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To synovial injury of the shoulder joint include fractures of the head and anatomical neck of the shoulder, isolated fractures of large and small tubercles, as well as fractures of the surgical neck of the shoulder. The last type of injury is the most frequent, especially among the elderly. There are the following types of fractures of the surgical neck of the shoulder: killed by a fracture in which the peripheral shard wedged into Central; abduction (abductor) and adduction (driven) fractures. At the killed and abduction fractures of the axillary region is administered belopotosky cushion, locking his neck and torso gauze bandage. The forearm is placed under an angle of 35-45 ° at the elbow joint on serpentine armband for Gervinho (wide gauze bandage, quilted wool), round double wrapped around the lower third of the forearm, wrist joint and hand. When adduction fractures in the axillary region enter the triangular bus, wherein the shoulder rests on its gently sloping side, the vertical part is on the trunk, and forearms are also recorded snake-like armband for Gervinho.
the Main method of treatment of fractures of the surgical neck of the shoulder is a functional method with a short period of immobilization and early exercise of the shoulder joint. During treatment of the fracture, the patient consistently performs three groups of special exercises, which should be combined with the bracing exercises, and in particular those which expand the chest, with the movements in the joints healthy hands and exercises that strengthen the muscles of the shoulders and back.
the Immobilization period. At the killed the fracture without displacement of fragments fracture of the abduction and the first period lasts 10-14 days, physical exercises prescribed on the 1-2 day after the injury, doing them sitting and standing with a slight inclination forward and to the side of the damaged hands. The first group of exercises consists of movements that increase the mobility of the shoulder girdle, relax muscles, reduce stiffness and increase scope of motion in the shoulder joint. The patient performs the following exercises: elevation of the shoulder girdle, the mixing and dilution of the shoulders, abduction and adduction of the shoulder with a small amplitude, holding a kerchief; a light swinging of her arm at the shoulder joint (forward, backward, sideways and circular movements), flexion and extension of shoulder with a small amplitude, holding a kerchief; isometric tension of the deltoid muscle, flexion and extension of fingers, dorsal and Palmar flexion of the brush in the wrist joint, circular motion brush, etc. to Patients with abduction fractures of the shoulder when performing exercises you should avoid significant drainage of the arm, which replicates the mechanism of injury, and may result in displacement of fragments.
Postmobilization period. With the reduction of pain and increase range of motion (10-14 days) the patient gradually moves on to exercises next group - lightweight, runs with self-help. Lightweight loads can be achieved by a shortening of the lever: to do the exercise bent arm, supports patient hands healthy, the use of gymnastic sticks, "unloading" the prop by hand with your fingers on the chest. During this period, especially exercises in the pool.
Estimated a set of special exercises used in the second period
1. I. p. - Standing, hands hanging down, fingers intertwined. To bend hands in elbow joints, to try to turn the shoulders (4-8 times).
2. I. p. - Standing, injured hand rests with fingers on chest. Shoulder abduction, the patient hands (4-8 times).
3. I. p. - Standing, healthy a hand for the injured. Active drainage of the injured arm, with the support of a healthy (4-8 times).
4. I. p. - Standing, torso slightly tilted forward, arms hanging. Free to shake hands, striving to detain them for a short time in the extreme points of motion (4-6 times).
5. I. p. - Standing, healthy hand on his belt, injured bent at the elbow joint. Diversion bent hands to the side and return to starting position (6-8 times).
6. I. p. - Standing with a stick in the lowered hands. Lift the stick forward slightly above the horizontal level (4-6 times).
7. I. p. - Standing, tilt trunk forward, arms hanging. Flapping motion with a small amplitude straight arms forward, backward, right, left, circular with gradually increasing amplitude (4-6 times).
it is important to perform the exercises do not cause pain; you should pay attention of patients on the need to relax the muscles.
the Recovery period. The basis for the transition to medical gymnastics according to the method of the third period is a free implementation of active movements of her arm and the contents of his weight on horizontal level (first bent, then straight line) within seconds, indicating that consolidation of fragments. The objective of this period is to restore full range of motion in the shoulder joint, the back of the volume and strength of the muscles surrounding the shoulder joint, especially the deltoid muscle. Using special exercises of the third group is active, executing a typical workload, in the initial position, standing and lying down. Standing patient performs independently flexion, abduction direct hand in a slow pace, trying to keep their time on weight. Due to slow movements and the lengthening of the lever arm during movement straightened hands, increasing muscular stress, strengthen muscles better. Offer the patient to try to bend the hands at the nape, lay them on their backs, developing the rotation of the shoulder outwards and inwards. If you were able to achieve flexion in the shoulder joint to the right angle, it is advisable to perform exercises in the supine position, as in this case, the mass of hands to help further increase the scope of movements. In the supine position, the patient performs exercises with the help of the healthy hand, using gymnastic stick and trying to bring the movement to an angle of 180 °. In this starting position is recommended as a rotation of the shoulder outwards from the self-help with a bent right-angle elbow joint. In the future, say a slight encumbrance of a hand while in motion, with the use of clubs, gymnastic sticks, light dumbbells (0.5 kg), etc. it is Recommended that swimming in the pool and perform exercises in warm water, workout at the gym, occupational therapy.
When adduction-extension fractures of the surgical neck of the shoulder method of rehabilitation treatment is somewhat different. From the first days after injury in the conditions of immobilization splint the patient performs breathing exercises and exercises that strengthen back muscles and shoulder blades together. This reduces the negative impact of the tightening straps on the function of the thorax and the mass of the tire on the spine. In physiotherapy sessions include specific exercises: movement in the joints of the fingers and the wrist joint, and a little later (5-7th day) - flexion and extension at the elbow joint with their forearm on the base of the tire, pronation and varus shoulder (this movement when the forearm was freed from the bandage). At a later date (average in a month after injury) shoulder and forearm free from fixing bandages and when tilted forward or to the side of the case (depending on the position of the fragments) the patient seeks first to separate the hand from the bus, and then to make a move without it (the tire behind your back and reject the record). In the torso of the patient performs the swinging of the shoulder joint (forward or sideways), followed by attempts to hold the hand of force the muscle tension in the end position. Under favorable x-ray data and the ability of the patient to keep the arm in the weight of the immobilization was stopped and later classes in the second and third period is carried out according to the method used in the abduction fracture.
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