EFFECTIVENESS OF MANUAL THERAPY ADDED TO CONVENTIONAL PHYSIOTHERAPY PROTOCOL IN PATIENTS WITH SURGICALLY TREATED PROXIMAL HUMERAL FRACTURES

Abstract

Proximal humerus fractures are the third most common fractures in adult patients. In developed economies, there is a tendency to increase the number of these fractures due to the aging population. Physical therapy is recognized as an important component in the management regardless of the fracture type or treatment protocol. The purpose of this blind, randomized study was to compare the effectiveness of two physical therapy interventions on the shoulder range of motion and function after surgical treatment of proximal humerus fracture: 1) supervised therapeutic exercise only (Control group – CG), 2) supervised therapeutic exercise with manual soft tissue mobilization and massage (Experimental group – EG). Ninty-six subjects diagnosed with proximal humerus fracture treated operatively were randomly assigned to one of these two groups. The rehabilitation included four phases, in each of which the patients underwent ten procedures. Shoulder range of motion was assessed with a universal goniometer for flexion, extension abduction, internal rotation, and external rotation. International SFTR method of measuring and recording joint motion was used. The results were analyzed with the statistical program SPSS Statistics 19. At the end of the study, we found statistically significant better results in the EG in flexion (152.8° ± 22.3°), abduction (145.3° ± 24.2°), external (61.1° ± 11.8°), and internal (75.3° ± 11.6°) rotations, compared to CG: flexion (140.7° ± 22.0°), abduction (130.6° ± 24.4°), internal (51.8° ± 15.6°) and external (63.5° ± 14.1°) rotations with statistical significance (p < 0.05). The extension showed improvement in both study groups, within the EG results being 52.9° ± 15.9° and in the CG 49.9° ± 5.5° - with no statistically significant difference between them. The DASH (Disabilities of the Arm, Shoulder, and Hand) scale was used for functional assessment of upper extremity. We established that the application of manual soft tissue mobilization with massage in the postoperative rehabilitation of patients with proximal humerus fractures leads to more effective restoration of shoulder joint function.