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. 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. A scapular fracture is a break in your shoulder blade scapula. Scapular fractures are uncommon, and displaced glenoid fractures are. The shoulder blade has a ridge going along it known as the spine of the scapula. 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. Immobilized at all times day and night off for hygiene and gentle exercise only 04 weeks.
The angle of the bone causes a deformity in the limb angular deformity 3. 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. Navigate to learn more about shoulder fracture protocol. 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. However there is conflicting evidence in the literature regarding the outcomes owing to retrospective design of studies, different classification systems, and diverse outcome tools. Feb 03, 2020 a scapular fracture is a break in your shoulder blade scapula. Nonoperative proximal humeral fracture rehabilitation. Rehabilitation programs for operative and nonoperative shoulder. Highenergy, blunt trauma injuries, such as those experienced in a. Begin normal light activities with the arm and shoulder. Specific interventions should be based on the needs of the individual and. Nonoperative care is usually chosen when the fracture is stable, minimally displaced or the patient is not a good candidate for surgery. Standard course patients will typically follow a standard postfracture rehab course if their fracture is.
Thus, scapula fractures occur at rates approaching those of distal tibia and humerus fractures. Horses with fractures of the neck or body of the scapula are usually non. Harold schock iii, md rotator cuff repair rehabilitation. Proximal humeral fracture postsurgical rehabilitation protocol. Scapula fractures represent less than 1% of all broken bones and many of them can be treated without surgery. Scapular fracture aftercare instructions what you need to. 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. Rehabilitation guidelines for standard reverse total. There was variability in our rehabilitation protocol involving the time to rom exercises which in. The intent of this rehabilitation protocol is to provide the physical therapist with a guidelinetreat ment. A scapular fracture is a fracture of the scapula, the shoulder blade.
Return to normal function and motion may require 3 to 4 months overall goals. Famous physical therapists bob schrupp and brad heineck present. Return to normal function and motion may require 4 months 6 months. Displaced scapular body fractures most commonly are treated conservatively. Scapula shoulder blade fractures the shoulder blade scapula is a triangularshaped bone that is protected by a complex system of surrounding muscles. Fractures of the scapula may occur in the body, neck, supraglenoid tubercle, spine, or glenoid cavity.
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. It is no means intended to be a substitute for ones clinical decision making. Extension and internal rotation not performed until 6 weeks 4. Any surgery poses some risk, such as nerve and blood vessel damage, bleeding, or infection. Shoulder fracture aurora clavicle fracture treatment denver. The scapula or the shoulder blade is a triangle shaped bone which is surrounded by a complicated web of muscles. 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. Scapular stabilization university of california, san francisco. Increase rom while protecting the fracture site you can be slightly more. Due to the potential of an acromion stress fracture one needs to. 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. Non displaced 2 part fracture good alignment does not involve an articular surface. Article pdf available in physiotherapy theory and practice.
A sudden increase of deltoid activity during rehabilitation could lead to excessive acromion stress. 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. Due to the potential of an acromion stress fracture one needs to continuously monitor the exercise and activity progression of the deltoid. 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. The protocol is both chronologically and criterion based for advancement through four postoperative phases. 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.
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. 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. This normally takes between 612 weeks to unite heal. 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. Reestablish dynamic shoulder and scapular stability.
Rehabilitation protocol for reverse shoulder arthroplasty this protocol is intended to guide clinicians and patients through the postoperative course after a reverse shoulder arthroplasty. Rehabilitation programs for nonoperative humeral fractures dr. Treating a scapula fracture the physician may recommend working with a physical therapist for rehabilitation. Pdf the scapula plays a critical role in the association between the upper extremity. The bone positioning is no longer in its correct, anatomical position displacement 3. Bony healing occurs usually within 6 to 8 weeks in adults 3. 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. Harold schock iii, md rotator cuff repair rehabilitation protocol the following document is an evidencebased protocol for arthroscopic rotator cuff repair rehabilitation. 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. 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. Depending on the severity of the fracture, the patient.
Increase movement as shown in the stage 2 exercises. The term scapula literally means skapulare to dig, because the greek anatomists who named it thought that the shoulder blade looked like a spade. 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. Scapula fracture shoulder blade fracture physioadvisor. The scapula is sturdy and located in a protected place, so it rarely breaks. Rehabilitation following reverse shoulder arthroplasty. Physical therapy protocols boston shoulder institute. Rehabilitation programs for operative and nonoperative. Outcomes of nonoperatively treated displaced scapular body ncbi. Arthroscopic anterior stabilization rotator cuff repair arthroscopic rotator cuff repair protocol arthroscopic rotator cuff repair faqs and postoperative guidlines rehabilitation after rotator cuff repair. The shoulder blade scapula is located in the upper back, and sits on top of the ribs. 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.
You have sustained a fracture to your scapula shoulder blade. Dec 05, 2018 as the name suggests a scapula fracture is a fracture of the scapula or the shoulder blade. Orthopaedic consultant bone specialist and fracture care specialist. A scapular fracture is a break in the continuity of the cortex of the scapula bone. Highspeed vehicle accidents are the most common cause. You will be advised at your fracture clinic when you may discard the sling and return to normal light activities using. Orif clavicle fracture spo twin cities orthopedics. This to ensure no further displacement and accurate nonoperative management. When a scapular fracture was identified, a ct scan with coronal, sagittal, and threedimensional reconstructions was performed to further evaluate the fracture. 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. Clavicle fracture rehabilitation protocol created date.
Rehabilitation guidelines for standard reverse total shoulder. Rehabilitation protocol for reverse shoulder arthroplasty. Displaced scapular body fractures most commonly are treated. Denards rehabilitation protocols open shoulder surgery.
Rehabilitation protocol for total shoulder arthroplasty. Rehabilitation protocol considerations why is the scapula important. Nondisplaced means less than 1cm of displacement and less than 45 of angulation 2. As the name suggests a scapula fracture is a fracture of the scapula or the shoulder blade.
Passive stretching exercises need to be continued until the shoulder has complete range of motion in it. A fracture of this bone is termed as a scapula or broken shoulder blade. Gentle er in scapular plane to available prom as documented in. These fractures account for less than 1 percent of all broken bones. Bony healing occurs usually within 6 to 8 weeks in adults 2.
Rehabilitation programs for orif humeral fractures with locking plate dr. Proximal humerus fracture nonoperative jason dieterle, do considerations. 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. Other major injuries often accompany scapular fractures, such as fractures in the shoulder, collarbone and ribs, or. In certain cases, surgery to repair a broken scapula is necessary.
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. Nonoperative proximal humeral fracture rehabilitation protocol general principles. 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. Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. 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. Below you will find links to physical therapy protocols for various surgical procedures. Physioadvisors detailed physiotherapy information on a scapula fracture includes.
Although formerly felt to be rare, scapula fractures have been shown to occur with a rate of 0. Postsurgical orif clavicle fracture or nonunion rehabilitation protocol phase 1. Post fracture proximal humerus rehabilitation guidelines. Rehabilitation protocol for total shoulder arthroplasty and.
The scapular plane is defined as the shoulder positioned in 30 degrees of abduction and forward. Surgery for a scapular fracture may be recommended when. Your collarbone, arm bones, lungs, or chest may also be affected. Strengthen scapular musculature to allow for proper scapulohumeral rhythm. Scapular fracture aftercare instructions what you need.
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. Rehabilitation protocol for rotator cuff repair this protocol is intended to guide clinicians and patients through the postoperative course of a rotator cuff repair. Dr adam seidl offers treatment for shoulder fractures and clavicle fracture in denver and aurora. Specific interventions should be based on the needs of the individual and should consider exam. 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. Proximal humeral fracture postsurgical rehabilitation.
Nonoperative proximal humeral fracture rehabilitation protocol. Rehabilitation following total shoulder arthroplasty. A successful outcome from orthopaedic shoulder surgery requires a multidisciplinary approach from our surgeons to physiotherapists. You may note that these protocols are more conservative than you have seen in your experience or heard from friends.
Restrict motion to 90 fe in the scapular plane 0 er at side ir to stomach. Frequency of inoffice visits 1 to 2 visits over first six weeks to monitor patient compliance and understanding shoulder range of motion. Treatment algorithm for progressing the rehabilitation program for a patient that has had a total shoulder arthroplasty. Reverse shoulder arthroplasty rsa shows a growing number of implantations and is a valuable option to improve shoulder function and decrease pain.
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. Post fracture proximal humerus rehabilitation guidelines r l humerus fracture. Rehabilitation programs for nonoperative humeral fractures. Clavicle fracture rehabilitation protocol range of motion immobilizer exercises phase i 06 weeks 04 weeks. Outcomes of nonoperatively treated displaced scapular body. 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. Rehabilitation programs for orif humeral fractures with. Protection phase weeks 06 goals protect the surgical reconstruction. Devinder garewal is an orthopaedic shoulder specialist. Bony healing occurs usually within 6 to 8 weeks in adults. Mobile, triangular and protected by an intricate system of surrounding muscles, the scapula isnt broken all that often. Jul 26, 2018 famous physical therapists bob schrupp and brad heineck present. Specific interventions should be based on the needs of the individual and should consider exam findings and clinical decision making. However, there is no consensus concerning the rehabilitation protocol following surgery.
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