This document, authored by Jared T. Lee, MD, outlines the rehabilitation plan for patients with a non-operatively managed proximal humerus fracture.
The protocol includes:
- **Phases of Rehabilitation:** Three phases (Phase I: Weeks 0-5, Phase II: Weeks 6-12, and Phase 4: Week 12 and on), each with specific restrictions and therapeutic exercises.
- **Phase I:** Focuses on reducing swelling and edema, minimizing pain, retarding muscle atrophy, and allowing bony healing. Restrictions include wearing a sling at all times except for physical therapy, hygiene, and dressing. Therapeutic exercises involve hand, wrist, elbow, and cervical AROM, grip and wrist strengthening, PROM, modalities, pendulum exercises, soft tissue mobilization, and scapular stabilization. Active-assisted range of motion (AAROM) is initiated as pain diminishes and the patient is less apprehensive.
- **Phase II:** Aims to progress range of motion, minimize pain, and retard muscle atrophy. The sling is used for comfort. Therapeutic exercises focus on establishing full passive range of motion (PROM), beginning active range of motion (AROM), multi-angle isometrics, and progressing to TheraBand exercises, UBE with no resistance, prone extension and abduction, and Biceps/Triceps strengthening.
- **Phase 4:** Focuses on the progression of functional activities, advanced sport, and recreational activity per the surgeon. The sling is discontinued. Therapeutic exercises involve isotonic strengthening with weights in all directions, increased TheraBand or rubber tubing resistance, increased stretches, and functional or sport activity for strength gain. Criteria for discharge include specific strength deficits, limb similarity index, scores on biomechanical functional tests, and no pain or instability complaints.
The document provides a phased approach to rehabilitation, starting with basic range of motion and progressing to strengthening and functional activities.