Expert: Gerald Anzalone, D.C. - 9/25/2009

Question
Five weeks ago i had a fall resulting in a four part proximal humaral fracture,i have been given exercises to do but i find them very painful due to the extreme pain in my swollen upper arm muscle.Am i doing the muscle at this point more harm than good ?

Answer
Lynne,

Thanks for your question. Technically, this question falls outside of the scope of the practice of chiropractic. However, in general, according to the Family Practice Notebook medical website, for a proximal humeral fracture:

  1. Rehabilitation should be slow
  2. Range of motion should be minimal in first 3 weeks
        1. Excessive motion results in displacement
        2. Stay in sling for first 3 weeks
        3. Frozen Shoulder risk is less than displacement risk
  3. Reevaluate weekly with shoulder x-rays

Exercise program:

  1. Pendulum exercises and circumduction after 14 days
        1. Use caution in first 3 weeks
        2. Start with arm in sling
              1. Bend at waist
              2. Allow arm to fall toward floor
              3. Rotate arm in circle
        3. Advance Exercise
              1. Arm out of sling
              2. Circles of greater diameter
  2. Advanced range of motion at 3 weeks
        1. Abduction via wall walking with fingers
        2. Internal rotation
              1. Start by touching hip
              2. Progress to touching mid-back
        3. Flex and extend elbow out of sling as tolerated
  3. Additional Exercises
        1. Isometric Exercises of rotator cuff and deltoid
        2. Consider physical therapy

You should definitely discuss your concerns with your physiotherapist and if necessary, your orthopedic surgeon.

I hope that this helps to answer your question.