Proximal Humeral Fracture

Proximal Humeral Fracture + tx

fracture of the humerus up towards the humeral head near the shoulder

• remember that compensation with early scapular rotation/elevation is common, and we want to avoid permanent compensation patterns (e.g., hiking)

• MEND vs MOVE— ***stabilize until physician clears

  • typically a sling for a few weeks

  • keep distal joints active (e.g., elbow, hands, fingers moving)

• ***start PROM (when cleared)

  • pendulum swings

  • towel glides

• ***then start AROM (when cleared)

  • open and closed chain

  • focus on scapulohumeral rhythm with no substitutions!

“wait (tick-tock goes the pendulum) for the surgeon to clear; no substitute for a grandfather clock”

standard mobility progression

standard: immobilization —> AROM —> PROM

• PROM has a risk of going too far, too quickly, which can cause damage

• e.g., for bones and healing fractures

tension-limiting mobility progression

tension-limiting: immobilization —> PROM —> AROM

• this is because we are most concerned with tension in the tendons; strictly controlled PROM will have less tension than AROM

• the shoulder is included with tendons because so much of its stability is due to the rotator cuff, which is tendons!

• pendulum swings are PROM with the advantages of AROM

  • letting gravity, instead of muscular tension, do the motion BUT it is graded by the person themself (client is in control)

glenohumeral rhythm

glenohumeral (shoulder) joint is a multiaxial ball-and-socket synovial joint that allows a wide range of motion across multiple planes of movement