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Figure of 8 Bandage
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Collar & Cuff Sling

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During Immobilization

1st Week : Sling, Strapping or fig. of 8 bandage Shoulder held in abduction, int. rotation & elbow 90 flexion No ROM or strengthening Ex. to shoulder Unaffected arm used for ADL

Patient is advised initially to sleep on a reclining chair & in later stages to roll over the unaffected side to come to upright position Weight bearing not permitted digits Full ROM Ex. to wrist, hand &

2nd Week : Gentle pendulum Ex. to shoulder in sling & gentle isometrics to deltoid

During Mobilization

4th Week : Gradual shoulder mobilization 6th Week : Gentle active shoulder movements, gravity eliminated pendulum Ex, Isometrics to deltoid & rotator cuff No weight bearing limb for ADL Patient is permitted to use the affected

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8th Week : Active to Active assisted Ex. in all planes Resisted Ex. Gradual Weight bearing is allowed 8th - 12th Week : Full active motion, Isometrics, Isotonics, Resisted Ex, Full weight bearing, Normal use of hand

Surgical treatment
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Mobilisation start after 10 days.

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During Immobilization(limb is

supported in slingsling-2 weeks)

1-2 Weeks : Thermotherapy to reduce pain Isometrics to shoulder muscles

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During Mobilization

After 2nd Week : Similar to clavicle fracture management

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During Immobilization

1-3Weeks : Arm is strapped to trunk in adduction & internal rotation Isometrics to deltoid ROM Ex. to wrist & digits

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During Mobilization

After 3rd Week : Limb is supported in a sling movements Full range Elbow

Small range shoulder mobilizations (flexion-extension; pendular movements in forward)

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Initiation of shoulder abduction (initially 45) & external rotation

Self-resisted isometrics & slow isotonic movements (home programme)

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After 12th Week : Heavy resisted Ex, Passive stretching & forced abduction & external rotation

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Same as in Ant. dislocation of shoulder Utmost care is taken in adduction & internal rotation

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Preventive Physiotherapy
Strengthen muscles & Ligaments : Self resisted isometrics & eccentric Ex. are taught to the patient In dept. weighted dumbells or weighted belts are used

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Achieve & maintain full range passive motion: Initially done by Therapist with patient in supine Arc of movement is; abduction-elevation, flexion-elevation & external rotation Extra care should be taken at the terminal range of elevation & external rotation

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During immobilisation-Limb is
supported in a sling for a week or two Active movements for elbow, wrist, fingers Shoulder mobilization started as soon as pain diminishes Full movements can be regained in few weeks

During mobilizationmobilization-

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Transverse Fractures treated conservatively

During Immobilization (POP UU-Slab) First 66- 8 Weeks : Radial Nerve injury Check the limb for presence of Strong wrist & finger movements biceps Isometrics for deltoid, triceps,

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During Mobilization 8 weeks onwards: Longer period of immobilization results in stiff & painful shoulder Before shoulder mobilization a pain relieving modality like TENS, US or SWD is needed 1st day; self assisted or passive ROM Ex. in a small range Ex. Progress to Codman's pendular

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Relaxed passive self stretching of abduction-elevation & flexion-elevation in supine lying Active Self resisted Resisted Ex. (Weighted dumbells, weight belts, Pulley) Use of wand, shoulder wheel, shoulder ladder

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Spiral Fractures treated

conservatively

During Immobilization (POP UUSlab) Same as in transverse fractures

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During Immobilization First 3 Weeks : Managed either by manipulation with close reduction or Dunlop traction Proper checking of plaster slab/traction to ensure proper immobilization & freedom of thumb & fingers Vigorous, strong full range movements to free joints

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During Mobilization 3 weeks onwards: elbow & forearm Accurate evaluation of ROM at the

Thermotherapy (Wax bath, Hot packs) will induce relaxation, reduce pain Movements at elbow should be initiated in the form of active assisted rhythmic movements in gravity eliminated position (use of roller skates) Relaxed swinging of elbow flexion with supination & elbow extension with pronation

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Causion :
Vigorous passive movements or passive stretching at the end of the limitation or any kind of massage should be forbidden to prevent myositis ossificans

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Posterior dislocation common Rx Closed manipulation immobilised in above elbow slab with elbow in flexion

Open reduction Excisional arthroplasty

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During Immobilization First 3 Weeks : Check POP cast to ensure ROM of free joints Full range of shoulder abduction in elevation & rotation Finger and thumb Ex. in elevated position with arm resting on the table top (reduces swelling)

During Mobilization

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3 weeks onwards: Evaluation of flexion-extension at elbow & supination-pronation at forearm Evaluation of degree of pain & swelling Suitable thermotherapy modality before mobilization (wax bath, hot packs) Relaxed, rhythmical active assisted mobilization of elbow & forearm bath Use of roller skates, wand or whirl pool

* * Functionally acceptable results can be gained within 66 -8 weeks

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Fracture of lower end of humerus humerus, , upper end of radius and ulna and ant dislocation of elbow

Objective is to gain maximum functional range of Elbow & hand Physiotherapy is as same in Elbow dislocation If it is not possible to gain full Elbow flexionextension, the range of supination-pronation

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is a distal fracture of the radius in the forearm with dorsal (posterior) displacement of the wrist and hand

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During Immobilization in below elbow cast (4(4-6 week)

First 3 Weeks : the shoulder Elevation of hand above the elbow & elbow above

Use of pulsed galvanic stimulation to reduce oedema (Sorenson-1983) Intermittent pressure glove to reduce swelling in the exposed fingers & thumb (Jobst-1983) Check POP cast Full range of passive movements to fingers

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Full range of movements to Elbow & Shoulder Adjuncts like moist heat pack, infra-red, ice massage, TENS

During Mobilization

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3 -6weeks : Thermotherapy to induce relaxation (hot packs, paraffin wax bath) Small range wrist mobilization Ex. to improve wrist flexion-extension Ex. To improve supination-pronation

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Same as in Colles Fracture

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