Orthopedic Care and Consultation
Exercises are very important way of keeping oneself fit for day to day physical stress. Exercises strengthen muscles so that they can cope with the injury or additional stress. The exercises used in rehabilitation of neck pain and back pain patients have been designed to increase the mobility and range of motion of the spine. Certain abnormal postures are a major culprit for back pain, these exercises counter those effects. [Read more...]
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Three Part Fractures
Three part fractures involves a fracture of surgical neck of humerus along with fracture of either greater tuberosity or lesser tuberosity. While surgical neck is quite displaced to miss out, small degree of tuberosity displacement may be easily missed and may require additional radiographic views.
Open reduction and internal fixation is the preferred treatment. Failure of the treatment may lead to hemiarthroplasy i.e. replacement of head component with prosthesis. [Read more...]
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Displaced fractures in an older patient with lower demands can be treated with conservative methods. In such cases the patient would even accept higher angulation and if the shoulder is well rehabilitated, the motion of shoulder joint would compensate most of the movements hampered by angulation.
However in young, active patients with higher demands, a surgical procedure would be necessary.
Closed Reduction
The arm is adducted and is flexed 90 degrees. This maneuver relaxes Pectoralis muscle.. A translation force (usually posteriorly and laterally) is applied to reduce the deformity while longitudinal traction is applied. After it is felt that reduction has been achieved a gentle reimpaction is tried.
After the fracture has been reduced immobilization is continued for 4 weeks.
If the fracture is reducible but unstable, percutaneous pins after closed reduction might be used. If a reduction cannot be achieved, open reduction and internal fixation are considered.
Rehabilitation After Surgery
If fixation is good and fracture is stable, early passive range of motion is instituted, including pulley elevation in the scapula plane, external rotation with a stick, pendulum, and hand and elbow range of motion. Progression to full stretches is rapid. Strengthening is added at 6 weeks.
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Ultrasound therapy involves production of longitudinal mechanical waves above the audible range (20 KHz). The frequencies used in physiotherapy vary from 0.75 MHz to 3 MHz. These are produced by distortion of quartz crystal, by a high frequency alternating current.
These sound waves require a conducting medium like oil or water to reach from the probe head to tissues. The probe head should be applied perpendicular to tissues to present refraction and it should be moved continuously to prevent concentration on one tissue area. Higher the frequency, greater the absorption and smaller the depth of penetration. [Read more...]
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