Justifi cation of the use of osteopathic correction in the complex rehabilitation of patients with consolidated fractures of the large tubercle of the humerus

Abstract

Introduction.Fractures of the proximal humerus occur in 4–5 % of all fractures and 50–80 % of all fractures of the humerus. The treatment of this type of fracture is a relevant issue. This is due, on the one hand, to a rather high frequency of occurrence of such fractures, and, on the other hand, to a signifi cant probability of the development of persistent functional disorders. The use of osteopathic techniques is possible both in acute (without alteration of the integrity of bone structures) and in chronic injuries of the musculoskeletal system. Their use during the rehabilitation process is especially valuable. Currently, there are few works in the scientifi c literature exploring the effectiveness of osteopathic treatment as part of the comprehensive rehabilitation of this group of patients. The foregoing has predetermined the purpose of this work. The goal of research — to substantiate the possibility of using osteopathic correction in the comprehensive rehabilitation of patients with consolidated fractures of the large tubercle of the humerus after conservative treatment.Materials and methods.From January 2016 to December 2018, in the Arbatsky consultative diagnostic centre at the Pirogov National Medical and Surgical Center a prospective, controlled randomized trial was conducted. The study included 30 patients with consolidated fractures of the large tubercle of the humerus. Patient selection and sampling was carried out by the continuous method. Patients were divided into two groups of 15 people by the method of simple randomization with the use of a random number generator. In the main group, therapy consisted of rehabilitation treatment (physiotherapy, exercise therapy) and osteopathic correction, including 3 sessions with an interval of 1 week. Patients in the control group received only rehabilitation treatment. Before and after treatment, all patients underwent an assessment of the severity of pain in accordance with the visual analogue scale, measurement of the volume of active movements in the shoulder joint with the use of a goniometer, assessement of the timing of recovery of shoulder function using the OSS questionnaire, as well as osteopathic examination according to the approved protocol.Results.Most often, patients with a fracture of the large tubercle of the humerus presented somatic dysfunctions of the thoracic region (both structural and visceral components), as well as chronic local dysfunctions of the sternoclavicular joint, the fi rst rib, individual vertebral motor segments. In patients of both groups receiving both isolated traditional rehabilitation treatment and traditional rehabilitation treatment in combination with osteopathic correction, there was a decrease in the severity of pain and an increase in the volume of active movements in the shoulder joint. Moreover, in the group that additionally received osteopathic correction, lower pain indicators and higher range of motion were noted compared with the control group. Also, the functions of the shoulder joint in patients of the main group were restored faster.Conclusion.The obtained results confi rm the advisability of including osteopathic correction in the program of comprehensive rehabilitation of patients with fractures of the large tubercle of the humerus.