Proximal humeral fracture and shoulder artroplasty: Rehabilitation treatment

Abstract

The proximal humeral fractures need a specific and specialist rehabilitation approach for their treatment, both for conservative or after shoulder artroplasty surgical implant. There are many factors that may influence the final recovery of the patient; the localization of the fracture (intra or extra capsular fracture), its size, the extent of the trauma, the general clinical conditions of the patient, the quality of the shoulder tissue and its personal ability to heal, the rehabilitative tecniques used, patient motivations and psicological aspects and how much time the patient have got to spend to follow the rehabilitation project to reach specific functional goals. The ROM deficit is the more common complication after proximal humeral fracture. The causes may be lack of articular congruence (stabilized meccanical rigidity without pain) or retraction of the capsulo ligament structures (changeable tissutal rigidity with pain). In most clinical situations (except prosthesis) an early passive articular mobilization in a safe range of motion (reduced ROM, on a scapular plane and avoiding rotations) will be usefull, postponing active mobilization and muscolar reinforce when there will be a safe clinical and radiological heal of the fracture or the prosthesis implant will be stable. The rehabilitation treatment of the patient that underwent surgical procedure of prosthesis implant (total shoulder arthroplasty, endoprosthesis, reverse shoulder arthroplasty, resurfacing prosthesis) needs in any case to avoid manual traction of the gleno humeral articulation or articular pompages, manual stabilizzation of the scapula, and in the first post surgery month to save humerous from rotations. In the end the clinical monitoring of many parameters (range of motion, muscolar force and endurance, coordinated skills, sportive gesture, daily living activity and functionality) using validated clinical tests (isokinetic and isometric tests, aerobic and anaerobic thereshold, scale to evaluate the functionality and the state of psychological health) will permit to understand if and at wich level the functional goals have been reached and will allow to observe far off the functional outcome.