Rehabilitation outcomes after proximal humeral fracture: An observational study

2021 ◽  
Vol 41 (2) ◽  
pp. 121-131
Author(s):  
Nicholas F. Taylor ◽  
Elizabeth Wintle ◽  
Claire Longden ◽  
Alexander T.M. van de Water ◽  
Nora Shields
Keyword(s):  
Decision Making ◽  
Proximal Humeral Fracture ◽  
Goal Attainment ◽  
Humeral Fracture ◽  
Shoulder Function ◽  
Global Rating ◽  
Range Of Movement ◽  
Rehabilitation Outcomes ◽  
Meaningful Activity ◽  
Shoulder Flexion

BACKGROUND AND PURPOSE: Fractures of the proximal humerus are characterised by slow recovery and ongoing disability. We aimed to describe the recovery of patients referred to community physiotherapy after proximal humeral fracture and determine if activity thresholds based on the Shoulder Function Index (SFInX) could inform physiotherapist decision-making. METHODS: Using a prospective observational cohort design, patients referred to community rehabilitation for physiotherapy were assessed for activity limitation (SFInX, DASH), quality of life (EQ-5D), pain levels (VAS), global rating of change, and shoulder range of movement at weeks 0, 6, 12 and 26. A focus group explored treating physiotherapists’ perceptions of using the SFInX. Characteristics of participants meeting SFInX clinically meaningful activity thresholds (+Δ17 units, score ≥73 units) were compared to those who did not. RESULTS: Participants (n = 38, mean age 78 years, 29 women, 29 conservatively managed) commenced physiotherapy a median of 12 (min 4, max 62) weeks after proximal humeral fracture and received a median of 8 (min 3 max 17) sessions over 8 weeks. N = 18 achieved +ΔSFInX ≥17 units by week 6. N = 15 achieved SFInX ≥73 units by week 26. Shoulder flexion range of 112° predicted +ΔSFInX ≥17 units at week 6 (AUC 0.74, 95% CI 0.58 to 0.90). Physiotherapists reported not basing management decisions on the SFInX. CONCLUSIONS: Patients after proximal humeral fracture make clinically meaningful improvements in shoulder activity after referral to physiotherapy. Decision-making based on SFInX activity thresholds or achievement of shoulder flexion of at least 112° may be informative but physiotherapists preferred making decisions based on individual goal-attainment.

Comparability of Patient-reported Outcome Measures and Clinical Assessment Tools for Shoulder Function in Patients with Proximal Humeral Fracture

2020 ◽  
Author(s):  
Elke Maurer ◽  
Christian Bahrs ◽  
Luise Kühle ◽  
Patrick Ziegler ◽  
Christoph Gonser ◽  
...  
Keyword(s):  
Strong Correlation ◽  
Proximal Humeral Fracture ◽  
Humeral Fracture ◽  
Patient Reported Outcome Measures ◽  
Shoulder Function ◽  
Patient Reported Outcome ◽  
Sf 36 ◽  
Patient Reported ◽  
Scoring Tools

Abstract Background Patient-reported outcome measures (PROMs) are gaining increasing importance in the context of quality management. Different PROMs and scoring tools are available to assess shoulder function after proximal humeral fracture (PHFx). In Europe, these include the Constant-Murley Score (CS), Neer Score (NS), Oxford Shoulder Score (OSS), University of California at Los Angeles Score (UCLA) and Disabilities of the Arm, Shoulder and Hands Score (DASH). In addition, the health-related quality of life can be assessed by the PROMs Short Form 36 (SF-36) and EuroQol (EQ-5D). Although all these test instruments assess shoulder function, the components to be answered objectively and subjectively vary and thus the possibility of independent assessment. The aim of the present study is to compare the correlation between the results of the different PROMs and the clinical screening tools in patients with PHFx. Methods 76 patients who were treated with angular stable plate osteosynthesis for a proximal humeral fracture between 01/2001 and 12/2005 were included in this trial. The outcome was measured with PROMs or clinical scoring tools such as CS, NS, OSS, UCLA, DASH, SF-36 and EQ-5D and a correlation coefficient between those evaluation tools was calculated. In addition, a distinction was made between the two force measurement methods (wrist [HG] vs. deltoid muscle [DM]) for CS. Results The correlation of the results of CS and NS (HG: r = 0.85; p < 0.001/DM: r = 0.93; p < 0.001), CS and UCLA (HG: r = 0.83; p < 0.001/DM: r = 0.86; p < 0.001), NS and UCLA (r = 0.91; p < 0.001) as well as DASH and OSS (r = 0.88; p < 0.001) was strongly expressed. A good comparability of the results was demonstrated between CS and OSS (HG: r = 0.63; p < 0.001/DM: r = 0.66; p < 0.001) and between CS and DASH (HG: r = 0.62; p < 0.001/DM: r = 0.61; p < 0.001). The correlation of CS (HG/DM) and UCLA with the EQ-5D index was also good. Assessment of the physical components of SF-36 with CS, NS, OSS, UCLA and DASH showed a moderate to good association, while the mental components of SF-36 showed a low correlation (p > 0.05). Conclusion The assessment of shoulder function after proximal humerus fracture showed a very strong correlation within the clinical questionnaires (CS/NS/UCLA) and the PROMs (OSS/DASH). A strong correlation also exists between the clinical questionnaires and the PROMs. There was only a moderate correlation with the EQ-5D. The moderate to strong correlation between the physical components of SF-36, with almost no correlation between the mental components of SF-36, indicates that the quality of life restriction is based on a physical, but not on a mental impairment.

scholarly journals The Shoulder Function Index (SFInX): a clinician-observed outcome measure for people with a proximal humeral fracture

2015 ◽  
Vol 16 (1) ◽  
Author(s):  
Alexander TM van de Water ◽  
Megan Davidson ◽  
Nora Shields ◽  
Matthew C Evans ◽  
Nicholas F Taylor
Keyword(s):  
Proximal Humeral Fracture ◽  
Outcome Measure ◽  
Humeral Fracture ◽  
Shoulder Function ◽  
Function Index

scholarly journals The Shoulder Function Index (SFInX): evaluation of its measurement properties in people recovering from a proximal humeral fracture

2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Alexander T. M. van de Water ◽  
Megan Davidson ◽  
Nora Shields ◽  
Matthew C. Evans ◽  
Nicholas F. Taylor
Keyword(s):  
Proximal Humeral Fracture ◽  
Humeral Fracture ◽  
Shoulder Function ◽  
Measurement Properties ◽  
Function Index

Reliability and validity of shoulder function outcome measures in people with a proximal humeral fracture

2013 ◽  
Vol 36 (13) ◽  
pp. 1072-1079 ◽  
Author(s):  
Alexander T. M. van de Water ◽  
Nora Shields ◽  
Megan Davidson ◽  
Matthew Evans ◽  
Nicholas F. Taylor
Keyword(s):  
Outcome Measures ◽  
Proximal Humeral Fracture ◽  
Reliability And Validity ◽  
Humeral Fracture ◽  
Shoulder Function

Nerve graft versus nerve transfer for neonatal brachial plexus: shoulder outcomes

2021 ◽  
Vol 27 (1) ◽  
pp. 87-92
Author(s):  
Brandon W. Smith ◽  
Kate W. C. Chang ◽  
Sravanthi Koduri ◽  
Lynda J. S. Yang
Keyword(s):  
Brachial Plexus ◽  
Clinical Data ◽  
External Rotation ◽  
Nerve Transfer ◽  
Shoulder Function ◽  
Nerve Transfers ◽  
Shoulder Flexion ◽  
Significant Difference ◽  
Transfer Strategies ◽  
Shoulder External Rotation

OBJECTIVEThe decision-making in neonatal brachial plexus palsy (NBPP) treatment continues to have many areas in need of clarification. Graft repair was the gold standard until the introduction of nerve transfer strategies. Currently, there is conflicting evidence regarding outcomes in patients with nerve grafts versus nerve transfers in relation to shoulder function. The objective of this study was to further define the outcomes for reconstruction strategies in NBPP with a specific focus on the shoulder.METHODSA cohort of patients with NBPP and surgical repairs from a single center were reviewed. Demographic and standard clinical data, including imaging and electrodiagnostics, were gathered from a clinical database. Clinical data from physical therapy evaluations, including active and passive range of motion, were examined. Statistical analysis was performed on the available data.RESULTSForty-five patients met the inclusion criteria for this study, 19 with graft repair and 26 with nerve transfers. There were no significant differences in demographics between the two groups. Understandably, there were no patients in the nerve grafting group with preganglionic lesions, resulting in a difference in lesion type between the cohorts. There were no differences in preoperative shoulder function between the cohorts. Both groups reached statistically significant improvements in shoulder flexion and shoulder abduction. The nerve transfer group experienced a significant improvement in shoulder external rotation, from −78° to −28° (p = 0.0001), whereas a significant difference was not reached in the graft group. When compared between groups, there appeared to be a trend favoring nerve transfer in shoulder external rotation, with the graft patients improving by 17° and the transfer patients improving by 49° (p = 0.07).CONCLUSIONSIn NBPP, patients with shoulder weakness experience statistically significant improvements in shoulder flexion and abduction after graft repair or nerve transfer, and patients with nerve transfers additionally experience significant improvement in external rotation. With regard to shoulder external rotation, there appear to be some data supporting the use of nerve transfers.

Arthroscopically treated proximal humeral fracture malunion

2002 ◽  
Vol 18 (9) ◽  
pp. 1020-1023 ◽  
Author(s):  
Viktor Hinov ◽  
Franklin Wilson ◽  
Gayl Adams
Keyword(s):  
Proximal Humeral Fracture ◽  
Humeral Fracture

scholarly journals Prognosis of proximal humeral fracture.

1990 ◽  
Vol 39 (2) ◽  
pp. 835-838
Author(s):  
Mako Hirano ◽  
Kazutoshi Nomura ◽  
Meisho So ◽  
Toshio Amano
Keyword(s):  
Proximal Humeral Fracture ◽  
Humeral Fracture

Five-year outcome after conversion of a hemiarthroplasty when used for the treatment of a proximal humeral fracture to a reverse total shoulder arthroplasty

2018 ◽  
Vol 100-B (6) ◽  
pp. 761-766 ◽  
Author(s):  
M. Holschen ◽  
M-K. Siemes ◽  
K-A. Witt ◽  
J. Steinbeck
Keyword(s):  
Shoulder Arthroplasty ◽  
Proximal Humeral Fracture ◽  
Constant Score ◽  
Total Shoulder Arthroplasty ◽  
Operating Time ◽  
Humeral Fracture ◽  
Reverse Total Shoulder Arthroplasty ◽  
The Mean ◽  
Reverse Total Shoulder

Aims The reasons for failure of a hemirthroplasty (HA) when used to treat a proximal humeral fracture include displaced or necrotic tuberosities, insufficient metaphyseal bone-stock, and rotator cuff tears. Reverse total shoulder arthroplasty (rTSA) is often the only remaining form of treatment in these patients. The aim of this study was to evaluate the clinical outcome after conversions from a failed HA to rTSA. Material and Methods A total of 35 patients, in whom a HA, as treatment for a fracture of the proximal humerus, had failed, underwent conversion to a rTSA. A total of 28 were available for follow-up at a mean of 61 months (37 to 91), having been initially reviewed at a mean of 20 months (12 to 36) postoperatively. Having a convertible design, the humeral stem could be preserved in nine patients. The stem was removed in the other 19 patients and a conventional rTSA was implanted. At final follow-up, patients were assessed using the American Shoulder and Elbow Surgeons (ASES) score, the Constant Score, and plain radiographs. Results At final follow-up, the mean ASES was 59 (25 to 97) and the mean adjusted Constant Score was 63% (23% to 109%). Both improved significantly (p < 0.001). The mean forward flexion was 104° (50° to 155°) and mean abduction was 98° (60° to 140°). Nine patients (32%) had a complication; two had an infection and instability, respectively; three had a scapular fracture; and one patient each had delayed wound healing and symptomatic loosening. If implants could be converted to a rTSA without removal of the stem, the operating time was shorter (82 minutes versus 102 minutes; p = 0.018). Conclusion After failure of a HA in the treatment of a proximal humeral fracture, conversion to a rTSA may achieve pain relief and improved shoulder function. The complication rate is considerable. Cite this article: Bone Joint J 2018;100-B:761–6.

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