Physiotherapists in Whitchurch treat many different conditions including the issues profiled below.

Physiotherapy for Fractures of the Humeral Head and Neck

Fractures of the upper part of the upper arm, the neck or head of the humerus, are common in older people who have fallen onto the arm but can occur in younger people who fall hard on the upper arm. The surgeon determines if the fracture is stable and not likely to require intervention. Physiotherapy checks difficulties with the hand, wrist and elbow and gives instruction in maintaining the ranges of motion of these joints. The ranges of the shoulder joint can be maintained in more stable fractures by the performance of pendular exercises, where the patient leans on their good hand and bends over at the waist, allowing the arm to hang forward like a pendulum and to swing back and forward gently as instructed.

At around three weeks from fracture the exercises are progressed to active assisted movements where the other arm is used to bring the arm up into flexion, and usually before six weeks the arm can be raised actively on its own to begin to restore strength into the shoulder muscles. Rotatory movement behind the back and behind the neck are also practiced to restore the vital rotation movements of the shoulder.

Shoulder Dislocation

The shoulder is an anatomically unstable joint as it is optimised for mobility rather than stability, allowing the hand to be placed in the very large number of positions required for optimal function. The shoulder socket (glenoid) is relatively small compared to the very large humeral head, leading to problems for the muscular and neurological systems as they struggle to keep the ball of the humerus centred on the socket during movement. The capsule of the shoulder, the fibrous bag which surrounds the whole shoulder joint, is relatively lax to allow for the large ranges of movement. This means it and its ligaments have little control over the joint and it relies on muscle control.

Dislocation is usually caused by a fall on the arm, especially if the arm in a position of abduction and lateral rotation, the position adopted by the .hands up!. posture. This is the most vulnerable position for the shoulder to dislocate anteriorly, i.e. the ball comes out of joint to the front. Immediate severe pain is the first symptom with the patient holding their arm in a protective position. Medical help is usually required to relocate the joint and there can be damage to the axillary nerve which control the deltoid muscle.