From the Guidelines
The duration of immobilization for a shoulder fracture should be as short as possible, typically not exceeding 2-3 weeks, to minimize the risk of frozen shoulder, and early range-of-motion exercises should begin within the first postoperative days. According to 1, following surgical treatment of a fracture of the shoulder, range-of-motion exercises including shoulder, elbow, wrist, and hand motion should begin within the first postoperative days. This approach is crucial for preventing frozen shoulder (adhesive capsulitis) and ensuring the best possible outcomes.
Some key points to consider for preventing frozen shoulder include:
- Early controlled mobilization as soon as medically appropriate
- Starting with pendulum exercises 3-5 times daily for 5 minutes each session
- Progressive passive and active range of motion exercises under the guidance of a physical therapist
- Applying heat for 10-15 minutes before exercises to improve tissue flexibility
- Pain management with appropriate medications like acetaminophen or NSAIDs to enable comfortable movement
It's essential to balance adequate immobilization for fracture healing with early enough mobilization to prevent stiffness, as prolonged immobility leads to joint stiffness due to the thickening and adhesion of the shoulder capsule. The specific timeline for immobilization and rehabilitation should be determined by an orthopedic specialist to ensure optimal recovery and minimize the risk of complications such as frozen shoulder. As noted in 1, overly aggressive physical therapy and exercises may increase the risk of fixation failure in the postoperative period, highlighting the need for a carefully planned rehabilitation approach.
From the Research
Duration of Immobilization for Shoulder Fractures
- The recommended duration of immobilization for a shoulder fracture is not clearly defined, with different studies suggesting varying periods of time 2, 3, 4.
- A study on primary anterior shoulder dislocation found that immobilization for one week or less had a similar rate of recurrent instability as immobilization for three weeks or longer 3.
- Another study on nonoperatively treated proximal humeral fractures found that 1-week immobilization and 3-week immobilization yielded similar results in terms of pain and functional outcomes 4.
Prevention of Frozen Shoulder
- Frozen shoulder, also known as adhesive capsulitis, can be a complication of immobilization after a shoulder fracture or dislocation.
- To prevent frozen shoulder, it is essential to maintain range of motion and strength in the shoulder joint during the immobilization period 5, 6.
- A study on reverse total shoulder arthroplasty found that 4 weeks of immobilization resulted in similar clinical and functional outcomes as 6 weeks of immobilization, with some patients experiencing faster recovery with the shorter immobilization period 6.
- Early mobilization and rehabilitation exercises can help prevent frozen shoulder and improve outcomes after a shoulder fracture or dislocation 3, 4.
Key Considerations
- The duration of immobilization should be individualized based on the specific fracture or dislocation, as well as the patient's overall health and activity level 2, 3.
- Regular follow-up with a healthcare provider is crucial to monitor progress and adjust the treatment plan as needed 5, 6, 4.
- Patients should be educated on proper immobilization techniques, as well as exercises to maintain range of motion and strength in the shoulder joint during the immobilization period 3, 4.