Is physiotherapy mandatory after a shoulder fracture

treatment Broken shoulder - humeral head fracture - humerus head fracture

The fracture of the humerus head, i.e. the ball of the shoulder joint, is in most cases caused by a fall directly onto the shoulder or onto the outstretched arm. But also in the context of a dislocation, a bone fracture can be the result. In total, approx. 5% of all human bone fractures affect the ball of the shoulder joint. With increasing age, the resistance of the human bone decreases, which significantly increases the risk of breaking a bone in the event of a fall. Preventive measures, be it to avoid falls (removal of tripping hazards) or for the purpose of strengthening bones (balanced diet, osteoporosis therapy, regular exercise, avoidance of nicotine), are of great importance.

Symptoms and Diagnosis

Broken bones close to the shoulder usually cause severe pain and restricted mobility. An X-ray examination and, if necessary, additional examinations such as computed tomography confirm the diagnosis and are essential for choosing the right therapy.

Computed tomography of a fracture of the humerus head: the ball has broken away from the shaft. This injury has little chance of healing without surgery

Conservative treatment

If the bone fragments are only slightly displaced, non-surgical therapy with brief immobilization and protection can be useful. However, bone healing takes several weeks and it is not uncommon for the shoulder to stiffen noticeably for a few months. This stiff shoulder, also called frozen shoulder, can then be cured with physiotherapy. In stubborn cases, the frozen shoulder can be successfully treated with minimally invasive surgery (arthroscopy) after the bone fracture has healed.

Operative treatment

If there has been a significant displacement of the bone fragments in the accident, the chances of a good healing and regaining of the shoulder function without surgery are poor. During the surgical procedure, the individual bone parts are brought back into the correct position and axis relative to the rest of the upper arm using screws and plates. Physiotherapy begins a few days after the operation so that the risk of stiffening can be minimized. Bone quality changes with age. The bone becomes more fragile and fractures become more difficult to treat. In certain cases, the secure anchoring of screws and plates can no longer be achieved. For such patients, the placement of an artificial joint offers a good option for successful treatment.

The x-ray 3 months after plating of the fracture shown above shows a correct restoration of the axial relationships. It took 4 months for the patient to move her arm back into her neck and over her head

Possible long-term consequences

Fractures of the humerus ball directly affect the shoulder joint. Therefore, in the medium and long term, there is an increased risk of developing shoulder joint wear (osteoarthritis). Since the blood supply to the bone fragments can also be damaged as part of the original accident, death of the bone (necrosis) is another possible complication. In this case, too, good pain relief and restoration of mobility and shoulder function can be achieved by means of an artificial joint.

Several years after the accident, the bullet's bone tissue showed signs of necrosis (death of the bone). The patient's pain could be effectively treated using an artificial joint