This information will guide you through the next 6 weeks of your rehabilitation. Use the information below to gain a better understanding of your injury and what can be done to maximise your recovery.
|About your injury:||
The shoulder is a ball and socket joint. During your dislocation part of this joint was fractured.
The shoulder joint does not respond well to being injured and longstanding stiffness is often inevitable. Following this type of injury you may never be able to fully lift the arm straight up in the air again. The main aim is to regain enough movement to perform day to day activities.
|Healing:||It normally takes between 6-12 weeks for this injury to heal.|
Take pain killers as prescribed. You may find it more comfortable to sleep propped up with pillows.
You may get a small patch of numbness on the outside of your shoulder. This is normal and should resolve over time.
Using your arm:
Wear the sling for 6 weeks to support your shoulder.
It is important to keep the shoulder moving to prevent stiffness but not to aggravate the injury.
You will be seen in Upper Limb Clinic in 1-2 weeks after your injury. You may have another x-ray of your shoulder and the Specialist will assess your injury. They may refer you to Physiotherapy.If you have not received this appointment within one week of receipt of this letter please contact your hospitals Appointment Line.
Area of your injury
If you are worried that you are unable to follow this rehabilitation plan, or have any questions, then please phone the Fracture Care Team for advice.
Or, if you are experiencing pain or symptoms, other than at the site of the original injury or surrounding area, please get in touch using the telephone or e-mail details at the top of this letter.
What to expect
Wear the sling all the time - even in bed at night.
Remove the sling for exercises and personal hygiene.
Start the "Initial Exercises" straight away. It might take a few days practice to feel comfortable with them.
Continue to wear the sling.
Progress to Stage 2 exercises.
X Do not lift your elbow above shoulder height as this will be painful.
The fracture will be largely healed.
Try not to use the sling.
Begin normal light activities with the arm and shoulder.
Increase movement using the Stage 3 exercises.
Start to lift your arm over-head.
X Heavy tasks may cause discomfort.
Advice for a new injury
Cold packs: A cold pack (ice pack or frozen peas wrapped in a damp towel) can provide short term pain relief. Apply this to the sore area for up to 15 minutes, every few hours ensuring the ice is never in direct contact with the skin.
Rest: Try to rest your shoulder for the first 24-72 hours. However, it is important to maintain movement. Gently move your shoulder following the exercises shown. These should not cause too much pain. This will ensure your shoulder does not become stiff and it will help the healing process.
Medical evidence suggests that smoking prolongs fracture healing time. In extreme cases it can stop healing altogether. It is important that you consider this information with relation to your recent injury. Stopping smoking during the healing phase of your fracture will help ensure optimal recovery from this injury.
For advice on smoking cessation and local support available, please refer to the following website: http://smokefree.nhs.uk or discuss this with your GP.
If you have stiffness in your elbow or hand from wearing the sling, you may wish to perform these exercises first. However, once they become easy you can start with the posture and pendulum exercises.
Initial exercises to do 4-5 times a day:
Finger and wrist flexion and extension
Open and close your hand as shown 10-15 times.
Then move your wrist up and down 10-15 times.
After a few days, hold a soft ball/ball of socks. Squeeze the ball as hard as possible without pain.
Hold for 5 seconds and repeat 10 times.
Elbow Bend to Straighten
Bend and straighten your elbow so you feel a mild to moderate stretch. You can use your other arm to assist if necessary. Do not push into pain.
Put your elbow at your side. Bend it to 90 degrees. Slowly rotate your palm up and down until you feel a mild to moderate stretch. You can use your other arm to assist if necessary. Do not push into pain.
Repeat 10-15 times provided there is no increase in symptoms.
Bring your shoulders back and squeeze your shoulder blades together as shown in the picture. Do this with or without your sling on.
Hold the position for 20-30 seconds and repeat 5 times provided there is no increase in symptoms.
Shoulder pendulum exercises
Stand and lean forward supporting yourself with your other hand. Try to relax your injured arm and let it hang down.
Continue for approximately 1-2 minutes in total provided there is no increase in symptoms. Remember to try and relax your arm.
Stage 2 exercises
Start these exercises 3 weeks post injury and to do 4-5 times a day:
Active assisted Shoulder flexion
Use your other hand to lift your arm up in front of you as shown in the pictures.
Repeat 10 times provided there is no increase in symptoms.
Active assisted External rotation
Keep the elbow of your injured arm tucked into your side and your elbow bent. Hold onto a stick/umbrella/golf club or similar. Use your unaffected arm to push your injured hand outwards. Remember to keep your elbow tucked in. Push until you feel a stretch.
If you don’t have a stick you could simply hold the injured arm at the wrist and guide it outwards.
Hold for 5 seconds and then return to the starting position. Repeat 10 times provided there is no increase in symptoms.
Stage 3 exercises
Start these exercises 6 weeks after your injury and to do 4-5 times a day.
When you have regained full range of movement in the stage 2 exercises without pain you can start to do these exercises without the support of your other hand. This is known as active range of movement. The, when you have regained full movement without helping with your other arm, you can build up your regular day to day activities.
Perform these exercises 10 times each. Only go as far as you can naturally, without doing any trick movements to try and get any further. The movement should increase over time and should not be forced.
Active Forward flexion:
With your thumb facing up, try to move your arm up, keeping it close beside your body.
With your thumb facing up and outwards, try to move your arm in a big arc out to the side.
Active External Rotation
With your elbow by your side, rotate your forearm outwards, keeping your elbow at about 90 degrees in flexion.