Shoulder Fractures & Broken Shoulders

Shoulder Fracture Fundamentals

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Trauma may cause a fracture of the humerus (ball) or the glenoid (socket) of the shoulder joint. The majority of these injuries can be treated without surgery with a good, long-term result. Some fractures are better treated with surgery because they may carry a high risk of arthritis if left alone. Some are unlikely to heal, or may heal in the wrong position if not treated surgically.

Fractures are either described as being displaced or non-displaced. Fortunately, nearly 80 percent of all shoulder fractures are non-displaced. This implies that the broken pieces remain near their anatomic position and treatment merely requires immobilization in a sling until the bone fragments heal. Most shoulder fractures heal in about six weeks. About 20 percent of shoulder fractures are displaced and may require some type of manipulation to restore normal anatomy.

Occasionally the rotator cuff muscles are injured or torn at the same time as the fracture. This can further complicate the treatment.

What are the symptoms?

• Shoulder Pain
• Swelling
• Tenderness
• Deformity or “bump” at the site of the fracture
• Discoloration around the upper arm
• Inability to normally move the arm without pain

What are my treatment options?

Medical

Most non-displaced fractures require immobilization in a sling until the fracture heals enough to be comfortable and permit motion without risk of dislodging the fracture fragments. X-rays are used to determine if sufficient healing has occurred to permit motion exercises.

It is vital to maintain flexibility of the elbow, wrist and fingers while resting the shoulder. With your doctor’s guidance, you may commence shoulder movement as the fracture heals. If the arm is moved too early, this can delay healing, but too little movement will result in stiffness.

Surgical

If the fracture fragments are displaced, surgical procedures may be necessary to bring the pieces together and fix them with wires, pins, plates or screws.

If the ball portion of the upper arm is broken, split or crushed, a shoulder replacement may become necessary.

Because the majority of shoulder fractures are non-displaced, recovery of good to excellent motion and function is often achieved. Displaced fractures often require surgery and may result in injury to the adjacent muscles. This can result in more shoulder pain, weakness and residual discomfort.

What are the risks of surgery?

Some of the risks of surgery of shoulder replacement include infection, wound healing problems, bleeding and injury to nerves and vessels near the fracture. Sometimes the shoulder gets very stiff. Occasionally, the fracture does not heal, and another operation may be recommended.

How do I prepare for surgery?

• Complete any pre-operative tests or lab work prescribed by your doctor.
• Arrange to have someone drive you home from the hospital.
• Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
• Call the appropriate surgery center to verify your appointment time. If your surgery is being done at Cleveland Clinic, call:

*   Main Campus: 216.444.HAND (4263)
*   Lutheran Hospital: 216.363.2311

• Refrain from eating or drinking anything after midnight the night before surgery.

What do I need to do the day of surgery?

• If you currently take any medications, take them the day of your surgery with just a sip of water.
• Do not wear any jewelry, body piercing, makeup, nail polish, hairpins or contacts.
• Leave valuables and money at home.
• Wear loose-fitting, comfortable clothing.

What happens after surgery?

We will ensure that you are comfortable and that you have adequate shoulder pain relief. You will receive prescriptions, etc., and your arm will be rested in a sling. Your surgeon and/or physical therapist will let you know whether any exercises are required.

How long is the recovery period after surgery?

This is often affected by the severity of your original injury. You may need assistance with dressing, bathing, washing and eating for five to 10 days. We will ensure that you have adequate amounts of pain medication to keep you comfortable.

Your doctor will examine you and evaluate your X-rays to determine your progress. Your return to work will be earlier for a desk job, and later for labor-related occupations.

What is the rehab after surgery?

Physical therapy to benefit motion and strength is often required to maximize recovery and improve outcome. Your doctor and therapist will work together and advise you on when to progress your activities and exercises.

How can I manage at home during recovery from the procedure?

This will depend on you and the presence of other injuries. You will be able to dress, feed and bathe yourself within a few days. You should keep the wound dry for the first five to 10 days.

How frequently should I schedule follow up appointments with my doctor following surgery?

You will be informed about the timing of your check-ups. Your doctor will review your progress and your X-rays periodically to let you know when to progress to the next level of activity.

Scapula fracture  · Virtual Fracture Clinic

This information will guide you through the next 6 weeks of your rehabilitation. Use the information below to gain a better understanding of your injury and what can be done to maximise your recovery.

Healing:	Your fracture is stable and does not need an operation. This injury normally takes 6-12 weeks to heal.
Pain:	Take pain killers as prescribed. You may find it easier to sleep propped up with pillows.
Using your arm:	Use the sling for the first 3 weeks to allow the soft tissues to settle. It is important to keep the shoulder moving to prevent stiffness but not to aggravate the injury.
Follow up:	You will see an Upper Limb Specialist about 3 weeks after your injury.  They may do another x-ray to evaluate the position of the fracture. The Specialist will talk through the next phase of your rehabilitation. If you have not received this appointment within one week of receipt of this letter please contact your hospitals Appointment Line.

Area of your injury

If you are worried that you are unable to follow this rehabilitation plan, or have any questions, then please phone the Fracture Care Team for advice.

Or, if you are experiencing pain or symptoms, other than at the site of the original injury or surrounding area, please get in touch using the telephone or e-mail details at the top of this letter.

What to expect

Advice for a new injury

Cold packs: A cold pack (ice pack or frozen peas wrapped in a damp towel) can provide short term pain relief. Apply this to the sore area for up to 15 minutes, every few hours ensuring the ice is never in direct contact with the skin.                                                    

Rest: Try to rest your shoulder for the first 24-72 hours. However, it is important to maintain movement. Gently move your shoulder following the exercises shown. These should not cause too much pain. This will ensure your shoulder does not become stiff and it will help the healing process.

Smoking advice

Medical evidence suggests that smoking prolongs fracture healing time. In extreme cases it can stop healing altogether. It is important that you consider this information with relation to your recent injury. Stopping smoking during the healing phase of your fracture will help ensure optimal recovery from this injury.

For advice on smoking cessation and local support available, please refer to the following website: http://smokefree.nhs.uk or discuss this with your GP.

Exercises

If you have stiffness in your elbow or hand from wearing the sling, you may wish to perform these exercises first. However, once they become easy you can start with the posture and pendulum exercises.

Initial exercises to do 4-5 times a day:

Finger and wrist flexion and extension

Open and close your hand as shown 10-15 times.

Then move your wrist up and down 10-15 times.

After a few days, hold a soft ball/ball of socks. Squeeze the ball as hard as possible without pain.

Hold for 5 seconds and repeat 10 times.

Elbow Bend to Straighten

Bend and straighten your elbow so you feel a mild to moderate stretch. You can use your other arm to assist if necessary. Do not push into pain. 

Forearm Rotations

Put your elbow at your side. Bend it to 90 degrees. Slowly rotate your palm up and down until you feel a mild to moderate stretch. You can use your other arm to assist if necessary. Do not push into pain. 

Repeat 10-15 times provided there is no increase in symptoms.

Postural awareness

Bring your shoulders back and squeeze your shoulder blades together as shown in the picture. Do this with or without your sling on.

Hold the position for 20-30 seconds and repeat 5 times provided there is no increase in symptoms.

Shoulder pendulum exercises

Stand and lean forward supporting yourself with your other hand. Try to relax your injured arm and let it hang down.

1. Swing your arm slowly and gently forwards and backwards.
2. Swing your arm slowly and gently side to side.
3. Swing your arm slowly and gently in circles clockwise.

Continue for approximately 1-2 minutes in total provided there is no increase in symptoms. Remember to try and relax your arm.

Stage 2 exercises

Start these exercises 3 weeks post injury and to do 4-5 times a day:

Active assisted Shoulder flexion

Use your other hand to lift your arm up in front of you as shown in the pictures.

Repeat 10 times provided there is no increase in symptoms.

Active assisted External rotation

Keep the elbow of your injured arm tucked into your side and your elbow bent. Hold onto a stick/umbrella/golf club or similar. Use your unaffected arm to push your injured hand outwards. Remember to keep your elbow tucked in. Push until you feel a stretch.

If you don’t have a stick you could simply hold the injured arm at the wrist and guide it outwards. 

Hold for 5 seconds and then return to the starting position. Repeat 10 times provided there is no increase in symptoms.

Stage 3 exercises

Start these exercises 6 weeks after your injury and to do 4-5 times a day.

When you have regained full range of movement in the stage 2 exercises without pain you can start to do these exercises without the support of your other hand. This is known as active range of movement. The, when you have regained full movement without helping with your other arm, you can build up your regular day to day activities.

Perform these exercises 10 times each. Only go as far as you can naturally, without doing any trick movements to try and get any further. The movement should increase over time and should not be forced.

Active Forward flexion:

With your thumb facing up, try to move your arm up, keeping it close beside your body.

Active Abduction

With your thumb facing up and outwards, try to move your arm in a big arc out to the side.

Active External Rotation

With your elbow by your side, rotate your forearm outwards, keeping your elbow at about 90 degrees in flexion.

Shoulder Fracture Surgery | OrthoVirginia

The type of surgery performed depends on the degree of damage, whether or not the fracture is displaced (out of position), and the bones and soft tissues affected. Surgical options include:

• Repair with hardware. The surgeon repositions the two ends of the facture into their normal alignment and holds them together with wires, pins, plates or screws.
• Partial shoulder replacement. The surgeon replaces the diseased head of the humerus with a prosthetic metal implant, while the other half of the shoulder joint, the glenoid, is left intact.
• Total shoulder replacement. The surgeon replaces the diseased head of the humerus with a highly polished metal ball attached to a stem, and replaces the glenoid with a plastic socket.
• Reverse shoulder replacement. In some complex fractures, the surgeon replaces the fractured head of the humerus with a socket attached to a stem in the arm bone, and replaces the glenoid with a highly-polished metal ball. The shoulder functions normally, although the positions of the ball and socked have been reversed.

Anatomy

The shoulder is a ball-and-socket joint made up of three bones: the humerus, scapula and clavicle. The muscles and tendons that surround the shoulder provide stability and support. All of these structures allow the shoulder to rotate through a greater range of motion than any other joint in the body.

When is surgery recommended?

Shoulder fracture surgery is recommended if the injury is severe, or the shoulder joint is displaced, not healing properly or not healing in the correct position. Surgery may also be necessary if the shoulder joint is very unstable.

What is the recovery time?

Recovery time varies based on your original injury and the type of surgery you have. A careful, well-planned rehabilitation program is critical to the success of shoulder fracture surgery. Most patients wear a sling for three to four weeks. Gentle physical therapy begins immediately following surgery to regain range of motion and progresses to include exercises that strengthen the shoulder joint. Total rehabilitation time usually takes several months, but as with all surgical procedures, specific recovery time varies by patient and demand. 

How Long Does It Take To Recover From A Shoulder Fracture?

How Long Does It Take To Recover From A Shoulder Fracture?

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The shoulder is made up of a group of bones that work together to make the shoulder and arm function. The shoulders are the complex joints that connect the arms to the body. It includes the humerus (upper arm bone), shoulder blade (scapula), and the collarbone (clavicle) and has the glenohumeral joint (ball and socket joints), acromioclavicular joint, and sternoclavicular joint.

A fracture in the shoulder can severely affect your mobility and cause severe pain. Shoulder fractures result from trauma or injury to the shoulder from a fall, sports injury, car accident, or direct impact to the shoulder. shoulder fractures can be very painful and may require surgery and medical attention. When you break your shoulder, it hurts. Therefore, immediately talk to your doctor and get treatment.

Hyderabad shoulder clinic surgeon Dr Chandra Skehar. B treats all types of shoulder fractures using the latest diagnostic techniques and treatments that will provide the best results. The goal of therapy is to restore movement and function to the arms and shoulders. Physiotherapy and controlled exercises tailored to your needs are essential to optimize recovery. 

Let us see this article to know more information about shoulder fractures and How long it takes to recover from a broken shoulder.

What is a Shoulder fracture?

A shoulder fracture is a broken bone in any part of the shoulder. These can range from thin cracks to complete cracks.  

Types of shoulder fractures:

A shoulder fracture can be:

• Non displaced: If the fractured segments of bone remain in place.
• Displaced: if the bone fragment breaks and the fragment is removed from its position. A displaced fracture may require surgery to realign the bone to heal in the correct position.

Most shoulder fractures are treated successfully without surgery. Non-surgical treatment is an option if the bones are not displaced, which means that the bones remain in the correct anatomical position.

Types of shoulder fractures include:

• Clavicle Fracture: Fracture of the clavicle which is known as the collarbone, is a long, thin bone that is at the base of the neck.
• Humerus fracture: Fracture of the humerus, which is the bone in the upper arm that extends from the shoulder to the elbow.
• Scapular Fracture: The scapula is a flat triangular bone in the upper back. Glenoid is part of the shoulder blades. These fractures are associated with falls or motor vehicle collisions and can cause shoulder dislocation or instability.

Contact Dr Chandra Sekhar. B If you have any of the following symptoms, to find out if you have a broken shoulder and experience the below symptoms:

• Shoulder pain
• Swelling or bruising on the shoulder
• Tenderness, pain to the touch, redness
• Your shoulder feels like it’s slipping out of place (shoulder instability)
• Your shoulders look deformed or out of place

Diagnosis of a fracture in the shoulder

To diagnose a shoulder fracture, the orthopaedic surgeon will order advanced imaging tests to determine the exact location of the fracture and the severity of your condition. We offer the latest advances in imaging tests and diagnostic tools to assess shoulder fractures, including:

• X-rays
• CT scan
• MRI
• Ultrasound of the musculoskeletal system

Our advanced imaging technology enables Hyderabad shoulder clinic musculoskeletal radiologist to provide an accurate diagnosis to help create the best treatment plan for treating your shoulder fracture.

How to treat a fracture in the shoulder:

Dr Chandra Sekhar. B  is a specialist in treating displaced and non-displaced shoulder fractures using the latest non-surgical and surgical techniques. Some shoulder fractures can be treated with non-surgical methods, while others require more complex surgical treatment to repair. Your treatment plan may require conservative and surgical techniques.

Most of the non-displaced shoulder fractures can be treated with conservative techniques, such as:

• Icing 
• Sling 
• Oral medication for pain relief
• Physiotherapy and exercise (started after the bone has begun to heal and under the close supervision of a physical therapist)

Most of the non-displaced fractures require immobilization in a sling until the fracture heals sufficiently to be comfortable and allow movement without the risk of displacing the fracture fragment. X-rays are used to determine if sufficient healing has occurred to enable movement exercise.

It is essential to maintain flexibility in your elbows, wrists, and fingers while resting your shoulders. With your doctor’s guidance, you can move your shoulder until the fracture heals. Moving the arm too early can slow healing, but too little movement causes stiffness.

Surgery:

If the fracture fragments are displaced, surgery may be required to assemble the parts and secure them with wires, pins, plates, or screws. If the ball of the upper arm is broken or bruised, the shoulder may need replacement.

Recovery from a broken shoulder

The healing time will vary depending on the type of fracture you have had. You may need help getting dressed, showering, and eating for five to ten days. Doctors make sure you have enough pain medication to keep you comfortable.

If you have a fracture that doesn’t require surgery, you will need to wear the sling for two to six weeks. Proximal fractures usually take the least time, whereas distal fractures take the longest.  

For severe fractures, you may need to have x-rays every few weeks for several months. Most people can return to their normal activity levels within a few months. Your doctor will examine you and evaluate your x-ray to determine your progress. You return to work earlier for office jobs and later for work-related jobs. Sometimes physical therapy or occupational therapy is needed to restore lost joint movement.

Recovery will largely depend on the severity of the fracture, the nature of the other injuries, and your general health. Recovery may take longer if you have an operation on the bone or nail plate at the same time. Meanwhile, the physiotherapist will create a series of individual exercises to increase shoulder mobility gradually. Follow the instructions, avoid possible injury during recovery, proceed slowly and try not to overdo it.

If you have surgery, you may need to wear a cast, sling, splint, or braces for several weeks. During this time, you will need to consult our doctor regularly so that he can assess how well the fracture is healing.

Age is also a relevant factor it takes longer for bone and tissue to repair in older people. However, on average, recovery from a broken shoulder can take about six weeks.

Exercises to increase the range of motion of the shoulder usually begin about a week after the injury. Delaying physiotherapy for too long can cause a loss of movement known as “frozen shoulder”. Regular arm movements will reduce stiffness and speed up your recovery.

Conclusion:

Hyderabad Shoulder clinic physical therapists, shoulder surgeons, and pain specialists create a personalized recovery plan to help you restore optimal shoulder function and significantly reduce or relieve pain caused by a shoulder fracture. Recovery depends on the severity of the fracture, its location, and the type of surgery you had. Because treatment is individualized, recovery is different for each person. Our doctor will discuss what will lead to your recovery, taking into account your lifestyle, special needs, and personal goals. For more information, Contact Dr Chandra Sekhar. B  at 9959588389 and book your appointment.

Proximal Humerus Fracture (Broken Shoulder)

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Basic Anatomy

Your shoulder is made up of three bones, the clavicle (collarbone), the scapula (shoulder blade) and the humerus (upper arm bone). The top part of your humerus is called the proximal part of the bone. Many muscles surround your shoulder. They include your rotator cuff muscles, deltoid muscle, pectorals muscle, and several strong muscles from your back. The arteries and nerves that supply your arm come out from under your clavicle bone and go down the arm in front of the shoulder.

Figure 1: A patient with a proximal humerus fracture. Front and side pictures show the swelling and bruising down the arm.

Figure 2: Skeleton model showing the proximal humerus and three other bones of the shoulder.

Figure 3: X-ray of a normal shoulder. The shoulder joint is between part of the scapula or shoulder blade (blue line) and the proximal humerus (green line).

Mechanism and Epidemiology

The proximal humerus is one of the most commonly broken bones in older people. It can occur after a normal fall or trip. Due to it being weaker in older people, the bone often breaks in multiple pieces.

For children and younger adults, a higher energy injury (like motor vehicle crashes, falls from height, and sports) is needed to break the proximal humerus. Because of the many muscles that attach to this part of the humerus, it can break in many different ways, and you need to talk to your doctor about the specific type of fracture you have.

Figure 4: Fracture lines separating (breaking) the proximal humerus into 2, 3, or 4 parts.

Initial Treatment

Proximal humerus fractures usually hurt a lot, especially when you try to move your arm. Simple breathing will cause pain. There may be a lot of swelling and bruising in your armpit, your chest, and down your arm. You may even have bruising in your hand or even fingers. When you first see a doctor, he or she will examine your shoulder and arm, and x-rays will be taken. Unless you have other injuries, most of the time you will be able to go home and will not be admitted to the hospital. You will likely be given a sling to use. Lying flat in a bed after a proximal humerus fracture can cause pain, so it may be more comfortable to sleep in a recliner chair. It is important to move your elbow, wrist, and hand to prevent stiffness. You should make an appointment with an orthopaedist or your primary care doctor for follow-up.

General Treatment

Most proximal humerus fractures can be treated without surgery. The broken bone will take 3 to 4 months to heal. During this time, you will need to perform exercises to regain range of motion, strength, and return to normal activities. Even if surgery is performed, recovery of full function often takes as long as 18 months. If surgery is not needed, there may be a time during which movement and lifting is limited. This decision will be made by your doctor based on your specific fracture.

Some proximal humerus fractures benefit from surgery. An orthopaedic surgeon can discuss your specific injury and the pros and cons of surgery vs. non-surgical treatment. Surgery is required if the bone came through your skin (open fracture) or is close to breaking through the skin. You may also need surgery if your shoulder is dislocated. Otherwise, there are few absolute reasons to do surgery. If surgery is chosen, the surgeon will make a cut over your shoulder, realign your bones, and use metal plates and screws to repair the broken bone. If your shoulder has broken into too many pieces and is unlikely to heal even if put back together, your surgeon may recommend replacing your shoulder instead of repairing it.

Figure 5: X-rays of a 2-part proximal humerus fracture treated without surgery. The image on the left was taken 2 weeks after injury and the image on the right shows the fracture healed 9 months later.

Figure 6: X-rays of a 3-part proximal humerus fracture before and after surgery.

Post-operative Care

While your proximal humerus fracture is healing, you will likely not be able to fully move your shoulder or lift objects that weigh more than 1 or 2 pounds. This may be due to pain and/or instructions from your surgeon. Many surgeons will ask you to avoid certain movements after surgery until the bone has begun to heal. Often, you will be prescribed physical therapy to help with motion, lifting, and pain after surgery. A sling may also be used for comfort. It is important to remove the sling several times a day and to move your elbow, wrist, and hand to prevent stiffness. Your ability to move your shoulder and lift more weight will improve as your bone heals. For best results, it is important to follow instructions from your surgeon.

Long Term

Long-term issues after fracture of the proximal humerus can include stiffness, soreness, and an inability to regain full, pre-injury strength. You may require several months of physical therapy to be able to return to your prior activities. Your shoulder may always feel and move differently compared to your uninjured side.

While most proximal humerus fractures heal, some may not heal or may heal in a position that causes discomfort or limits motion. Some people may develop arthritis and this can result in increasing pain and stiffness. These complications can occur with or without surgery. In older patients, shoulder replacement may be recommended if pain becomes too severe. In younger patients, your surgeon may recommend removal of the hardware or other surgery.

Figure 7: X-ray shows a shoulder replacement, which may be performed if the fracture is irreparable, or after complications following non-operative treatment or surgical repair.

More Information

Adults:

Children:

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Babar Shafiq, MD
Edited by the OTA Patient Education Committee and Steven Papp, MD (section lead)
X-rays and images from the personal collection of Dr. Shafiq and Christopher Domes, MD

Common Shoulder Fractures

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January 18th 2018

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Fracture of the Shoulder Blade Adelaide, SA

What are scapular fractures?

The scapula (shoulder blade) is a flat, triangular bone providing attachment to the muscles of the back, neck, chest and arm. The scapula has a body, neck and spine portion.

Scapular fractures are uncommon but do occur and require a large amount of force to fracture.

What are the causes of scapular fractures?

They are usually the result of intense trauma, such as a high-speed motor vehicle accident or a fall from a height onto one’s back. They can also occur from a fall on an outstretched arm if the humeral head impacts on the glenoid cavity.

What are the symptoms associated with a scapular fracture?

Symptoms of a scapular fracture include the following:

• Pain: Usually severe and immediate following injury to the scapula.
• Swelling: The scapular area quickly swells following the injury.
• Bruising: Bruising occurs soon after injury.
• Impaired Mobility: Decreased range of motion of the joint occurs, often with an inability to straighten the arm.
• Numbness: Numbness, tingling, or coldness of the hand and forearm can occur if the blood supply is impaired or nerves are injured.
• Popping Sound: A cracking or popping sound, also referred to as crepitus, can often be heard or felt at the time of the fracture.

Diagnosis of scapular fracture

Scapular fractures should be evaluated by an orthopaedic surgeon for proper diagnosis and treatment.

Your surgeon will perform the following:

• Medical History
• Physical Examination

Diagnostic Studies may include:

• X-rays: A form of electromagnetic radiation that is used to take pictures of bones.
• CT scan: This test creates images from multiple X-rays and shows your physician structures not seen on regular X-ray.
• MRI: Magnetic and radio waves are used to create a computer image of soft tissue such as nerves and ligaments.

Treatment of scapular fractures

Most scapular fractures are not significantly displaced due to the strong supporting soft tissue structures surrounding it. Therefore, most scapular fractures are treated conservatively and with an early motion to reduce the risk of stiffness and will usually heal without affecting shoulder movement.

Conservative treatment options include:

• Immobilization: A sling is used for comfort and to support the shoulder to allow healing to take place. This is usually worn about 3-6 weeks depending on the type of fracture and how well you heal.
• Prescription Medications: Pain medications will be prescribed for your comfort during the healing process.
• Physical Therapy: Early progressive range of motion exercises is essential in restoring full shoulder function. Your physician will most likely refer you to a Physical Therapist for instruction on proper exercises and early motion of the shoulder to prevent complications.

Surgical Introduction

Fractures of the scapula involving the neck or glenoid or with severe displacement have been associated with poor outcomes when treated non-operatively. will usually require surgical intervention to realign the bones properly and restore afunctional, Pain-free range of motion to the shoulder joint.

Scapular fracture repair surgery has historically been performed through a large, open incision. Newer, minimally invasive techniques have evolved and surgery to repair scapular fractures can now be performed through arthroscopy.

90,000 Fractures of the scapula – treatment, symptoms, causes, diagnosis

The scapula is a bony structure in the upper back that connects the shoulder to the rib cage. The scapula also forms a rosette (glenoid) of the shoulder joint that connects the humerus to the scapula. The acromion and coracoid process are bony protrusions whose function is to connect the clavicle to the scapula. The shoulder blade is surrounded by a thick layer of muscles that are responsible for functional movement in the shoulder joint.

• Fractures of the scapula are rare and account for less than 1% of all fractures.
• Fractures of the scapula are more common in young men aged 25-45 due to occupational activities and injuries. Fractures of the scapula are associated with sports, road traffic accidents and other blunt trauma.
• For a fracture of the scapula, significant force is required and, as a rule, a fracture of the scapula is accompanied by other injuries, which requires a thorough examination.
• Fractures can be localized in different parts of the scapula.

Reasons

Fractures of the scapula are caused by direct trauma with a large force vector. Typically, in 80% of cases, scapula fractures are accompanied by injuries to the chest, lungs and shoulder. Therefore, in the presence of a fracture of the scapula, a thorough examination for the presence of concomitant injuries is necessary. The main causes of scapula fracture are as follows:

• Traffic accidents
• Falls with direct shoulder injury
• Fall on outstretched arm
• Direct hit, e. g. with a baseball bat or hammer

Symptoms

Pain, swelling, and bruising may appear both in the scapula in the upper back and in the upper shoulder above the coracoid process and acromion.

• The patient will hold the hand on the side of the injured scapula, pressed against the body.
• Hand movement will increase scapula pain.
• The patient will not be able to raise his arm from the side of the scapula fracture.
• The patient may experience pain with each deep breath, as the chest moves during breathing. This movement can cause the broken scapula to move, causing pain.
• There may be a flattening or deformation of the shoulder with a fracture of the scapula.

Symptoms that require medical attention if a shoulder or upper back injury occurs:

• Pain on movement in the injured shoulder
• Shoulder edema
• Bruises around the shoulder
• If shoulder pain does not decrease within 3-5 days

Symptoms such as shortness of breath, numbness in the injured arm, severe pain in the arm or shoulder, deformity of the shoulder, especially when there are other chest injuries to the neck or back, are grounds for emergency hospitalization.

Diagnostics

The diagnosis of a fracture of the scapula is established on the basis of examination and analysis of instrumental research methods.

• Chest and shoulder x-rays are taken.
• CT scan of the abdominal cavity and chest, to identify possible trauma to other organs and systems.
• CT of the shoulder is necessary if it is necessary to exclude an intra-articular fracture.

Sometimes scapula fractures are diagnosed during examination associated with more serious injuries (falls, road accidents).

Treatment

Since scapula fractures are often associated with severe, potentially life-threatening injuries, the patient must be urgently hospitalized.

• It is necessary to fix and restrict any movement. Fixation can be carried out using a special bandage. The arm is bent at the elbow joint, brought to the body and suspended on a kerchief bandage.
• Apply an ice pack, avoiding direct contact of the ice with the skin, to the injured area to reduce swelling and discomfort.
• Due to the fact that in 80% of cases of fracture of the scapula is accompanied by other injuries, the patient must be hospitalized in the emergency department of the emergency room.

Most scapula fractures are treated without surgery.

The use of non-steroidal anti-inflammatory (NSAID) and analgesics can reduce pain and inflammation. The drugs are prescribed in the presence of pain syndrome during the period of bone tissue regeneration.Given the side effects of these drugs, the drugs should be taken only under the supervision of the attending physician.

Immobilization, as a rule, is necessary for 3-4 weeks before the disappearance of pain

exercise therapy. Exercise should be started as early as possible (you can start a week after the injury) so as to avoid the development of periarthritis of the shoulder scapula (a decrease in the range of motion can occur with prolonged immobilization of the shoulder).

Physiotherapy is used in the recovery period to improve regeneration and improve blood circulation in the shoulder.

Surgical treatment

Surgical treatment for fractures of the scapula is necessary for some types of fractures, mainly in cases where there is damage to the glenoid cavity (rosette) or the neck of the scapula. Timely consultation of a traumatologist allows you to determine the necessary treatment tactics.

Forecast and prevention

Fracture of the scapula can be avoided with the utmost care when practicing the following sports:

• where there is a high risk of falls (rock climbing, parachuting, hang gliding)
• contact sports (football, hockey) mixed style fighting

Always wear seat belts when driving.

Most scapula fractures heal without complications within 6-8 weeks. Fractures, in which there is damage to the glenoid cavity of the shoulder, require a long recovery and, as a rule, are accompanied by certain complications.

Complications after a fracture of the scapula can be as follows:

• Decreased range of motion in the shoulder
• Decreased Strength
• Persistent pain
• Bursitis
• Arthrosis
• Since most patients with scapula fractures have other serious injuries, the prognosis in such cases depends on the nature and severity of these injuries (for example, spinal fractures, head injuries, internal injuries such as rupture of the spleen or liver) …

Fracture of the scapula, clavicle – fracture symptoms, first aid and treatment, rehabilitation – Department of Traumatology, Central Clinical Hospital, Russian Academy of Sciences

The scapula is relatively rarely injured, since it is blocked by muscles on all sides. Clavicle fractures are relatively common. Children and young people suffer more often.

Fractures and dislocations of the clavicle and scapula may be due to impact, fall on the shoulder joint, or outstretched arm.

Fracture symptoms and diagnosis

• Deformation of the clavicle is visible;
• abnormal mobility;
• swelling;
• crepitus of bone fragments.

The presence of the listed signs of a fracture does not cause difficulties in making a diagnosis.

The initial diagnosis can only be made on the basis of swelling, tenderness, and hematoma. The final diagnosis will be made by the surgeon based on the X-ray examination.

Treatment

The victim is given an anesthetic and the limb is fixed. The hand should be hung on a scarf or attached to the body with a bandage. Hospitalization in the traumatology department is recommended. The patient should be transported in a sitting position.

• Treatment begins with pain relief.
• The next stage is the reposition of bone fragments;
• immobilization using rings or an eight-band dressing.

The general principle of treatment for fractures of the scapula and collarbone is to apply a bandage that will provide the greatest peace of mind with relaxed muscles and prevent displacement.

Fracture of the scapula without displacement of the fragments is treated by the imposition of a diverting splint. Healing occurs within 36-5 weeks.

If the fracture is displaced, bone fragments are repositioned using a skeletal traction system (the installation takes place under local anesthesia).

Surgical treatment is used if the splinter affects the nerve bundle or there is a threat of skin perforation.

A complex of physiotherapeutic procedures and physiotherapy exercises are recommended for patients.

The lack of effective medical care leads to dysfunction of the limb, as it happens:

• change in biomechanical parameters;
• muscle atrophy;
• strength reduction.

Where to go?

Fractures of the clavicle and scapula are treated in the trauma department of the Central Clinical Hospital of the Russian Academy of Sciences. Highly qualified doctors will provide accurate diagnostics, provide treatment and help restore lost functions. Appointments are made on the website. Answers to your questions can be obtained by calling the specified phone number.

Fracture of the scapula – Medical center “Liko-Med”

Publication date
3 October 2018

What is it?

The blade breaks relatively rarely.This usually happens due to severe traumatic effects, for example, in a car accident. The broken scapula must be immobilized. This fracture will heal on its own over time. Severe trauma may require surgery.

Ambulance

Call an ambulance immediately if injured in an accident and severe shoulder pain accompanied by shortness of breath, decreased sensitivity in the injured arm, or abdominal pain.Also, emergency help is needed if the shoulder is deformed or if it is impossible to move the shoulder or arm.

What to expect?

Most scapula fractures heal within two months without complications. Serious fractures may require surgery. Fractures in children tend to heal better and more quickly than in adults, because children’s bones are less fragile and continue to grow. Severe fractures in adults can lead to decreased range of motion, loss of strength, chronic pain, and early arthritis.

Treatment

Typically, scapular fractures are treated with pain relievers and ice to reduce swelling. The shoulder is usually immobilized with a sling for up to one month until the pain goes away. Your doctor may recommend a range of movement exercises for the recovery period of the shoulder. This contributes to the complete restoration of movement, which may take from six months to a year. Some scapula injuries can be severe enough to require surgery.Surgeons use plates and screws to hold broken bones together.

What can you do yourself?

Because scapula fractures are often associated with potentially life-threatening severe injuries, their assessment should be done in a hospital emergency department. On the way to the hospital, you should keep your hand motionless, securing it in a sling. To reduce swelling and pain, ice should be applied to the injured area for 20 minutes.

How does it get worse?

Attempts to move the injured shoulder aggravate the victim’s condition.

When to see a doctor?

90,000 Interventions for the treatment of shoulder fractures in adults

Relevance

Fracture of the upper part of the humerus (proximal humerus) is a common injury in the elderly. This is often referred to as a shoulder fracture. Typically, a bone fracture (bone breaks) occurs at a location just below the shoulder, usually after a fall. Most of these fractures occur without compromising the integrity of the skin overlying the fracture.The affected arm is often supported with a bandage until the fracture has healed sufficiently to allow movement of the shoulder to be restored. More severe (displaced) fractures can be treated with surgery. This may include fixing the fracture fragments using various means. Alternatively, the upper part of the fractured bone can be replaced (half “shoulder” replacement hemiarthroplasty). Less commonly, the entire joint is replaced, including the articular capsule (complete “shoulder” replacement). Physical therapy is often used to help restore function.

Search results

We searched medical databases up to November 2014 and included randomized trials (31 studies) with a total of 1941 participants. Only one study tested most of the 18 treatment comparisons. The best evidence came from eight studies, one of which was a relatively large multicenter study. These studies investigated whether surgical treatment was better than non-surgical treatment for displaced fractures.

Main results

Nine trials evaluated non-surgical treatment for less severe fractures. One trial showed that the belt type was generally more comfortable than the body bandage. There was some evidence that early mobilization (within one week), compared to delayed mobilization (after three weeks), resulted in less pain and faster recovery in people with “stable” fractures.Two studies provided weak evidence that many patients could achieve positive outcomes with sufficient instruction (instruction) for independent exercise.

Eight studies, involving 567 people with displaced fractures, compared surgical versus non-surgical treatment. Patient-reported pooled results from the five most recent studies showed that there were no significant differences between the two approaches for measures of effect such as function and quality of life at 6, 12 and 24 months.There was little difference in mortality between the two groups. Twice as many patients in the group with surgical intervention were operated additionally or a second time. More patients in the surgery group had adverse events.

Twelve trials (744 participants) studied various surgical methods. There was weak evidence for some differences (eg complications) between some interventions (eg different devices or different ways of using devices).

There was very limited evidence showing similar results for early mobilization versus delayed after surgical fixation or hemiarthroplasty.

Quality of evidence

Most of the 31 studies identified deficiencies that could affect the validity of their results. We believe that the evidence was either high or moderate quality when comparing surgery versus non-surgical treatment.This means that we are very confident that these results are reliable. The quality of the evidence for other comparisons was rated as “low” or “very low,” which means that we have very little confidence in these results.

Conclusions

Surgical interventions do not lead to a better outcome for most people with displaced fractures of the proximal humerus and are likely to result in a greater need for follow-up surgery.There is insufficient evidence to determine the best non-surgical or surgical treatment for these fractures.

Mikhail Borisovich Tsykunov. FSBI “NMITs TO named after N.N. Priorov”

Main directions of medical and diagnostic activities

• Organization of the rehabilitation process in traumatology and orthopedics
• Development of rehabilitation programs for pathology of the organs of movement and support
• Development and testing of new methods of establishing a rehabilitation diagnosis, rehabilitation actions and rehabilitation equipment
• Management of planned research topics of employees
• Supervision of dissertation work of employees and external applicants in the specialties “14.01.15 – traumatology and orthopedics “,” 03/14/11 ˗ Rehabilitation medicine, sports medicine, physiotherapy exercises, balneology and physiotherapy “
• Scientific editing of translations of monographs
• Expert work in the commissions of the Ministry of Health of the Russian Federation on medical rehabilitation issues
• Scientific editing of materials for publication in the journal “Bulletin of Traumatology and Orthopedics named after N.N. Priorova “
• Preparation and editing of clinical guidelines for traumatology and orthopedics (section – rehabilitation)

Educational activities:

• Residency training in the specialty “physiotherapy exercises and sports medicine”
• Reading a course of lectures of primary specialization in the specialty “Physical and Rehabilitation Medicine”
• Preparation of tests and situational tasks in physical and rehabilitation medicine for the accreditation of specialists

Education

Graduated from the Pediatric Faculty of the 2nd Moscow Medical Institute.N.I. Pirogov, clinical residency in physiotherapy exercises and medical supervision of the same university.

Data on advanced training and (or) professional retraining

Regularly improves qualifications;

Certified as a traumatologist orthopedist;

Physician in physiotherapy exercises and sports medicine;

Physiotherapist;

Trained and certified in physical and rehabilitation medicine, incl.h. ERSRM (European Association for Physical and Rehabilitation Medicine), is the deputy. Chairman of the CPP (Union of Rehabilitologists of Russia), a member of ERSPM and IRSPM (World Association for Physical and Rehabilitation Medicine).

Scientific activity, professional achievements

Since 1978 he has been working in the Department of Medical Rehabilitation of CITO, first as a doctor, then as a researcher, and from 1995 to the present time, the head of the department.

Since the publication of the journal “Bulletin of Traumatology and Orthopedics named afterN.N. Priorova ”is the executive secretary of its editorial board. He is a member of the editorial boards of several leading scientific journals in Russia on rehabilitation issues.

Author of monographs, guidelines, textbooks, reference books, clinical guidelines and articles in scientific journals.

Is engaged in the training of residents in the specialty of physiotherapy exercises and sports medicine, graduate students and doctoral students, has patents of the Russian Federation.

90,000 “Night of Sapper Spades” 1989 in Tbilisi.Eyewitness memories 30 years later

• Nina Akhmeteli
• BBC, Tbilisi

April 9, 2019

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Video caption,

Tbilisi the events of April 9, 1989,

April 9, 1989 is one of the most tragic dates in the history of modern Georgia. Thirty years ago, troops broke up a peaceful anti-Soviet demonstration in central Tbilisi.

Indefinite protest actions began in connection with the demands sounded in Abkhazia to withdraw from the Georgian SSR. But soon the demonstrators in Tbilisi began to call for the independence of Georgia.

The operation to suppress the demonstration began at about 4 a.m. on 9 April. During the dispersal, batons, sapper shovels and toxic substances were used.

Photo author, TASS / Shakhvelaz Aivazov

As a result of the dispersal, 20 people were killed, of which three were minors, and the majority were women.

Another victim of those events was 25-year-old Gia Karseladze, who was killed after the announcement of the curfew.

About two hundred people were hospitalized during and in the first hours after the dispersal, thousands went to hospitals in the following days.

A curfew was declared in the city, but the violence used by the soldiers of the Soviet army only rallied the supporters of Georgia’s sovereignty and independence.

“On the morning of April 9, the Soviet Union ceased to exist for Georgia.Everything was in place: the Central Committee, the government, and the security forces – only the Soviet Union was gone, no one listened to decisions and instructions from above, “says Irakli Menagarishvili, director of the Center for Strategic Studies, who was then Minister of Health of the Georgian SSR.

Photo author, Yuri Mechitov

On April 9, 1991, exactly two years after the tragic events in Tbilisi, the act of restoring the country’s independence was adopted.

Participants of those events remember the night, which in Georgia began to be called “Bloody Sunday”.

Lali Kanchaveli, mother of the deceased 15-year-old Eka Bezhanishvili

Eka went to rallies. I did not interfere with this, because then everyone walked, everyone gathered, and there was no fear. On that day, her father took her to physics, she went to the teacher.

From there she went to Rustaveli Avenue. But I was late for home, although I was never late. We went to look for her at eight o’clock in the evening.

I remember that I found her and just then the patriarch came out to the protesters. She said we’ll listen to the patriarch and leave, but then we didn’t have time to leave.

The Patriarch called on people to move to the Kashveti church, but there were calls from the people and those who supervised [the protest action] not to do this.

Photo by Yuri Mechitov

Patriarch of Georgia Ilia II appealed to the rally to those who were shortly before the dispersal, urging them to go to the church of Kashveti and warning them of the real danger, which may be in minutes.But participants mitin ha remained on the avenue – approx. BBC .

I remember in a dream that I was holding her hand. My husband was then looking for her from the other side, he was pushed aside by a wave of people towards the Kashvetskaya church.

After the words of the patriarch, the dispersal began, and then I don’t remember anything. I lost consciousness, apparently from a blow … Probably, they hit me first, she did not leave me, then they hit her too.

My hair was then dyed a light color. I was later told that one of the police officers said: “A dark-skinned, curly-haired girl was killed at a fair-haired woman.”

My relatives have been looking for me for four days. It was difficult to recognize me, I looked like an 80-year-old, swollen, teeth knocked out. When I came to, my consciousness was scattered, I could not count until five. The arm was broken. I could not move my leg …

I was first treated in Aramyants ( Tbilisi hospital . – BBC ), then transferred to a neurological hospital. When I was transported there, my daughter was buried.

Photo author, TASS / Shakhvelaz Aivazov

Photo caption,

Thousands of people came to the funeral of those killed on April 9

I have a trace of the impact just below the shoulder blades. Later we learned that there were poisonous substances. I was taken to Germany, my husband was helped at work with this.

They cleaned my blood, but it was not possible to fully restore my leg so that I could walk on my own.They said we are doctors, but not gods. Today I cannot walk even 10 meters alone. My leg grows numb, and I fall. And I go at home using a chair.

Commission of People’s Deputies chaired by Anatoly Sobchak named “ undoubtedly recognized ” Chloroacetophenone and Si toxic substances causing , among others , severe lacrimation, sharp pain in the eyes, burning in the throat and blistering of the skin. In samples , also , a suffocating substance chloropicrin was found, but the commission did not find an explanation for its origin. In the report it was noted that the picture of intoxication of the participants of the Tbilisi rally was characterized by “ mass character, a significant number of moderate and severe poisoning, certain features of clinical manifestation in the form of signs of” neurotropic “action ” .

Photo author, Yuri Mechitov

I didn’t attend my daughter’s funeral, I didn’t even know about it.For 40 days of Ekuna, I was also in the hospital. When I started to come to my senses, I asked where she was. I was told that she was in the village, then with relatives. No one could dare to tell me the truth, and it was only when my mother came to me with a photograph in her hands that I began to guess what had happened. Everything gradually began to recover in memory after six months….

Eka’s skull was broken and her arms were broken. Later I found out, I collected it piece by piece from what my relatives were quietly whispering about.They sprayed [toxic substances] into her because, as they said, her hair was brown then, although she had curly black hair and her face was swollen. It was impossible to recognize her – she looked like an adult woman.

She had notes. She wrote how a person can die so as not to leave their mark. I don’t know what can be seen in this trail, because after that we went through so many misfortunes.

I often thought that – and I will only say about my child – if Georgia needed such a sacrifice in order for Georgia to be happy, let Eka be this sacrifice.If only the Lord did not take me away so that I could not convey to her the news that her homeland became happy.

Mimosa Parjiani, senior physician of the Tbilisi Ambulance Center

Up to 40 ambulance teams constantly went to this meeting. We replaced each other. The ambulance then only accepted emergency calls, because everyone was mobilized, everyone was expecting something unpleasant. And this, unfortunately, happened.

It was a demonstration of violence, injustice and suppression of the desire for freedom.It was horror. They walked with shovels and poisonous substances. These young people fell, they crossed over them, trampled …

As soon as the acceleration began, we drove up from below, from the side of the Kashveti church. At that moment there was no fear, you do not feel danger. I concentrated on getting as many victims as possible out of that place and rescuing them.

Everyone was injured there then. Firstly, mass hysteria, a moment of fear, and secondly, intoxication, gas poisoning, tearing, they could not see, coughing and injuries, of course – some had heads, some had backs.Everyone there was injured, including the ambulance doctors. My eyes still bother me.

Photo author, TASS / Vladimir Valishvili and Ivan Shlamov

Photo caption,

After the dispersal of the demonstration in the streets of Tbilisi, a curfew was imposed

There was an attempt to use violence against us. When I tried to open all the doors of the ambulance so that as many victims as possible got into it, one of the soldiers came out and swung a shovel. He did not hit, but with such a threatening gesture he made me understand that I should stop.But we, of course, took these victims to the hospital.

After that I went back to check if someone had stayed there – either under a tree or somewhere in the hills of rubbish.

The most terrible thing that remained in my memory was the morning Rustaveli Avenue on April 9th. The military groups who spoke to each other were contented and happy. And terrible silence, only the sound of the wind.

Piles of rubbish, bags, shoes and mattresses used by the protesters. On the eve it was a smiling, cheerful, singing Rustaveli, and on the second day – a destroyed avenue.Many years have passed, but this terrible picture remains in my memory.

Photo author, Yuri Mechitov

Irma Inaridze, activist, Women’s Initiatives Support Group

On April 7, I came tired from one of the rallies and remember that on April 8 in the morning I was awakened by the roar of a tank. The tanks were already in the city, and I don’t even remember how I jumped up then, got dressed and ran to Rustaveli.

According to report of the Sobchak Commission, on April 8, three squadrons of military helicopters flew around the city at low altitude, and military equipment with armed soldiers proceeded along the streets of Tbilisi and past the protesters, which played a provoking role approx. BBC .

We met in front of the monument to Akaki Tsereteli and Ilya Chavchavadze. There I saw all my friends who were alarmed by the fact that there was a punitive detachment and tanks in the city.

We then decided that we must stand there and show that we have no strength but our unity. We must demand more sovereignty and the right to vote so that we have more freedom.

Photo author, Yuri Mechitov

For us then, this freedom was all united: our ideological, mental, and sexual freedom; what worried us as young people was liberation from this Soviet abyss.All this was in one and therefore was called the “national liberation movement”.

We knew that people could be dispersed. But I didn’t expect this to happen.

I was sitting on the stairs at the Government House. Then there were statues and nearby bushes. The guys stood behind so that the people who were sitting on the stairs would not be driven there and shot ….

I remember that someone started dancing, singing, I well remember the sound of truncheons on the helmets that the soldiers were holding in their hands when the tanks were walking.

I remember screaming, some guy stood behind me and shouted: “What are you doing, there are women and girls standing here!”

When I got off the stairs, it was impossible to move from the spot. The crowd began to move in a wave due to the crush, I fell, there were people on me, and I almost suffocated.

Photo author, Getty Images / TASS

Photo caption,

Government House, where the demonstrators gathered

My friend called me in some terribly thin voice, grabbed my hair, and I woke up.We crawled and fell into the pit. The bushes were apparently broken, and I remember that the broken sprout dug into my stomach, but I could not change position – I was in such a state that I did not feel the body.

Then our police officers saw us, and they literally threw us onto the street that runs from the Government House. A guy I knew took me home to my grandmother.

In the morning she took me to the hospital, and only there I learned that there were dead. Although I felt that something terrible had happened, because I remember in black and white shots these screams and this mess of people.My whole body was bruised, both eyes were reddened….

Photo author, Yuri Mechitov

The collapse of the Soviet Union began on April 9. I have a metaphor: the Soviet Union is like a thick Chinese wall of brick layers. We must gradually get bricks out of this wall.

It is our duty to try to make this wall as thin as possible. It started on April 9th ​​and continues today. This is a very long process.

What to do and what not to do if you have problems with the spine – Rossiyskaya Gazeta

A council of experts was held at the RG media center, which discussed a topic of concern, without exaggeration, to millions of Russians.These are back pain, health and spinal column diseases.

Jalal Saidbegov, professor of the Sapienza University of Rome, doctor of medicine, author of the just published book “If your back hurts”, took part in the discussion; Head of the Department of Nervous Diseases of the Moscow State University of Medicine and Dentistry, Doctor of Medicine, Professor Igor Stulin; Head of the Department of Pathophysiology, Moscow State University of Medicine and Dentistry, Doctor of Medicine, Professor Igor Malyshev; and about. Head of the Center for Manual Therapy of the Moscow Healthcare Department, Candidate of Medical Sciences Sergei Kanaev; Sergei Trukhanov, associate professor of the Department of Nervous Diseases, Moscow State University of Medicine and Dentistry.

Dear experts, why are more and more people experiencing back pain at an ever younger age?

Jalal Saidbegov: Indeed, the pathology of the spine is getting younger. My youngest patient was a 12-year-old girl who was diagnosed with two rather large intervertebral hernias. And according to statistics, after 35-40 years, up to 80 percent of the population suffers from back pain caused by a hernia or protrusion of the disc, or discopathy.What is the reason for this? With the fact that today a person is constantly sitting – at home, at work, on vacation, etc. The famous Swedish orthopedic traumatologist, Professor Nahimson measured how the pressure in the intervertebral discs changes depending on the posture. So, when a person sits leaning forward, the intradiscal pressure increases significantly, due to which the disc wears out, discopathies, protrusions, etc. are formed.

Igor Malyshev: The quality of diagnostics also contributes to the growth of morbidity.If earlier no one went to doctors with back pain and did not get into any statistics of the program, today both the rejuvenation of pathology and the increase in the number of patients are, of course, partly due to better diagnostics and people’s faith in medicine.

Sergey Kanaev: WHO regularly publishes global data on morbidity, disability, etc. In such a report for 2017, the first place among the reasons that disrupt the normal functioning of a person is pain in the lower back.Fifth place is neck pain. Despite the fact that formally these conditions do not affect life expectancy and mortality, they greatly reduce the quality of life. And the quality of life is the main goal of modern medicine. Yes, the main cause of back pain is a sedentary lifestyle, and from childhood. Previously, after school, children walked, ran, played in the air.

At school they were taught how to sit properly, how to use a book holder. Now children mostly sit or even lie at home – at the computer and gadgets.Now computers have taken over office work, not only does a person sits all day, he also sits incorrectly. You need to sit so that the center of gravity of the head coincides with the center of gravity of the body, the shoulders should be relaxed. Instead, the monitor stands on the side, the person sits half-turned, in an unnatural position, the shoulders are raised, tense. Often the size of the fonts on the screen is not adjusted, so the person also pulls his neck towards the monitor. Naturally, the back muscles will be overstrained, and by the evening due to muscle hypertonicity, the shoulders, neck and head will ache.And if this is repeated from day to day, hypertonicity becomes chronic, and here we have a ready patient with chronic pain in the neck and lower back.

80 percent of the population suffers from back pain

From the school anatomy course, we remember that the nerves that extend from the spinal cord innervate all internal organs, all body systems. Does the condition of the spine affect the functioning of the brain?

Igor Stulin: The main artery that supplies blood to the brain is the carotid artery.It supplies the brain up to 70 percent of the blood from one heartbeat, the remaining 30 percent goes to the kidneys, liver and other organs. But there are also vertebral arteries that carry blood to the cerebellum, to the brain stem, where the center of balance and other important parts are located. Any vertebral artery, before it delivers blood there, makes five bends. And violations in the spine at the level of the cervical spine, of course, can prevent this. Therefore, it is very important to determine with the help of modern diagnostic methods the indications and contraindications for manual therapy in the cervical spine.Unfortunately, this selection is not always carried out carefully, and this can lead to dramatic outcomes.

Sergey Kanaev: I run the only specialized center for manual therapy in Russia. 9-10 thousand patients come to us a year. But we do not take everyone for treatment, because there are contraindications to these methods, there are quite a few of them. And if the doctor does not take into account the patient’s contraindications for manual therapy, this is dangerous. But if the selection is correct, there is no risk.I would like to remind you that the Ministry of Health and the Ministry of Education and Science have established uniform qualification requirements for all manual therapists. And the indications, as well as contraindications, are also the same everywhere. If they are not followed somewhere, this only means that either the doctor is not qualified, or the leadership that allows such a doctor to work.

Igor Yurievich, you are studying the body’s immune response to various diseases. Is there a connection between the state of immunity and the occurrence of problems with the spine?

Igor Malyshev: Spinal pathology is not a monopathology.It is associated with metabolic disorders and the immune system. Why does manual therapy have a beneficial effect on some patients, and even after spinal surgery they recover quickly and well? Others seem to have done everything right, but there is no recovery, there is even a deterioration. The idea that the immune system somehow affects the spine arose a long time ago. Scientists also paid attention to the fact that some patients have spontaneous resorption of intervertebral hernias. Research has shown that two factors play a very important role.The first is which cells are present in the interdisk space. It turned out that there are many immune cells. Among them there are T cells, which are specialized in resorption, that is, the destruction of hard tissues – bone and cartilage. And there are macrophage cells that secrete substances that can lyse, that is, dissolve bone and cartilage tissue. The second factor is that there are no vessels in the cartilaginous capsule of the vertebrae. And as a result of mechanical pressure, macrophages begin to produce a factor that enhances the growth of blood vessels.And they help relieve inflammation. When we compared the histological picture of different patients, it turned out that some people have many macrophages and new vessels – and they recover well. Other macrophages and blood vessels do not have, and the result of the treatment, too. Perhaps it is the mechanical effect on the spine, which is used by the doctors of manual therapy, that activates the work of immune cells. Therefore, it seems to me that it is necessary to introduce into the practice of manual therapy doctors, and an initial assessment of the immune status.Then the success of the treatment can be much higher.

When back problems arise, residents of large cities can easily find adequate medical care. But many Russians live in small towns and villages where there is no chiropractor or immunologist. Who is there to contact for help?

Sergei Kanaev: It is most logical to consult a doctor who regularly monitors him and knows all his concomitant diseases. This is a local therapist or general practitioner.They can prescribe the simplest therapy that is safe for the patient. It is often sufficient to take only non-steroidal anti-inflammatory drugs. But keep in mind that there are many of them on the market, and they all have serious side effects. Therefore, you should not take them yourself. The doctor who observes the patient and knows his concomitant diseases will prescribe drugs that are safe for him specifically.

If you have back pain, you should not postpone the visit to the doctor. While the patient is treating himself or rushing about private medical practitioners, precious time will be lost

Jalal Saidbegov: I recommend painkillers very rarely.And in no case do I advise you to use warming ointments, pepper plaster. If there is a hernia, then the inflammation is already there, with warming it can only intensify.

Sergey Kanaev: The second point is that often lower back pain masks a much more serious disease. And if within some reasonable time his condition does not improve, then the doctor must decide which specialist the patient should be referred to – a rheumatologist, a neurologist, or immediately to a neurosurgeon. And in some cases, surgical treatment will be the method of choice.That is why you should not postpone the visit to the doctor if you have back pain. While the patient is being treated himself, thinking where to go or rushing about private practicing doctors, the level and qualifications of which are unknown, precious time will be lost at best. Moreover, it is a sin to be honest, people who do not have proper education often pass themselves off as manual therapy doctors or osteopaths. Even a banal massage is often taken by people who do not even have a secondary medical education.

What treatment methods are considered the most justifiable today?

Sergey Kanaev: From the point of view of evidence-based medicine, now the only approach to the treatment of back pain is an interdisciplinary multimodal approach.There is no one method that can replace all the others. Treatment methods can be roughly divided into medication and non-medication. According to international reviews, physiotherapy exercises, manual therapy show effectiveness comparable to drug methods. And there are no significant advantages of one method over another. Therefore, it is also necessary to take into account the availability of a particular method, safety, as well as the patient’s adherence to one or another treatment.

Are the manual manipulation techniques themselves standardized, clinical guidelines developed? Or is it some kind of creativity every time?

Sergey Kanaev: These methods of influence are strictly standardized, manual therapy doctors are taught the same way.But this can be compared to the fact that all housewives know how to cook borscht, but everyone cooks differently. The manipulations themselves are clearly described. But which of them and how to apply to a specific patient – this is the subject of medical experience, if you like – medical art. It is no longer possible to prescribe this by any standards or orders.

There are many centers in Moscow that provide such services. There are also doctors who claim to have developed their own method of treatment. Jalal Gadzhievich, you are using your own method – non-invasive repositioning of the vertebrae and joints.What is its essence?

Jalal Saidbegov: This technique is based on the approaches of the doctor Nikolai Andreevich Kasyan, a hereditary chiropractor. When manipulating the cervical spine, we use the technique of the Czech doctor Karel Levit. It seems to some that this is a very easy profession – I did three, four steps – and cured the patient. I’ve been doing this for 33 years. And every day I learn from each patient, I discover something new for myself. And it’s a very stressful job if you do it seriously.As for osteopaths, chiropractors – in my opinion, this is the problem of modern medicine. In the United States, to become an osteopath, you need to study at a university for five years. In Italy, and even in Russia, these “specialists” often have no medical education at all.

Igor Dmitrievich, have you ever had any patients who had complications after manual manipulations?

Igor Stulin: I know of five cases with tetraparesis, that is, paralysis of all limbs. Only an emergency operation can help such people.

There is also such a pathology as spinal instability. Human anatomy is very different, the ligamentous apparatus too. And the vertebral artery is so peculiar that it can split. I would not recommend manual exposure to such patients.

Hanging on the horizontal bar from time to time is beneficial for the health and flexibility of the spine. Photo: Shostak Danila / TASS

Can blood pressure rise after a course of massage?

Igor Stulin: Quite.The patient may have high blood pressure, some kind of pathology of internal organs, diabetes mellitus manifests itself very badly in this regard.

Sergey Kanaev: But again, this is not a problem of manual therapy as a method of treatment, but a problem of patient selection. The second problem is the choice of a doctor. It would never occur to anyone to go to an acquaintance to some miracle doctor who will perform a knee operation with a kitchen knife at home. But for some reason, going to a person who positions himself as a chiropractor, osteopath, massage therapist, but in fact is not, is quite often.Naturally, without the necessary examination and taking into account concomitant diseases, a person will receive the whole range of complications.

Most neurologists advocate conservative methods for the treatment of intervertebral disc herniation. And in what cases is a hernia surgery inevitable?

Jalal Saidbegov: Pain syndrome is not present in all hernias. About 25 percent of hernias, even of large sizes, the person himself does not even suspect. They are found by accident, performing an MRI for some reason.Conversely, it is not just hernia that can cause pain. Sometimes it is caused by an excessive amount of intra-articular fluid. Pain receptors can also be irritated by inflammation. But these conditions do not require surgery. Therefore, the selection for surgical treatment must be very careful.

Sergey Kanaev: The cause of back pain can be not only a lesion of the disc, often it is caused by ligaments and muscles.

In practice, neurosurgeons unjustifiably expand the pool of “their” patients, or, conversely, do not notice someone?

Sergey Trukhanov: There are some small studies on this topic.We often cite not very high numbers of positive and conditionally positive outcomes in those patients who were operated on. This is most likely due to the excessive expansion of the patient pool.

Igor Stulin: Herniated discs are found in almost every healthy person. A survey was carried out of 400 young doctors who are being trained to work on submarines. They all had MRI scans, and 80 percent of them found this notorious hernia, which never showed up and will never show up.Nothing hurts the patient, and sometimes they say to him: we will remove this silent hernia, and you will have a guarantee that pain will not occur. But there is a good principle: the best surgery is the one you don’t need to do. Therefore, before deciding on an operation, you need to listen to the opinion of three different doctors, or even four.

Jalal Saidbegov: For many years I have been a member of Eurospine, the world’s most authoritative association of spine pathology doctors. At her congresses every year they say more and more often: it is necessary to operate less.

But at every congress there is an exhibition – new equipment, artificial discs, etc. The interests of manufacturing companies are behind all this.

D Please give your recommendations to those who have back problems.

Jalal Saidbegov: You need to analyze your lifestyle, pay special attention to children, especially when they go to school. There used to be Erisman’s desks in schools, which he invented back in 1870. There was a crossbar under the desk on which you could put your feet.In this case, the lower back is not strained. And if this support is not, then the load goes to the intervertebral discs. It would be worth returning to these desks, making them adapted to the child’s growth, adjusting them in height, providing a stand for a book, a tablet, etc. There would not be as many scoliosis in children as today.

This probably also applies to office workers sitting?

Sergey Kanaev: As soon as a person feels that he is uncomfortable, begins to experience a feeling of stiffness, tightness, he just has to get up, stretch, walk for a few minutes.

Jalal Saidbegov: I recommend hanging on the horizontal bar for a minute. And if there is no horizontal bar, but there are strong doors, then on them. Finally, you can simply stand at the table, lean on it with outstretched arms and lower abdomen, and hang, relax your lower back, count to ten. This gives good relaxation to the muscles of the entire back. And, of course, to do feasible physical education: walk more, swim, move.

Important

Contraindications to the use of manual influence on the spine:

– “cauda equina syndrome”;

– displacement of the spinal cord, structural changes in it;

– deterioration after long conservative treatment;.

– increased permeability of the vascular wall,

– infectious diseases,

– high blood pressure,

– violation of blood rheology;

– oncological processes in the central nervous system and in the vertebrae;

– acute injuries;

– osteoporosis.