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Farhad O. Moola MD, Inc.: Orthopedic Surgery University of British Columbia

This document outlines a 4 phase physiotherapy program for nonoperative treatment of proximal humerus fractures. Phase 1 (weeks 2-4) focuses on range of motion exercises and postural correction without strengthening. Phase 2 (weeks 5-8) begins self-assisted strengthening to 90 degrees elevation and adds scapular exercises. Phase 3 (weeks 9-12) progresses to full range of motion and adds isometric strengthening. Phase 4 (>12 weeks) emphasizes flexibility, rotator cuff strengthening, and sport/work specific exercises.

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136 views1 page

Farhad O. Moola MD, Inc.: Orthopedic Surgery University of British Columbia

This document outlines a 4 phase physiotherapy program for nonoperative treatment of proximal humerus fractures. Phase 1 (weeks 2-4) focuses on range of motion exercises and postural correction without strengthening. Phase 2 (weeks 5-8) begins self-assisted strengthening to 90 degrees elevation and adds scapular exercises. Phase 3 (weeks 9-12) progresses to full range of motion and adds isometric strengthening. Phase 4 (>12 weeks) emphasizes flexibility, rotator cuff strengthening, and sport/work specific exercises.

Uploaded by

Sima Denisa Laura
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Farhad O. Moola MD, Inc.

Orthopedic Surgery
University of British Columbia
Trauma • Hand Surgery • Shoulder & Elbow Reconstruction
_______________________________________________________

Proximal Humerus Fractures: Nonoperative Treatment


Outpatient Physiotherapy Phase 1: (Weeks 2-4)
ROM
• Cervical, elbow and wrist ROM
• Pendulum exercises
• Instruct in home program
Strengthening
• No cuff strengthening
• Begin and instruct in program of postural correction
• May begin scapular retraction and depression
• Grip strengthening
Sling
• Arm in sling at all times except for exercises and bathing; Includes sling at night (sleeping in recliner
chair optimal); Discontinue sling between 2-4 weeks

Outpatient Physiotherapy Phase 2: (Weeks 5-8)


ROM
• Begin self-assisted forward elevation to 90° and progress in 20° increments per week
• May use pulleys
• Begin self-assisted ER with progressive return to full in 20° increments per week
• IR in scapular plane as tolerated (No IR behind back)
• No cross body adduction
• Grade I-II scapulothoracic and glenohumeral mobilizations
Strength
• No cuff strengthening
• Continue scapular retraction and depression
• Lower extremity aerobic conditioning
Other
• Modalities to decrease pain and inflammation
• Cryotherapy as necessary

Outpatient Physiotherapy Phase 3: (Weeks 9-12)


ROM
• Progressive return to full forward elevation and external rotation
• May begin posterior capsular stretching program
• May begin IR behind back
• Grade III-IV glenohumeral and scapulothoracic mobilizations
• Begin anterior chest wall stretches (pectoralis minor)
Strength
• Instruct in home program and begin submaximal isometrics in flexion, abduction, IR, ER and extension
• Add progressive isotonics with low resistance, high repetitions as tolerated
• Emphasize anterior deltoid strength and scapular stabilization
• Emphasize upper trapezius, serratus anterior force couple rehabilitation to create stable scapular base
• Assess for and correct compensatory movement patterns
• UBE with low resistance
• Continue aerobic conditioning

Outpatient Physiotherapy Phase 4: (> Week 12)


ROM
• Progressive return to full motion in all planes
• Emphasize posterior capsule stretching
• Maintenance home flexibility program
Strength
• Continue rotator cuff and scapular strengthening program
• Progressive increase in resistance as strength improves
• Continue UBE with progressive resistance as tolerated
• Recreation/vocation specific rehabilitation
• Maintenance aerobic conditioning home program
______________________________________________________________________
New West Orthopedic and Sports Medicine Center
#102-65 Richmond Street, New Westminster, BC V3L 5P5 Tel: 604.526.4646 Fax: 866.883.1615

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