Broken Shoulder

Broken Shoulder Blade Overview

The scapula or shoulder blade is a bony structure found on the upper back that connects the upper arm to the chest wall (thorax). It also forms the socket part of the shoulder joint connecting the upper arm (humerus) to the socket (glenoid). The acromion and coracoid processes are bony bumps found on the upper part of the scapula, and they function to connect the scapula to the collarbone. The scapula is surrounded by thick layers of muscle that are responsible for the smooth movement of the shoulder joint.

• The shoulder blade (scapula) is rarely broken (broken bones are also called fractures). Of all bone breaks, shoulder blade breaks occur less than 1% of the time.
• Scapular fractures occur more often in young men ages 25 to 45 because of the activities and trauma they encounter. These occur with athletic activities, motor vehicle accidents, and other forms of blunt trauma.
• Broken shoulder blades are often caused by heavy forces that might also include severe injuries to the chest, lungs, and internal organs.
• Fractures (breaks) have been reported at many areas along the scapula.

Broken Shoulder Blade Causes

Scapular fractures are caused by direct trauma involving a large amount of force or violence. Associated injuries to chest wall, lungs, and shoulder occur in up to 80% of people with broken shoulder blades. Common causes of broken shoulder blades include the following:

• Motor vehicle accidents
• Falls with direct trauma to the shoulder
• Falls onto an outstretched arm
• Direct trauma such as from a baseball bat or hammer

Broken Shoulder Blade Symptoms

Pain, swelling, and bruising may occur over the shoulder blade in the upper back or on the top of the shoulder overlying the coracoid and acromion processes.

Other signs of a broken shoulder blade may include:

• Holding the injured arm close to the body
• Moving the arm increases the pain
• Inability to lift the arm
• Having pain with each deep breath due to movement of the chest wall with each breath; this movement may in turn move the shoulder blade, causing pain.
• Shoulder appears flattened or deformed

When to Seek Medical Care

Call your doctor if you notice any of these conditions:

• Pain with movement of the shoulder
• Swelling of the shoulder
• Bruising around the shoulder
• If shoulder pain fails to improve within 3-5 days

Significant trauma to the shoulder, chest wall, back, or neck can cause severe injuries and should be evaluated in a hospital’s emergency department.

• If you experience any of the following with an injury, call 911 for an ambulance immediately:
  • Shortness of breath
  • Decreased sensation in the affected arm
  • Abdominal pain
• Go to the emergency department for evaluation if you experience the following:
  • Severe pain or deformity of the shoulder
  • Inability to move the shoulder or arm
  • Weakness, numbness, or persistent tingling in the injured arm

Exams and Tests

A doctor will be able to diagnose a broken shoulder blade after a thorough physical examination and imaging.

• Shoulder and chest X-rays are taken.
• CT scans of the abdomen and chest are sometimes indicated to evaluate other injuries.
• MRI or CT scans of the shoulder are sometimes needed to diagnose fractures of the shoulder socket (glenoid).
• Fractures of the scapula are sometimes discovered during extensive evaluations after major trauma from falls, motor vehicle accidents, or direct trauma.

Broken Shoulder Blade Treatment Self-Care at Home

Because shoulder blade fractures are often associated with severe, potentially life-threatening injuries, they should be evaluated in a hospital’s emergency department.

• Immobilize the arm immediately. Don’t move it. This can be accomplished with a sling looped over the neck and the bent elbow, which holds the affected arm close to the body.
• Apply ice to the area to reduce swelling and discomfort.
• Apply ice for 20 minutes at a time, and avoid direct contact of the ice to the skin.

Medical Treatment

The goal of treatment is to maintain function of the shoulder. Most fractures of the body of the scapula are treated without surgery.

• Ice is used for swelling, and pain medications are used for pain control.
• The shoulder is immobilized in a shoulder sling for 3-4 weeks until the pain goes away.

Surgery

Surgical treatment may be needed for certain types of scapular fractures, mostly those involving the shoulder socket (glenoid) or neck of the shoulder blade. Early consultation with an orthopedic surgeon (a surgeon who specializes in bone injuries) or a trauma surgeon will help determine what course of treatment is best for you.

Other Therapy

Early physical therapy with exercises designed to improve the range of shoulder motion usually is started about one week after the injury. It is important to start these exercises early to avoid a frozen shoulder. A loss of motion in the shoulder can occur if the shoulder is not used for a prolonged period.

Next Steps Follow-up

Broken shoulder blades should receive ongoing treatment by an orthopedic surgeon or sports medicine specialist to ensure proper healing.

• Follow the instructions you are given when you leave the hospital and avoid potential trauma while recovering.
• Pain medications and immobilization will likely be needed to control pain while early in the recovery period.

Prevention

Broken shoulder blades can be prevented by avoiding high-risk activities such as the following:

• Activities with potential for falls from significant heights such as rock climbing, hang-gliding, or skydiving
• Contact sports
• Driving without a seatbelt

Outlook

Most fractures of the shoulder blade heal without complications within 6-8 weeks. Fractures that involve the shoulder socket or scapular neck develop more complications.

• Complications may include the following:
  • Loss of range of motion
  • Loss of strength
  • Persistent pain
  • Early arthritis
• Many people with scapular fractures have other serious injuries, and their prognosis depends on the nature of these other injuries.

Synonyms and Keywords

scapula fracture, fractured shoulder blade, broken scapula, broken shoulder blade

Proximal Humerus Fracture (Broken Humerus)



Proximal Humerus Fracture (Broken Humerus) | Reno Orthopedic Center

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  • Bruce Witmer, MD Spine & Pain Care

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  • Eric Boyden, MD Joint Replacement

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  • Jackson Jones, MD Joint Replacement

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  • John Zebrack, MD General Orthopedic Surgery

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CT Images of the Shoulder

What does a broken collarbone /clavicle look like on a CT scan?

According to news reports, Tony Romo of the Dallas Cowboys had a CT scan showing a broken left clavicle. At this point it appears he will not need surgery but will be off the field for 6 to 8 weeks. 

Clavicle fundamentals

The clavicle (collarbone) connects the shoulder to the chest wall. Fractures can result from either an indirect trauma like a fall to an outstretched arm or due to a direct hit to the collarbone.

Sports with a high probability of direct or indirect trauma from falls or contact include football, hockey, and skiing. The clavicle, or collarbone, rests over very important structures: the subclavian artery and vein are the major circulatory structures supplying the arm with blood. The brachial plexus are the nerves coming out of the neck and going to the arm. Clavicle fractures can, but rarely do, cause injury to these structures.

Symptoms

As with any like fracture acute clavicle or shoulder pain, swelling and bruising are the most common symptoms along with pain when moving the arm.

What to do

Immediately after injury or impact the arm should be immobilized in a sling for comfort. To reduce swelling and pain, ice may be applied and anti-inflammatory medication used if appropriate.

Treatment options

Over 90 percent of such fractures heal without surgery. Two common options are use of a sling or a splint (i.e., figure 8 splint). Both are meant to keep the fragments still throughout the healing process of approximately 6 to 8 weeks. As your bones mend, you can start limited motion exercises to help prevent a frozen shoulder.

Most fractures do not require surgery; however, surgery may be appropriate if the collarbone is widely separated. Surgery is also recommended when nerve vessel injury occurs or if the fracture has not healed properly. If the fracture brakes through the skin surgery may be appropriate to minimize the risk of infection.

X-schouder – Startradiology

Indication/Technique

The primary reason to make a shoulder x-ray is to confirm or exclude the presence of a fracture. Additionally, the image can provide information on the position of the shoulder joint, any bone abnormalities (including bone tumors) and soft tissue disorders (think of calcifications in the rotator cuff muscles).

Many hospitals have their own protocol for shoulder imaging.

A standard image normally includes an anteroposterior (AP) image (fig 1). It can be made either in endorotation or in exorotation.

Figure 1. Anteroposterior (AP) image. a.  Positioning. b. Image in endorotation. c. Image in exorotation.

Options then include a Y image (= scapulolateral image), an axial image (arm in 30-degree abduction), and an apical oblique image (AP image where the beam is aimed 45 degrees craniocaudal).

Figure 2. Positioning (a) in a Y image (b).

Figure 3. Positioning (a) in an axial image (b).

Figure 4. Positioning (a) in an apical oblique image (b).

Each image has benefits and drawbacks. 
Axial (fig. 3) and Y images (fig. 2) effectively detect luxations. In the axial direction, the glenoid and humeral head can also be accurately assessed. A significant drawback is the abduction the patient must make (particularly for the axial image), which may be painful in a trauma setting. The Y image may be less painful, but the small glenoid/humeral head fragments may be missed. 
The benefit of the apical oblique image (fig. 4) is that the Hills-Sach lesions and glenoid fractures are reliably detected (see Luxations section). Additionally, patients generally find this image non-painful.

Acromioclavicular (AC) image

The AC joint is imaged from anterior to posterior.  The beam is aimed caudocranial and may vary from 10-15° to 30-45° (fig. 5).

Figure 5. Positioning (a) in a 10-degrees acromioclavicular (AC) image (b).

Normal anatomy

AP image

The humeral head is not perfectly symmetrically round. On the AP image, the head has a configuration of a wooden walking stick (fig. 6).

♦ Figure 6. Normal configuration of the humerus on an AP image.

See the normal anatomy on the AP image by moving the mouse to figure 7 and figure 8.

♦ Figure 7. Normal shoulder anatomy in an AP image in endorotation.

♦ Figure 8. Normal shoulder anatomy in an AP image in exorotation.

Y image

The Y configuration is formed by the scapula (= stem), the scapular spine and the coracoid process (= legs). The central point in the Y shape is the glenoid. The humeral head should overlap the center of the Y shape (fig. 9).
Orientation tip: anterior is the side of the rib cage.

♦ Figure 9. Normal anatomy in a Y image of the shoulder.

Axial image

For orientation: compare the glenohumeral joint with a golf ball (humeral head) and a tee (glenoid). The acromion and the coracoid process could be visualized as the index finger and thumb respectively, always pointing towards anterior (fig. 10).
Reminder: the ABC rule: Acromion, golf Ball, Coracoid process.

♦ Figure 10. Normal anatomy in an axial image of the shoulder (a/b).

Apical oblique image

The humeral head should be located at the level of the glenoid.

♦ Figure 11. Normal anatomy in an apical oblique image.

Acromioclavicular (AC) joint

The bottom of the acromion should align with the bottom of the distal clavicle (fig. 12). If not, be alert for an AC luxation.

♦ Figure 12. Normal anatomy in an AC image (a/b).

Checklist

The following points may be used as a guide to assess shoulder X-rays.

1. Can the images be accurately evaluated? Has everything been imaged? If not, have an additional image made if you cannot reliably answer the question.

2. Is it the shoulder of a child or an adult? What is your general impression of the bone?

3. What is the position of the humeral head? Is there normal articulation with the glenoid? (Is it in a luxated position or is there e.g. osteoarthritis?).

4. If an AC image: can you draw a straight line at the bottom of the acromion/clavicle? 

5. Check each cortex. Are there irregular cortical interruptions anywhere? If so, can you see a fracture line?

6. Are there abnormalities outside of the shoulder joint? (Think of ribs, lungs and soft tissues?)

Pathology

• Fracture

• Luxation

• Osteoarthritis

• Rotator cuff impingement

Proximal humeral fracture

Fracture (= broken bone): interruption in the continuity of the bone.

Fracture (= broken bone): interruption in the continuity of the bone.
Proximal humeral fractures occur frequently, particularly in elderly osteoporotic patients.
A commonly used classification is the Neer classification. The humeral head is subdivided into 4 segments (fig. 13):

I.  humeral shaft.

II. humeral head (the articulating segment).

III. greater tubercle (where rotator cuff muscles insert except the subscapularis muscle).

IV. lesser tubercle (where subscapularis muscle inserts).

Figure 13. The 4 segments of the humeral head.

The anatomical neck is located between the 2 tubercles and the humeral head. 
The surgical neck is a predilection site for fractures and is located between the humeral shaft and the 2 tubercles.

In a humeral fracture, fracture fragments may move away from their normal anatomical position, also known as dislocation. 
In a proximal humeral fracture, there is dislocation if:

– the fracture fragment moves >= 1 cm

and/or

– angulation (= curving) of a fracture fragment of > 45°

Neer classification (fig 14/15):

• 1-part: non-dislocated fractures (well over 80% of all proximal humeral fractures).
• 2-part: dislocation with a fracture through the surgical neck or the greater tubercle or the lesser tubercle.
• 3-part: dislocation with a fracture through the surgical neck with the greater tubercle or together with the lesser tubercle.
• 4-part: dislocation with a fracture through the surgical neck and the greater tubercle and lesser tubercle and through the anatomical neck.

Figure 14. Examples of a 1-part, 2-part, 3-part and 4-part proximal humeral fracture.

♦ Figure 15. Greater tubercle fracture without dislocation, 1-part proximal humeral fracture (a). A 4-part proximal humeral fracture dislocation (b) A fat-fluid level can be seen in the 4-part fracture, suggestive of lipohemarthrosis.

 

If a 3 or 4-part fracture is suspected, an additional CT scan is generally made.

Unfavorable prognostic characteristics for fracture healing & stability:

• Many “parts”.
• >1 cm dislocation at the level of the medial transition of the humeral shaft to the humeral head (= disruption of the “medial hinge”). Vascularization is compromised (high risk of humeral head necrosis!).
• Dislocation of greater tubercle in subacromial space (= space immediately under the acromion).

Luxation

Luxation: dislocation, interruption of the normal interrelation between the components of a joint.

Anterior shoulder luxation (> 95%)

Findings in anterior luxation (fig. 16/17):

• AP image: the humeral head is located under the coracoid process.
• Axial image: the humeral head (golf ball) is anterior of the glenoid (tee).
• Y image: the humeral head is no longer located centrally in the Y configuration, it has moved to anterior (= towards the rib cage).

♦ Figure 16. Anterior shoulder luxation on an AP image, with dislocation to anterocaudal (a). Compare the position with a normal image (b).

♦ Figure 17. A Y image in an anterior shoulder luxation. The shoulder is dislocated to anterior (a). Compare the position with a normal Y image (b).

Posterior shoulder luxation (< 5%)

In a posterior shoulder luxation, the shoulder is luxated backward. Posterior luxation is rare and usually arises as a result of electroshock therapy or muscle spasm in an epileptic seizure. It is a condition that is frequently missed.

Findings in posterior luxation:

• AP image: the humeral head has lost its characteristic walking stick configuration. The head looks rounder now, like a lightbulb. This is called the lightbulb sign (fig. 18). The patient cannot exorotate the arm, which is in mild endorotation.
  If the humeral head is rotated internally with sufficient force against the back rim of the glenoid, the trough line sign can be seen (fig. 19). This is an additional line projecting over the humeral head (directly lateral from the inside of the humeral head contour). This additional line corresponds with an indentation fracture (see Shoulder luxation complications section).

♦ Figure 18. Lightbulb sign in a posterior shoulder luxation on an AP image (a). A normal AP image of the right shoulder for comparison (b).

♦ Figure 19. Trough line sign (red dotted line) in posterior shoulder luxation (a). A normal AP image of the right shoulder for comparison (b).

• Axial image/apical oblique image: the humeral head (golf ball) is posterior of the glenoid (tee).
• Y image:  the humeral head is posterior of the Y configuration (= away from the rib cage). See figure 20.

♦ Figure 20. Y image of a posterior luxation of the left shoulder (a). A normal right shoulder for comparison (b).

Pitfalls:

• If a patient is in pain, he/she will not always be able to exorotate the shoulder, holding it in an endorotation position. This could give rise to a lightbulb sign. So always check in the other directions whether this is actually a posterior luxation.
• Trauma/fracture may cause hemorrhage in the joint, pushing the humeral head downward (caudal dislocation, termed drooping shoulder). This is a pseudo-luxation. Once the hemorrhage is resorbed, the pseudo-luxation will resolve (usually within 1-2 weeks).

Shoulder luxation complications

The shoulder joint socket surface (= glenoid) is enlarged by a cartilage ring, the so-called labrum. The labrum consists of cartilage and connective tissue. This outer socket ring increases shoulder joint stability. 
In an anterior shoulder luxation, the humeral head is dislocated forward/downward with great force. In a traumatic luxation, this movement will usually damage the labrum at the caudoanterior side, also known as the Bankart lesion. With sufficient force, a part of the bony glenoid may be involved (= bony Bankart lesion) (fig 21).

♦ Figure 21. A patient with persistent instability following anterior shoulder luxation. This is a bony Bankart lesion. Also note the fractures and the irregular humeral head.

A traumatic luxation will usually cause an impaction fracture (‘indentation’) on the outer-far side of the humeral head, the so-called Hill-Sachs lesion. As the lesion is on the posterolateral side, an AP image in endorotation is the most effective way to detect the lesion (fig. 22).
Mechanism: an anterior luxation is caused by a forceful movement in the anterocaudal direction. The (soft) cartilage of the posterolateral humeral head is forced against the front of the glenoid, causing an indentation.  
The (rare) posterior shoulder luxations may cause similar complications, but then at the exact opposite location. The reversed Bankart lesion (posterior glenoid side) and the reversed Hill-Sachs lesion (anterior humeral head side). The reversed Hill-Sachs lesion presents on a shoulder x-ray as the so-called trough line sign (fig. 19).

♦ Figure 22. Status after relocated anterior shoulder luxation. The AP image (in endorotation) reveals a defect of the posterolateral humeral head consistent with Hill-Sachs lesion (a). A normal AP image for comparison (b).

Both the Hill-Sachs lesion and the Bankart lesion may be difficult to detect on a conventional x-ray. Therefore a CT or MRI of the shoulder is frequently opted for if one of these lesions is suspected.

Acromioclavicular (AC) luxation:

The AC joint is most reliably assessed on the AC image. The joint can be imaged under various angles. 
The underside of the acromion should align with the underside of the distal clavicle (fig. 23). If there is a dislocation of more than 8 mm, be alert for an AC luxation (note: 8-10 mm may still be normal in some adults). The clinic, including the piano key phenomenon, is key to the diagnosis of AC luxation.
When in doubt, imaging the other AC joint may be helpful.

♦ Figure 23. Normal articulation (a) vs. an AC luxation (b).

Osteoarthritis

Osteoarthritis gives rise to diverse symptoms. Patients may complain about progressive load-dependent pain and/or reduced shoulder function. 
The osteoarthritis may be primary with no obvious identifiable cause. Secondary osteoarthritis may develop following a fracture or a rotator cuff muscle rupture.

Radiological characteristics of osteoarthritis (fig. 24/25):

• Narrowing of the joint space (secondary to labrum disorders and loss of cartilage).
• Subchondral sclerosis (increased bone production secondary to increased pressure with cartilage loss).
• Osteophyte formation (bone exostoses attempting to increase the joint surface).
• Subchondral cysts (secondary to microfractures of the subchondral bone and pressure of the synovial fluid).
• Synovitis

♦ Figure 24. Osteoarthritis of the glenohumeral joint (a). A normal shoulder for comparison (b).

♦ Figure 25. Osteoarthritis of the AC joint (a). A normal AC joint for comparison (b).

Rotator cuff impingement

Impingement (= pinching) of the rotator cuff muscles, biceps brachii longus and the subacromial bursa is the most common cause of rotator cuff pain. The pain is generally located at the front and lateral side of the shoulder. Lifting the upper arm (= abduction) can be particularly painful.
In impingement, the tendons and/or bursa have become pinched between the summit of the shoulder (= acromion) and the humeral head. 
Chronic impingement may lead to weakening or degeneration (= tendinopathy) of the tendons. In view of its location and vascularization, the supraspinatus tendon is the most susceptible to impingement.
Even though this is soft tissue pathology, the shoulder x-ray may provide evidence for rotator cuff impingement.  Chronic impingement may give rise to calcifications in the tendon, particularly the supraspinatus tendon (fig. 26). This process is also known as tendinitis calcarea. The exact cause of this accumulation of calcium is unknown.

♦ Figure 26. Tendinitis calcarea of the supraspinatus tendon.

Sources

• B.J. Manaster et al. The Requisites – Musculoskeletal Imaging. 2007.
• N. Raby et al. Accident & Emergency Radiology – A Survival Guide. 2005.
• R.W.Bucholz Rockwood & Green’s Fracturen in Adults. 2006.
• Richtlijn Acute primaire schouderluxatie: diagnostiek en behandeling. 2005, Nederlandse Orthopaedische Vereniging.
• Richtlijnen Regio West Richtlijnen voor behandeling van Letsels van het steun- en bewegingsapparaat.
• R.F. Kilcoyne et al. The Neer classification of displaced proximal humeral fractures spectrum of findings on plain radiographs and CT scans. AJR Am J Roentgenol 1990.

Author

• Annelies van der Plas, MSK radiologist Maastricht UMC+

• Prof.

  dr. J.L. Bloem, radiologist LUMC

24/01/2014 (English translation 16/07/2016)

Copyright
All the work (text, illustrations, visual elements) seen on this website is copyright by Annelies van der Plas.
It may not be used without written permission of Annelies van der Plas.

Test Yourself

Test Yourself

The Shoulder

The Shoulder

Norwich Image Interpretation Course

Heidi Nunn (Advanced Practice Reporting Radiographer)

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Fracture prevalence
Projections
Normal paediatric anatomy
Proximal humerus
Clavicle
Scapula
Glenoid

Anterior dislocation
Posterior dislocation
Acromioclavicular joint subluxation
Pseudo-subluxation
Rotator cuff arthropathy
Bone metastases
Simple bone cyst

(hover over images to zoom, click to enlarge)

• Assess skeletal radiographs using a systematic approach
• Understand the different radiographic projections and how the anatomy changes with position
• Understand what injuries will be demonstrated on different projections
• Describe shoulder girdle anatomy
• Understand mechanisms of injury and the likely fractures/dislocations which may result
• Recognise less common fractures to the individual bones of the shoulder girdle
• Accurately describe glenohumeral dislocations and associated fractures
• Understand common eponyms
• Recognise potential ligament injuries
• Identify normal paediatric anatomy and the development of secondary ossification centres
• Recognise common pathological conditions seen around the shoulder girdle

• A fall onto the shoulder tends to result in specific injuries depending on the general age of the patient:

• AP – then view image.

  The second image may be:

• Supero-inferior axial or infero-superior axial if the AP is normal, and the patient can easily abduct their arm.
• Modified axial, or lateral scapula “Y” view. The patient does not need to abduct their arm for these views and these projections can be easily obtained with the patient on a trolley.

• Are usually easy to spot. If the fracture is minimally displaced and overlies the scapula/ribs, an angled up projection is helpful.
• Fractures of the middle third of the clavicle are most common (especially in <20 year olds). Fractures of the lateral third are more likely to be seen in an older age group. Fractures of the medial third are uncommon.

• Will occur due to high velocity, eg, RTA.
• Can be subtle due to overlying ribs/clavicle. If the mechanism of injury fits, then the scapula must be scrutinised, particularly the blade and spine of the scapula, and also the corocoid and acromion processes:

• Fractures to the anterior lip of the glenoid are usually very subtle and are therefore easily missed. They may occur due to direct trauma or following anterior dislocation.

• Tend to occur due to muscle spasm during epileptic fits, or electric shock.
• The humerus is usually internally rotated, therefore the humeral head has a “light bulb” appearance on the AP. This is not always the case, however. There is widening of the joint (>6mm) as the humeral head is displaced laterally; this is called the rim sign. On the axial, the humeral head will be displaced towards the acromion/away from the ribs:

• Associated with avulsion fractures of the lesser tuberosity. Also, a medial and anterior humeral head compression fracture may be evident (trough line).

• Width of the normal joint is less than 7mm in adults. Widening indicates moderate sprain with rupture of the acromioclavicular ligament.
• The inferior surfaces of the lateral clavicle and the acromion should be level. Subluxation is identified when the clavicle is elevated due to rupture of the coracoclavicular ligaments:

• Blood within the joint causes inferior subluxation of the humeral head, however, this is not a true dislocation. Look for a possible underlying fracture:

• Causes superior elevation of the humeral head, with reduction in the subacromial space, often with erosions developing on the inferior surface of the acromion. Causes impingement of the supraspinatus tendon. May occur in association with RA.

• Primary tumours often metastasise to the proximal humerus, and it is important to search for any moth-eaten, lytic lesions, or areas of sclerosis.
• Potential lesions may be an incidental finding on a non-fractured humerus, or the fracture may be pathological in origin:

• A benign lytic lesion that is often seen at the diametaphyseal region of the proximal humerus. Again, may be an incidental finding, however, will sometimes fracture.
• “Falling fragment sign” is sometimes seen, which refers to cortical fragments from the fracture, which fall through the fluid-filled lesion:

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Shoulder Fracture in Children – What You Need to Know

1. CareNotes
2. Shoulder Fracture in Children

This material must not be used for commercial purposes, or in any hospital or medical facility. Failure to comply may result in legal action.

WHAT YOU NEED TO KNOW:

What is a shoulder fracture?

A shoulder fracture is a break in a shoulder bone. The shoulder bones include the humerus (arm bone), scapula (shoulder blade), and clavicle (collarbone).

What are the signs and symptoms of a shoulder fracture?

• Pain and swelling
• A change in the shape of your child’s shoulder or a bump near the shoulder
• Trouble moving the shoulder or arm
• A grinding or cracking noise when your child moves the shoulder or arm
• Numbness or tingling in your child’s arm, hand, or fingers

How is a shoulder fracture diagnosed and treated?

Your child’s healthcare provider will examine him or her. X-ray pictures will show the location of the fracture and how severe it is. Treatment will depend on your child’s age, the location of the fracture, and how severe the fracture is. It may take several weeks for your child’s fracture to heal. Your child may need any of the following:

• NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor’s order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If your child takes blood thinner medicine, always ask if NSAIDs are safe for him or her. Always read the medicine label and follow directions. Do not give these medicines to children under 6 months of age without direction from your child’s healthcare provider.
• Acetaminophen decreases pain and fever. It is available without a doctor’s order. Ask how much to give your child and how often to give it. Follow directions. Read the labels of all other medicines your child uses to see if they also contain acetaminophen, or ask your child’s doctor or pharmacist. Acetaminophen can cause liver damage if not taken correctly.
• Prescription pain medicine may be given. Ask your child’s healthcare provider how to give this medicine safely. Some prescription pain medicines contain acetaminophen. Do not give your child other medicines that contain acetaminophen without talking to a healthcare provider. Too much acetaminophen may cause liver damage. Prescription pain medicine may cause constipation. Ask your child’s healthcare provider how to prevent or treat constipation.
• A sling or elastic bandage may be used to prevent your child’s shoulder from moving. This will keep your child’s bones together and let them heal. Rarely, a cast may be used to hold your child’s bones together.
• Closed reduction is done to put your child’s bones back into the correct position without surgery.
• Surgery is done to put your child’s bones back in the correct position. Pins, screws, or metal plates may be used to help hold your child’s bones together.

How can I manage my child’s symptoms?

• Use the sling or elastic bandage to prevent movement as directed. Instead, your child’s healthcare provider may show you how to pin your child’s sleeve to his or her chest. Only remove the sling, bandage, or pin to bathe or dress your child.
• Apply ice on your child’s shoulder for 15 to 20 minutes every hour or as directed. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel before you apply it to your child’s skin. Ice helps prevent tissue damage and decreases swelling and pain.
• Have your child rest his or her shoulder as much as possible. Do not let your child put pressure on his or her shoulder or arm. Do not let your child use the arm to lift anything. Do not let your child do activities that may cause another injury. Examples include sports, riding a bike, or playing on the playground. Ask your child’s healthcare provider when he or she can return to usual activities.
• Handle your child gently to prevent more injury. Gently turn your baby or small child. Do not pick up your baby or child by the arm.
• Take your child to physical therapy as directed. A physical therapist teaches your child exercises to help improve movement and strength, and to decrease pain.

How can I help prevent a shoulder injury?

• Have your child wear protective sports equipment that fit properly. Examples include shoulder pads and a chest protector.
• Feed your child foods high in calcium. Examples include milk, cheese, and yogurt. Calcium helps keep your child’s bones strong.
  

When should I seek immediate care?

• Your child’s pain gets worse, even after he or she rests and takes pain medicine.
• Your child’s arm, hand, or fingers feel numb or cold and look pale.
• Your child’s arm is swollen, red, and feels warm.
• Your child cannot move his or her hand or fingers.

When should I call my child’s doctor?

• Your child has a fever or chills.
• Your child’s splint becomes damaged.
• You have questions or concerns about your child’s condition or care.

Care Agreement

You have the right to help plan your child’s care. Learn about your child’s health condition and how it may be treated. Discuss treatment options with your child’s healthcare providers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© Copyright IBM Corporation 2021 Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or IBM Watson Health

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

How To Sleep Comfortably With A Broken Shoulder

How To Sleep Comfortably With A Broken Shoulder

Views:
11,010

Shoulder Fracture? Oh! One of the biggest challenges for fracture sufferers is figuring out what to expect when the fracture heals and how to sleep well if they experience fracture pain at night. One of the major fears is hitting themselves (or their partner) in the head with their casts, waking up in excruciating pain every few hours, or just worrying about crushing their healing fracture by tossing and turning all night.

Broken bones or fractures are not only painful but also very uncomfortable. During the healing process, you will need to make adjustments to the daily activities we usually do on autopilot. Simple tasks like driving, cleaning, and even sleeping take effort.

Most fractures take six weeks or more to heal completely. 

Sleeping yourself comfortably can be a challenge. To complement this, your doctor will usually give you specific instructions on how to maintain a particular wound or position. Dr Chandra Sekhar B shoulder surgeon in Hyderabad offers information about how to sleep comfortably with a broken shoulder.

How to sleep comfortably with a broken shoulder

Often, when it comes to sleeping with a broken bone, most people worry about further injury or waking up with more pain. Since we don’t completely control the actions of our bodies during sleep, it’s natural to worry about worsening an already bad situation. If you pay special attention to the way you prepare your bed, you will be able to fall asleep in no time without stressing your nighttime movements. 

Adjust your position

The elevation prevents blood from pooling at the injury site and prevents swelling in the area. Not only is the swelling causes pain in the bone that has been fractured, but it can also slow down the healing process.

In order not to offend the injury, lay down on your bed so that you don’t overturn. Adding a few pillows to your sleep can help overcome this. Having firmness on both sides of your body can keep you in place. If you usually sleep well, place a pillow under the sheets. This will prevent you from squeezing it while you sleep and can keep you stable. If you want to feel comfortable, using an armchair or sleeping on the sofa will help. This ensures you don’t move too much and can provide a stable height for your broken bone. If you have one, a recliner is a great way to sleep with a broken collarbone or rib.

Dress comfortably:

Pressure and confinement in a cast are not only uncomfortable and awkward, but it can also be very hot. During the hot summer months, this extra warmth can be a significant source of frustration when trying to sleep. When you sleep in clothes that don’t make you feel stuffy and that are easy to put on and take off, your bedtime is much easier to manage.

Since a cast will make your limbs larger than usual, it is best to wear light, loose clothing. Consider button-down shirts if you can’t lift your arms.

Always take your pain medication prescribed by the doctor:

Besides your initial worry about sleeping with a broken bone, the pain itself will likely do whatever it takes to keep you awake. For the first few weeks, you will need to take medicine as directed by the doctor. Continuing this will prevent changes in pain relief.

If you feel the pain relievers aren’t working, talk to your doctor about increasing your dose or prescribing another medication. As time goes by and the pain you feel lessens, switching to over-the-counter medicines will also help with pain during treatment.

Try sleeping alone:

As if figuring out how to sleep with a fracture wasn’t bad enough, your partner may need to make some adjustments on their own. Learning how to sleep comfortably is quite a process for you. In the first few days, it helps (nicely) to ask all the people you are used to sleeping with to sleep somewhere else. Or maybe you should try sleeping in the living room or on the sofa.

If you become more comfortable with the most comfortable sleeping way, you can share the bed again, but think about a pillow to separate until it heals.

A few extra tips

If you follow the advice above, it will be easier to fall asleep with a broken bone. The rest of your daily routine requires a little more effort. Here are some additional tips to consider. If you do it right, you can sleep well too.

• Buy a unique pillow such as a body pillow for lifting. Holding the broken bone above your heart prevents blood from pooling and causing swelling.
• First, try sleeping on your back while supporting yourself on several pillows. If this doesn’t help, adjust slowly to the side position if possible.
• Sleep in the middle of the bed, so you don’t fall in the middle of the night.
• Leave a dim light somewhere in the bedroom or directly in front of it so you can find your way when you need to get up.
• If your bed is uncomfortable, drag it onto a sofa, lounge chair, or lounge chair in another room.
• Let friends and family help you.
• Eat right and drink lots of water.
• Work with your orthopaedic surgeon and physical therapist.
• Apply ice to the injured part

Conclusion: 

Remember that rest is a critical component of healing and restoration. If you can’t sleep late at night, sleep during the day in a high position. If you have concerns about sleeping in a cast or any other stabilizing medical device, contact Dr Chandra Sekhar. B at 9959588389.

90,000 Examples of treatment for fractures of the humerus

A fracture of the humerus in the recent past was an extremely serious problem for the patient. With such a fracture, the patient was deprived of the opportunity to serve himself in everyday life for several months. It is difficult to perform even basic household work with one hand. Also, the patient was forced to wear a massive plaster or plastic bandage, which makes normal wearing of clothes, travel in transport, hygiene procedures problematic (it is impossible to just take a normal shower).

The photo shows an example of a bandage applied for a fracture of the humerus according to the “old” principles of treatment. It is not difficult to imagine how the patient feels in such a bandage, given that it must be worn for at least 2 months.

At the current stage of the development of traumatology, there are methods that allow e to effectively help the patient, without burdening him with wearing a plaster or plastic bandage , in the nearest time after the operation, literally in a few days, to return him to a normal lifestyle .

Here are some clinical examples of the treatment of patients with fractures of various parts of the humerus.

All operations were performed by Orthocenter specialists.

Fractures of the upper shoulder (proximal humerus).

Such fractures, if improperly treated, can lead to severe movement disorders in the shoulder joint, when the patient simply cannot reach his head with his hand. Surgical treatment of such fractures is difficult and requires a highly qualified surgeon and the use of modern techniques.If these conditions are met, it is now possible to achieve almost complete restoration of the function of the shoulder joint.

Examples from the practice of Orthocenter specialists.

A patient with a severe fracture of the upper section (surgical neck) of the humerus.

X-ray before surgery.

The operation was performed: osteosynthesis of the humerus with a modern polyaxial plate LCP.

A plaster cast was not applied after the operation, the full range of motion in the shoulder joint was immediately allowed, the development of the joints. The patient was able to go to work a few days after the operation, fully attended to herself in everyday life, wore normal clothes, i.e. soon after the operation, she returned to normal life.

Result after 1 month. after operation. The limb function is fully restored.

A patient with a very severe fracture of the upper humerus with significant displacement of fragments.

X-ray before surgery.

The operation was performed: osteosynthesis of the humerus with a polyaxial plate LCP.

A plaster cast was not applied after the operation, physical education for the joints and muscles of the limb was started immediately after the operation.

Result in 1.5 months. after operation.

The limb does not differ at all from the healthy one, the scar at the site of the operation is not visible (a cosmetic suture was applied). The function of the shoulder joint is fully restored.

A patient with a comminuted fracture of the upper humerus.

X-ray before surgery.

The operation was performed: osteosynthesis of the humerus with a high-tech Targon nail.

A plaster cast was not applied after the operation, physical education for the joints and muscles of the limb was started immediately after the operation.

Result 3 days after surgery.

The sutures have not yet been removed, edema, bruises on the limb after the fracture are visible. The patient can already perform simple household work, serve herself without assistance.

Fractures of the middle section of the shoulder (diaphysis of the humerus).

Previously, the operation was performed through a large incision (15-20 cm) to insert the plate. In this case, there is a risk of damage to the radial nerve, which runs in the middle third of the shoulder. The radial nerve is extremely sensitive to the impact and sometimes its displacement to the side to install the plate leads to a block of conduction of impulses along it for several months. A large incision also leads to long-term healing of the postoperative wound, severe pain syndrome, it is necessary to limit the load on the limb for a long time.

At present, with sufficient qualifications of the surgeon and modern equipment, the operation can be performed through small incisions that become invisible some time after the operation, with minimal tissue trauma and minimal risk of complications.

A patient with a comminuted fracture of the middle humerus.

The operation was performed: osteosynthesis of the humerus with a rod with locking screws inserted retrograde.

A plaster cast was not applied after the operation, physical education for the joints and muscles of the limb was started immediately after the operation.

Result in 4 months. after operation.

It can be seen that the muscles and the function of the joints have fully recovered.

A patient with a fracture of the middle section of the humerus.

The operation was performed: osteosynthesis of the humerus with a rod with locking screws inserted retrograde.

Result in 2 months. after operation.

Limb function fully recovered.

Intra-articular fractures of the lower section (condyles) of the humerus with damage to the elbow joint.

Such fractures are extremely difficult to treat, due to the complex anatomical structure of the elbow joint, as a rule, the multi-fragmented nature of the fracture, low bone density in this area, especially in elderly patients due to osteoporosis. In case of unstable fixation after surgery, a plaster cast is required, which leads to the formation of movement restrictions (contracture) in the elbow joint, sometimes patients can never develop movements in full.With inadequate restoration of the complex articular surface of the elbow joint, arthrosis develops after the operation, accompanied by pain and limitation of movement.

For a full recovery of a limb after this type of fracture requires a high qualification of the surgeon and the use of modern surgical techniques.

Here are some clinical examples from the personal experience of Orthocenter specialists.

A patient with a severe intra-articular fracture of the lower part (condyles) of the humerus with severe damage to the elbow joint.

X-ray before surgery.

The operation was performed: osteosynthesis of the humerus with modern LCP plates, the anatomy of the elbow joint was fully restored.

The plaster cast was not applied after the operation, the development of movements in the joints of the limb was immediately allowed. Result 5 days after surgery. The stitches have not yet been removed, edema is visible, bruising on the limb after the fracture. Good limb function is already visible.

Result in 3 months.after operation. The limb function is fully restored.

A patient with a severe intra-articular fracture of the lower part (condyles) of the humerus with damage to the elbow joint.

X-ray before surgery.

The operation was performed: osteosynthesis of the humerus with LCP plates, the anatomy of the elbow joint was fully restored. The plaster cast was not applied after the operation; the development of movements in the joints of the limb was immediately allowed.

Result 14 days after surgery. The stitches have just been removed. The function of the limb is already visible, sufficient to serve oneself in everyday life.

Result in 3 months. after operation. The limb function is fully restored.

A patient with an extremely severe injury: severe intra-articular fracture of the lower humerus with damage to the elbow joint with a fracture of the middle third of the ulna with displacement of fragments (road injury).

X-ray before surgery.

The operation was performed: osteosynthesis of the humerus with LCP plates, the anatomy of the elbow joint was fully restored, osteosynthesis of the ulna with a rod with blocking through small puncture incisions (up to 1 cm).

The plaster cast was not applied after the operation, the development of movements in the joints of the limb was immediately allowed. Result 3 weeks after surgery. Good limb function is already visible.

Result in 4 months. after operation. The limb function is fully restored. The limb is no different from a healthy one.

Useful information about fractures of the shoulder and forearm bones

What are shoulder fractures.

Distinguish between a fracture of the proximal and distal epiphysis, as well as the diaphysis.

Fracture of the proximal epiphysis of the humerus occurs when falling on the elbow or on an outstretched arm.There are fractures of the head, anatomical neck (intra-articular), transtubercular fractures, fractures of the surgical neck (extra-articular) and tears of the greater tubercle of the humerus.

Symptoms of shoulder fracture

The shoulder joint is enlarged due to edema and hemorrhage. Movement is limited or impossible due to pain. Pounding on the elbow causes pain in the shoulder joint. At the site of the fracture, pathological mobility and crepitus are determined. Clinical manifestations are less pronounced with a punctured fracture.
Fracture of the diaphysis is the most common fracture of the humerus and accounts for more than 50% of all fractures of the shoulder. It occurs both from a direct blow to the shoulder, and when falling on the elbow, with a sharp movement (throwing a grenade, etc.). In adults, the fracture of the diaphysis of the humerus is always complete (transverse, oblique, helical, comminuted), in children – subperiosteal. Fractures are more common in the middle third of the shoulder, where the bone diameter is narrowest.

Shoulder fracture symptoms.

Pain, pathological mobility, severe deformity.On palpation, bone fragments are clearly felt. Often the radial nerve is injured, with a violation of skin sensitivity and the inability to extend the fingers of the hand.

Deformity of the lower third of the shoulder and elbow joint. The forearm is bent, movements in the elbow joint are sharply painful.

In transcondylar fractures, the relationship between the lines connecting the condyles and the olecranon is disturbed (compare with the healthy side).

Fracture of the forearm bones.

There are fractures of the proximal pineal gland, diaphysis and distal pineal gland.
Fracture of the proximal epiphysis is divided into a fracture of the ulnar and coronoid processes of the ulna and a fracture of the head and neck of the ray. These fractures occur mainly when falling on the elbow (hitting the elbow) or outstretched arm.

Symptoms of forearm fracture.

Pain and swelling at the fracture site, limb dysfunction. In case of a fracture of the olecranon, a semi-bent position of the hand is characteristic (the hand hangs down), the victim supports it with a healthy hand.With a fracture of the coronoid process, swelling in the elbow bend and tenderness on palpation is determined. With a fracture of the head or neck of the radial bone, a sharp soreness in the area of ​​the outer elbow bend and a violation of the rotational movements of the forearm are determined. Sometimes a bone crunch is felt. The forearm is in a pronated position and bent at the elbow joint.

Fractures of the diaphysis of the bones of the forearm.

Arises from direct impact. There are fractures of both one and two bones at the same (more often) or at different levels.Sometimes fractures are accompanied by dislocation of the radius. In children, fractures of the diaphysis of the forearm are usually subperiosteal (“green twig”).

Symptoms of a fracture of the shaft of the bones of the forearm.

Pain during axial and frontal loading, swelling (with displacement of fragments – deformation), pathological mobility.

Fracture of the distal epiphysis of the forearm bones.

The most common fracture of the forearm bones. It is also called a fracture of the forearm (radius) in a typical location.It occurs when a fall with an emphasis on an extended (extreme fracture) or bent (flexion fracture) hand. Often accompanied by a detachment of the styloid process of the ulna, which leads to the formation of a bayonet-like deformity.

Symptoms of fracture of the distal epiphysis of the forearm bones.

The presence of a bayonet-like deformity and bulge on the palmar surface, swelling, local pain on palpation and axial loading, a sharp restriction of movement in the wrist joint indicates a fracture of the forearm bones at the distal end.

Rehabilitation after a fracture of the shoulder (shoulder neck) in Moscow

The humerus is the largest bone in the arm. Her injury can significantly reduce a person’s standard of living and ability to work, and ultimately lead to disability. Therefore, do not underestimate the importance of timely and adequate assistance and rehabilitation measures. It is they that allow the hand to return the lost functions, and the patient – the usual quality of life.

Types of fractures of the humerus and principles of treatment

Types of fracture

Depending on the location:

• intra-articular – anatomical neck and head;
• extra-articular – surgical neck.It can damage nerves and blood vessels, so bleeding and sensory disturbances are common. If you do not provide assistance in time, the injury becomes the cause of paresis;
• the main (middle) part of the bone or diaphysis of the shoulder;
• the distal section, located closer to the elbow.

Fractures without displacement, with displacement and impacted fractures are also distinguished.

Principles of Treatment

It is important to start recovering from a humerus fracture as soon as possible.Most often, conservative treatment is sufficient (plaster cast, physiotherapy, massage and exercise therapy), in especially severe cases, an operation is required. Therapy should be carried out daily, sometimes up to several times a day, unless the doctor chooses a different schedule. It is not recommended to interrupt workouts if there is no indication for this.

All methods are selected individually, taking into account the diagnosis and characteristics of the patient: rehabilitation after a fracture of the humerus with displacement differs significantly from treatment after injury without displacement, since the immobilization period in the first case will be longer.

During the rehabilitation period, the rehabilitation program changes: the doctor corrects it based on the intermediate results and the type of limb immobilization (plaster cast, soft tissue bandage, etc.).

Stages of rehabilitation

1. Immobilization. Lasts up to three weeks. During this period, it is important to ensure the immobility of the limb. To avoid circulatory disorders, metabolism and prevent muscle atrophy, the doctor prescribes massage and physiotherapy exercises (breathing exercises, passive exercises and active ones, during which unfixed joints work).
2. Functional. Lasts up to 6 weeks. The main role during this period is played by active exercises – both classical physiotherapy exercises and exercises in the water. Gradually, the load on the joint increases, the patient can use weights, work on simulators with biofeedback, and do yoga. The usual everyday activities help to develop fine motor skills: the patient brushes his teeth, dresses, laces his shoes, makes the bed, etc. It is not recommended to strain the limb too much.It is important to report any pain or discomfort to a specialist.
3. Training. Lasts up to 8 weeks. As a rule, by this period, the patient can already self-serve himself, and it is important to strengthen the muscles and restore the range of motion. You can also train only under the supervision of a doctor and only after the integrity of the bone and other tissues has been fully restored. Remember that a humerus fracture is a serious injury and it is contraindicated to start vigorous strength training within 2-3 months after injury.

Contraindications for fracture

Only a qualified specialist can determine the type of injury and draw up a treatment and rehabilitation program after examination and examination (usually X-ray). It is contraindicated to strain the limb, as this can lead to displacement of bone fragments, you cannot self-medicate and independently diagnose yourself, postponing a visit to the doctor.

Each method of treatment has a number of its own contraindications, which may include diabetes mellitus, pregnancy, blood clotting disorders, endocrine and mental diseases, benign and malignant tumors, etc.That is why doctors of “Blagopoluchiya” carefully examine all patients before drawing up a treatment program.

Signs of a fracture of the shoulder and body of the humerus

1. Acute pain at the site of injury or nearby, aggravated by exertion.
2. Crunching hand on palpation or movement.
3. Change in the shape of the hand, shortening, swelling, edema, drooping hand.
4. Bruising, bruising or bleeding – hematoma may even appear in the area of ​​the hand.Also, with an injury, the color of the skin can also change: it becomes pale.
5. Stiffness in movement: in some cases the patient cannot even move the arm to the side.
6. Disorders of sensitivity, not only directly in the area of ​​the fracture, but also in the area of ​​the hand, which is associated with damage to the nerve.

Symptoms can be both severe and mild, depending on the fracture itself and the individual characteristics of the patient, in particular, his pain threshold.We recommend not to ignore even minor symptoms and consult a doctor in a timely manner – then both treatment and rehabilitation will take less time, and the likelihood of returning the lost functions will be much higher.

Therapeutic exercises for injuries of the shoulder joint

Physiotherapy allows you to avoid muscle atrophy, normalizes their tone, improves blood circulation of tissues, so that they receive the necessary microelements. Regular (several times a day) exercises activate the regeneration processes, reduce pain, and return the limbs to their previous mobility.

We recommend performing exercises on the injured arm, doing breathing exercises, developing a healthy limb. This allows you to strengthen the body as a whole and increase ventilation of the lungs, especially when the hand is still in a cast. It is advisable to alternate between dynamic and static exercises, for large and small muscles, strength and stretching.

The doctor selects the rhythm, amplitude, number of repetitions, training duration. It is important that the load increases gradually – first, the patient develops the shoulder joint, then returns the usual mobility to the whole arm, and then strengthens the muscles.

Velvet Arm Cuff Sling for Rotator Cuff Surgery and Broken Arm

Velvet arm cuff Sling for rotator cuff, surgery and broken arm arm

1. Product Features:
Arm cuff with sling
Velvet fabric materials for convenience.
Simple design and comfortable to wear.
Function as a three-way torn tourniquet and the main force is transferred to the shoulder;
Effectively relieve patient neck fatigue.
Material: Velvet, Foam, Velcro, Polyamide.
Size: S / M and L / XL
Color: Black or white – these are the main customized colors available if MOQ (minimum order quantity).

2. Materials and wash:

Material: Velvet, foam, Velcro straps, polyamide.
Not dry clean
Do not bleach
Do not dry at
Do not iron

3. About our company:
We are a top quality OEM manufacturer of orthopedic braces and sports-supported medical kit products in China for many years.
International concept, fluent English communication, sales professionals, skillful, top quality stitching, medical grade work, materials and reliable supplier, reasonable prices, etc.
We are always ready for your most reliable Chinese supplier.

4. Ours: Certification by SGS, CE, EC Representative!
* Our company – From SGS company inspection with report.
* All our products comply with the requirements set out in the Council Directive for the harmonization of the laws of the Member States in relation to the Medical Device Directive (93/42 / EEC).To assess in relation to the safety limits, the following standards apply: EN 1441, EN980;
* We are the EU representative to the United Kingdom are responsible for this declaration and any products.

5. Our main products:
Protection of the lines: cervical cancer, ELECTRONIC ENGINE START LOCK POSITION, LUMBAR SUPPORT on the belt and arm, ribs, Under the collarbone ELECTRONIC ENGINE START LOCK, etc .;
Upper limbs: arm, arm and sling, knee brace, wrist pad, fingerprint separator, etc.D .;
Lower limbs: ankle brace, sleeve for shin, knee, thigh, foot care and extra soft insole;
Seat cushioning and thermoplastic materials, plaster, etc.).

6. FAQ (Frequently Asked Questions):
6.1. How do I get Price Quotes?
Our sales contacts are available via email request over the Internet and instant messaging chat via Skype, WeChat, Whatsapp, or even QQ; Just provide detailed information for your request including: Target product model, estimated quantity, size, customized logo or not, any change in materials or color or not, port of shipment, certification, etc.NS. ). We will then reply to you as soon as possible as possible: Email reply within 24 hours; Internet communication within 2 hours.

6.2. Are special product modifications and the retail package logo possible?
Yes.
Our Professional Sample Making Group are rich experience in any customization according to client’s request.
Our Design team is working on for various types of customization and retail logo package making – boxes, plastic tanks, case, hanging bags, etc.Etc.).
Just Send Us Your Ideas And We Will Help Make It Happen Like A Perfect Field.

6.3. How Soon Can I Expect To Get Samples?
Samples will be ready for shipment within 5-7 days for you model free;
And takes approximately 4 – 6 business days by road via International Express to contact you.

6.4. What is your total production lead time for a bulk order?
In general, about 25-35 business days after the initial payment, depending on the type and quantity of the order you selected as High Season or Free When You Place Your Order.

6.5. What is your usual trading term?
We usually accept terms such as EXW, FOB, CFR and CIF etc.
You Can Choose The Most Convenient And Cost Effective As You Would Like;
Or you could discuss with us if you are not experienced, we would like to repeat our best recommend the best way for you with our over 10 years of international trade experience.

6.6. What kind of payment method do you accept?
1) TT or Western Union for Sample orders or Small trial order.
2) Bulk order, 50% deposit to start production, 50% balance before shipment.

6.7. What are your benefits?
Our staff are with more than 10 years of experience in international trading, are familiar with clients all over the world and can easily communicate and discuss any custom freely in demand with the client.
Our skilled workers on the device using superior quality stitching and quality control.
About delivery time and strict quality control are the main guarantees for power supply circuits no problem.

7. What Express do you usually use to send?
RE: Generally through the customer’s express invoices, if they have; Or we choose our agent for DHL, UPS, FedEx, TNT Express, etc.). It takes 3-7 days to reach anywhere in this world.

8. If we have customized samples, then – in terms of cost?
RE: Yes, customized sample costs can be refunded when the order quantity reaches.

9. How is your factory quality guarantee?
RE: Litigation sample confirmation;
Preliminary samples order confirmation;
Onsite customer quality control;
Or third party onsite quality control;
All available for customer selection.

For each officially confirmed order, a set of prototypes will be provided to the customer for final confirmation; Only when the analysis of samples is confirmed then our mass production will run exactly on the basis of a high quality preliminary sample.

90,000 broken shoulder images at a low price! broken shoulder image with pictures, pictures on Alibaba.com

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90,000 The most unusual streets in the world.Where to look for beautiful alleys for a photo

Mysterious alleys and rocks instead of walls, fantastic zigzags and houses of all colors of the rainbow, colorful street art, an arch of cherry blossoms and a wisteria tunnel have collected the most beautiful streets from all over the planet.

The most beautiful and unusual streets in the world

Setenil de las Bodegas, Andalusia, Spain

The most convenient way to get to the town of Setenil de las Bodegas is from Malaga: the journey by bus or car will take about an hour and a half

The picturesque Andalusian town of Setenil is famous for its snow-white houses with basalt rocks instead of walls and roofs.It is difficult to walk along the local streets without pressing your head into your shoulders, but how many cool photos you can take in the image of Atlanta!

The most amazing rock and cave cities in the world

Fondamenta San Mauro, Burano Island, Venice, Italy

You will immediately make friends with the colorful island quarter of Venice Burano

According to legend, houses on Burano were painted in bright colors so that fishermen could see them from afar even in heavy fog and drop anchor in time.Locals still have to agree on the colors of the houses on Fondamenta San Mauro Street and those adjacent to the city government: you must first figure out whether your facade will fit into the street’s palette. Come to Burano and see for yourself: it has no equal in color!

15 fun things to do in Venice and on the islands of the lagoon

Quirky Zigzag Lombard Street

Lombard Street in California is considered the most curved street in the world. And all thanks to her site on the Russian Hill with eight sharp turns.Such dizzying serpentines help smooth out the steep slope of Rushen Hill in San Francisco.

25 mountain roads, one of which will make you feel sick

Wisteria Tunnel, Kawachi Fuji Garden, Japan

The enchanted wisteria tunnel awaits you in Kitakyushu

A magical garden with a tunnel framed by bunches of Chinese wisteria, located in Kitakyushu, Japan’s Fukuoka prefecture. You can get to Kitakyushu by plane from Tokyo, then by rented car along Route 62 to Kawachi Fuji Garden.Travel time from the city center is less than 30 minutes.

16 Ways to Unravel Japan

Rocamadour, Occitanie region, France

Rocamadour brings you to the Middle Ages

The tiny rocky medieval town of Rocamadour above the Alzou River valley in southwestern France is a cult site for Christian pilgrims. People come here to bow to the Black Madonna in local Notre Dame, see the Basilica of Saint-Sauveur, the crypt of Saint Amadour and the palace of the Bishops of Tulle.

The Way of the Cross begins at the castle and stretches to the cross of the Crusaders. But even if you are far from religion, Rocamadour will set you in a sublime mood. How else, if walking leisurely along the local picturesque streets, you suddenly notice that Durendal, the sword of the protagonist of the French epic Roland, is sticking out right from the rock?

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Molyvos village (Mithimna), Lesvos island, Greece

A flower-filled street in the heart of the fishing village of Molyvos has been called the most beautiful in the world many times.It is impossible not to succumb to the charm of these toy houses and magic lanterns in the lilac haze of wisteria – it is better to sit down at the table of the most cozy cafe right away and raise a toast to the fact that life is wonderful!

11 friends of Santorini. The most beautiful islands in Greece

The Magic Circle, Swindon, Wiltshire, UK

The English town of Swindon in Wiltshire is worth a visit, if only for the sake of winding a few circles around the craziest intersection in the world.Red Bull was inspired by the local Magic Circle to shoot a spectacular TV commercial showing the Magic Roundabout in all its glory – from above.

Where to go in the UK if you’ve already been to London

Blue Streets, Chaven (Chefchaouen), Morocco

In Morocco, the gray days were canceled

The streets of the Moroccan Chavin are flooded with blue sky. It seems that the only thing that is neither blue nor blue are cats and flower pots. All together, it turns the town into a huge color therapy salon: just admire the bright colors, and the smooth surface of sun-weary cats – what else is needed for happiness?

13 best things to do in Morocco

Edinburgh’s Royal Mile is the most beautiful way to walk the Scottish mile.The 1.8 km Royal Mile begins at Edinburgh Castle and descends to Holyrood Palace, where the Queen of Great Britain stops when she comes to Scotland. The mile is littered with souvenir shops, whiskey shops, interesting museums and fabulous cafes, where it is especially cozy to hide from the eternal Scottish drizzle.

By the way, the shortest street in the world is also located in Scotland. This is Ebenezer Place in Wick in the Highlands in the north of the country.Ebenezer Place is 2.06 meters long.

13 things to do in Edinburgh

The brightest corner of Buenos Aires

Caminito Street in the La Boca area of ​​the Argentine capital owes its striking facades to 19th century Italian immigrants. Glory to the colors, the tradition has survived to this day, and today La Boca is perhaps the most cheerful corner of Buenos Aires. At least, very few people manage to pass the colorful houses without a smile.

10 of the brightest cities in the world

Jauniela Street in Old Town is perhaps the most atmospheric place in the Old Town. No wonder that it was she who played the role of Bern’s Flower Street in Seventeen Moments of Spring and Baker Street in The Adventures of Sherlock Holmes and Dr. Watson. Don’t miss the wonderful restaurant “1221”: you would like to make an inspired movie about local dishes according to medieval recipes.

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It’s hard to believe the existence of this beech alley, but it’s not Photoshop!

Dark Hedges is the most impressive beech alley in the world.The trees along the boardwalk next to Grayshill House were planted four centuries ago. During this time, the beeches have grown so tall and so beautifully intertwined with branches that this place becomes the most photographed in all of Northern Ireland for a year, and the film crew of “Game of Thrones” filmed here the main artery of Westeros – the Royal Route.

Full list of Game of Thrones filmed locations

Annecy Canal Embankment, France

Air tickets for a French postcard through Geneva airport – by clicking on the photo

The postcard town of Annecy in the east of France knows how to show itself from the best perspective: the local embankment is buried in flowers, snow-white swans glide along the openwork bridges, and look out from the old roofs picturesque Alps.

The most convenient way to get to Annecy by car is from Switzerland: it is 40 minutes from Geneva airport. A bonus to the fabulous landscapes are the marked mountain lakes routes that start right from Annecy.

Yes, you are in a fairy tale! 25 toy towns of the world

To find out when it is cheaper to fly to Rio, click on the picture

In the 1980s, the Chilean artist Jorge Celarón settled in one of the unsightly areas of Rio de Janeiro – in a house on the stairs in Lapa on Manuel Carneiro Street.Determined to make a work of art out of the place where he lives, Jorge began to create bright drawings in a primitive style. Most often, he portrayed pregnant women or himself, also on demolitions. He sold these paintings for 10-20 reais, and with the proceeds he bought tiles, painted tiles and laid them out the stairs near the house – step by step.

The work glorified Selaron: they wrote about him in magazines and filmed reports, and tourists brought him tiles from different parts of the world. But fame did not change the artist: every single day for 23 years, he got up at dawn and continued to work.I wanted to get more done before it got dark, and said that the work would end only on the day of his death. And so it happened: on January 10, 2013, Jorge Celaron was found dead on the steps of a staircase that was named after him. When you walk from Lapa to Santa Teresa on the Selarona Staircase, knowing how much work has gone into it, the unusual tiles are even more impressive.

27 stunning bird’s-eye views

If you still think London is gray and hazy, take a look at the Niles Yard courtyard in Covent Garden.Local doors, window frames, sculptures, benches and flower beds are painted in all colors of the rainbow, and the characters who spend time here are not inferior in color.

People come to Nils Yard not only to take hippie selfies for Instagram: there are several vegetarian cafes and shops with organic products, natural cosmetics and handmade soaps, as well as live concerts and theatrical performances.

London is affordable: a local resident advises on how to save money in the British capital

When nature itself builds arches

The magical cherry blossom tunnel between Herstrasse and Breitestraße in Bonn, Germany can be walked every April.During cherry blossoms, fairs, festivals and concerts take place here, and at night, when the tunnel is illuminated with colorful lights, this place becomes one of the most romantic places in Germany for a spring walk.

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Haji Lane, Kampong Glam, Singapore

In addition to Gardens by the Bay, the Merlion statue and the Singapore Flyer, in Singapore you should definitely drop by the bohemian Haji Lane between Arab Street and Bali Lane.

Haji Lane, dotted with cool graffiti, houses mini-boutiques of world designer brands and art galleries, mixed with trendy cafes and traditional oriental eateries. Haji Lane is a Mecca for Singaporean hipsters: don’t miss this quirky street if you want to be on trend with musical, gastronomic and urban innovations.

Interesting route in Singapore for 3-4 days

Rue Abrevoir, Montmartre, Paris, France

La Maison Rose restaurant in an ivy-covered pink house at 2 Rue de l’Abreuvoir is an extract of bohemian Montmartre.They say that when this house was still of the usual white color, the artist Maurice Utrillo painted it in the dawn rays – peach. Because of this, they began to make fun of him – and so that reality would not differ from his sketch, temperamental Utrillo secretly repainted the building pink one night. This color perfectly blended into the romantic palette of Montmartre and was fixed not only on the walls, but also in the name of the restaurant.

Paris: 10 steps towards romance

“Philosophical Trail” Tetsugaku no Michi, Kyoto, Japan

In the 19th century, the two-kilometer promenade along the canal in Kyoto was called the “Trail of Writers”.Then here, from the Buddhist temple Ginkaku-ji to the sanctuary of Nanzen-ji, the founder of the Kyoto existential school Kitaro Nishida loved to walk in meditation. In honor of him, the street under the shade of hundreds of cherry trees was renamed the “Philosophical Trail”.

Tetsugaku-no-michi looks most beautiful in spring, when cherry blossoms bloom, and in autumn, when the forest on Higashiyama to the east of the canal shimmers with magical colors. You can get to the “Philosophical Trail” in Kyoto by city bus – you need the stop “Ginkakuji-mae”.

The best flower routes in the world

The 359-meter Baldwin Street in Dunedin, New Zealand is officially listed in the Guinness Book of Records as the coolest street in the world. It rises quite sharply from 30 meters to 100 meters above sea level, and at the most dashing section it does it at an angle of up to 19 degrees.

Since the late 1980s, Baldwin Street Gutbuster has been held every year on Baldwin Street: participants first run up the street and then slide down, trying to break the speed record.The place is generally popular not only among fans of unusual selfies, but also among extreme people. They drive off Baldwin Street on everything – on motorcycles, bicycles, skateboards, and even on trash cans and refrigerators! And since 2002, the “Candy Contest” has been held here: sweets are numbered and lowered down the street – those who are the first to find themselves in a special funnel win.

90,000 Recovery after shoulder fracture – schemes and techniques

Description of rehabilitation. Methods and terms of recovery.

Shoulder fracture: rehabilitation

Shoulder joint is a movable joint formed by the scapula and humerus. A fracture of the shoulder joint is actually nothing more than an intra-articular fracture of the humerus, or rather, a fracture of its supra-tuberous part. Often, patients confuse the concept of a shoulder fracture when it comes to the area outside the joint cavity. Fracture of the shoulder joint is not a frequent injury, despite the increasing injuries in the world, nevertheless, it requires special approaches in treatment and rehabilitation, as various complications are so frequent.

Rehabilitation: description

The causes leading to fractures are severe injuries and blows, both directly to the joint area and indirectly (for example, falling on an outstretched arm). Often, a fracture of the shoulder joint is accompanied by concomitant injuries and fractures in other locations. Osteoporosis, that is, the softening of bone tissue, often has a strong aggravating effect. With this disease, the bones weaken, and they do not need such a significant blow to break.It should be said that the rehabilitation of fractures of the shoulder joint in osteoporosis and other dystrophic diseases is burdened, often full monthly courses with additional medication are required.

The fracture of the shoulder joint is open and closed. The latter is much more favorable prognostically. Based on the essence of the terminology, open fractures are accompanied by a gaping outward bone fragments, and as a result, the joint cavity. An infection instantly joins, making recovery treatment a very difficult process.Also, with open fractures, large defects in the bone are often formed, requiring complex reconstructive plastic surgery.

Make an appointment and get a comprehensive consultation from a traumatologist-orthopedist, sports medicine doctor Ondar Temir Evgenievich:

Terms of rehabilitation

The restoration of bone integrity depends on a number of both general and a number of local factors. Among the general factors, it is worth mentioning the age of a sick person, his physical and of course neuropsychic state, the constitution of a person matters, how well his endocrine system, metabolism, etc. are functioning.e. Among the local factors are the comparison of bone fragments, whether there is sufficient blood supply. You should also take into account the data of X-ray examination and clinical data on the functional endurance of the fused bone. If there was an open fracture, then the presence of infection should be considered. All these factors can significantly increase the rehabilitation period, which can be calculated in months or even years!

The average time of bone fusion with fractures of the phalanges, ribs and metacarpal bones is about 3 weeks, with a fracture of the clavicle in 4 weeks, wrist and tarsus, metatarsus, shoulder and forearm – in 2.5 months, lower leg – in 3 months, hips – 4 months, femoral neck – 6 months.Exercise therapy is prescribed already from 10-14 days after the fracture in the form of passive exercises, and active rehabilitation lasts about a month and a half after immobilization (removal of the fixing bandage). That is, if we roughly summarize the terms, then depending on the type of fracture, its severity and the location of the fracture, rehabilitation takes from 1 month to 1 year.

Rehabilitation method

• Power supply correction. This is the first place where recovery begins, since amino acids, antioxidants, vitamins and minerals are needed for the growth of healthy bone tissue.The amino acids needed by the body during the recovery period after fractures are arginine, proline, glycine and glutamine. These are one of the important constituents of proteins that form bone mass. That is why you need to increase your protein intake by 10–20 mg per day. Antioxidants have the ability to reduce inflammation without slowing the tissue healing process. These are vitamin C, vitamins D, K and B6. These vitamins act as catalysts for chemical reactions during fracture healing.Minerals such as zinc, copper, calcium, phosphorus and silicon are also essential for normal bone regeneration. So, the diet should contain dairy products (milk, cheese, cottage cheese, sour cream, kefir and yogurt), dishes containing natural gelatin (marmalade, fruit jelly, aspic, jelly), antioxidants (fruits, vegetables and nuts).
• Immobilization of the joint, limb. In the event of mobility (with improper fixation of the limb), the blood supply is disturbed, the period of bone tissue fusion increases.
• Physiotherapy. It is important to carry out at least two courses of physiotherapy – during the immobilization of the limb, and immediately after removing the bandage / gib. Physiotherapy focuses on the surrounding tissue in order to eliminate muscle atrophy, reduce swelling, increase blood circulation and reduce pain. The purpose of the procedures immediately after removing the bandage is to put a load on the muscle tissues, preparing the limb for further work in the exercise therapy hall.
• Exercise therapy. Exercise should be started 10-14 days after applying the bandage.First, it is passive gymnastics, and then active gymnastics with a further increase in the load. The tasks of exercise therapy are to restore the volume of movement of the injured limb, restore tissue elasticity, and strengthen the muscular apparatus.
• Massage. It is an important component during the rehabilitation period and it can be carried out in several courses in order to prevent contracture, reduce edema and the fastest fusion of bone tissue by increasing blood circulation!

In any case of a fracture, it is very important to immediately begin rehabilitation measures, since there is a risk of contracture development and a decrease in the range of motion in the joints, especially for fractures of the ankles and hand, that is, those joints that consist of small bones.

You can sign up for a consultation by calling +7 (495) 477-55-40 or via the online feedback form.