Shoulder avulsion fracture

[anna]

I would like some advice with regads to an avulsion fracture of a shoulder. It happened 4 weeks ago with a fall. One orthopaedic surgeon suggested a sling and physio and another one suggested 6 weeks rest in a sling. When should rehabilitation start? What kind of rehab would you suggest? And wouldnt the shoulder become very tight after a 6 week rest period or is it essential for healing?

[physiobob]

Can you advise where and the mechanism of injury. If possible can you also upload an x-ray or mri image? You are unfortunately looking at 6 weeks rest really however treatment should look at advice and movements to maintain joint movement in directions that do not place undue stress on the avulsion itself. i.e. A torn external rotator can be passively externally rotation and perhaps actively internally rotated from an externally rotated position back to neutral even with light resistance. Think a bit out of the box for this one but justify why you are doing what and whether there is or is not load on the healing avulsion.

[anna]

The patient fell from a ladder and couldnt remember what position he landed in. Loading the xrays??? Sorry, this email is already challenging my computer skills It looks like it is the supraspinatus that was mainly involved with the avulsion fracture. Flex is painful from 90 degrees upwards and abduction starts hurting at 80 degrees. I gave him pulley exercises (ie active assisted) into flex and abd within limits of pain just to avoid a frozen shoulder. Int and ext rotation I left for now. Thank you for the reply !!! Your input really helped !