Proximal humerus fracture rehabilitation.

UNLABELLED: The occurrence of proximal humerus fractures will continue to rise with the increasing elderly population. Many patients with proximal humerus fractures have osteoporosis and have poor neuromuscular control mechanisms. This predisposes them to future falls and additional fractures. Patients continue to have shoulder problems as a result of the fracture for many years after the injury. Rehabilitation is central to addressing the problems caused by the fracture. The review of the literature on proximal humerus rehabilitation suggests that treatment must begin immediately if the harmful effects of immobilization are to be avoided. Electrotherapy or hydrotherapy does not enhance recovery and joint mobilization has limited evidence of its efficacy. In the United Kingdom most patients are immobilized routinely for 3 weeks or longer and are referred for physical therapy. The best available evidence for shoulder rehabilitation emphasizes using advice, exercise, and mobilization of limited joints to restore upper limb function. Placing controlled stresses throughout the fracture site at an early stage will optimize bone repair without increasing complication rates. This approach requires cooperation between the referring surgeon and therapist and will optimize the patient's shoulder function and maintain their functional independence. LEVEL OF EVIDENCE: Diagnostic study, level II (systematic review of level II studies). See the Guidelines for Authors for a complete description of levels of evidence.