, but if the fracture is well fixed, then you can get by with a regular bandage - a scarf. After the plaster is removed, recovery begins, which lasts up to 4 months.

Rehabilitation

The most important component of the treatment of a fracture of the shoulder joint is the rehabilitation process. It consists of such important components as massage, physiotherapy and physiotherapy exercises. Moreover, physiotherapy procedures should be carried out in courses - up to 10 procedures after a few weeks after the injury.

Therapeutic exercise should begin in the first days after the implementation of medical treatment. So, after 3 days from the moment of damage, you should begin to make active movements, but without excessive load on the fingers of the sore hand. Also, do not forget about a healthy hand, which also needs to be exercised.

After 7 days after injury or surgery, you need to isometrically strain the muscles of the shoulder. Isometric - this means that the exercise should be performed without moving the joint. But first you should train a healthy hand and only then move on to the patient.