Justifi cation of the use of osteopathic correction in the complex rehabilitation of patients with consolidated fractures of the large tubercle of the humerus

Introduction. Fractures of the proximal humerus occur in 4–5 % of all fractures and 50–80 % of all fractures of the humerus. The treatment of this type of fracture is a relevant issue. This is due, on the one hand, to a rather high frequency of occurrence of such fractures, and, on the other hand, to a signifi cant probability of the development of persistent functional disorders. The use of osteopathic techniques is possible both in acute (without alteration of the integrity of bone structures) and in chronic injuries of the musculoskeletal system. Their use during the rehabilitation process is especially valuable. Currently, there are few works in the scientifi c literature exploring the effectiveness of osteopathic treatment as part of the comprehensive rehabilitation of this group of patients. The foregoing has predetermined the purpose of this work. The goal of research — to substantiate the possibility of using osteopathic correction in the comprehensive rehabilitation of patients with consolidated fractures of the large tubercle of the humerus after conservative treatment.

Materials and methods. From January 2016 to December 2018, in the Arbatsky consultative diagnostic centre at the Pirogov National Medical and Surgical Center a prospective, controlled randomized trial was conducted. The study included 30 patients with consolidated fractures of the large tubercle of the humerus. Patient selection and sampling was carried out by the continuous method. Patients were divided into two groups of 15 people by the method of simple randomization with the use of a random number generator. In the main group, therapy consisted of rehabilitation treatment (physiotherapy, exercise therapy) and osteopathic correction, including 3 sessions with an interval of 1 week. Patients in the control group received only rehabilitation treatment. Before and after treatment, all patients underwent an assessment of the severity of pain in accordance with the visual analogue scale, measurement of the volume of active movements in the shoulder joint with the use of a goniometer, assessement of the timing of recovery of shoulder function using the OSS questionnaire, as well as osteopathic examination according to the approved protocol.

Results. Most often, patients with a fracture of the large tubercle of the humerus presented somatic dysfunctions of the thoracic region (both structural and visceral components), as well as chronic local dysfunctions of the sternoclavicular joint, the fi rst rib, individual vertebral motor segments. In patients of both groups receiving both isolated traditional rehabilitation treatment and traditional rehabilitation treatment in combination with osteopathic correction, there was a decrease in the severity of pain and an increase in the volume of active movements in the shoulder joint. Moreover, in the group that additionally received osteopathic correction, lower pain indicators and higher range of motion were noted compared with the control group. Also, the functions of the shoulder joint in patients of the main group were restored faster.

Conclusion. The obtained results confi rm the advisability of including osteopathic correction in the program of comprehensive rehabilitation of patients with fractures of the large tubercle of the humerus.

1. Макарова С. И., Алейников А. В. Лечение переломов проксимального отдела плечевой кости: проблемы и пути решения. Нижегородский медицинский журнал. 2005; 4: 48–53 [Makarova S. I., Alejnikov A. V. Lechenie perelomov proksimalnogo otdela plechevoj kosti: problemy i puti resheniya. Nizhegorodskij medicinskij zhurnal. 2005; 4: 48–53 (In Russ.)].

2. Kristiansen B., Barfod G., Bredesen J., Erin-Madsen J., Grum B., Horsnaes M., Aalberg J. Epidemiology of proximal humerus fractures. Acta Orthop. Scand. 1987; 58: 75–77.

3. Russo R., Vemaglia Lombardi L., Giudice G., Ciccarelli M., Cautiero F. Surgical treatment of sequelae of fractures of the proximal third of the humerus. The role of osteotomies. La Chirurgia degli Organi di Movimento. 2005; 90 (2): 159–169.

4. Chun J. M., Groh G. I., Rockwood C. A. Jr. Two-part fractures of the proximal humerus. J. Shoulder Elbow Surg. 1994; 3: 273–287.

5. Gruson K. I., Ruchelsman D. E., Tejwani N. C. Isolated tuberosity fractures of the proximal humeral: current concepts. Injury. 2008; 39: 284–298. https://doi.org/10.1016/j.injury.2007.09.022

6. Дунай О. Г., Суворов О. Е., Маркин Г. А., Нечипоренко П. И. Лечение переломов проксимального отдела плечевой кости. Травма. 2014; 4: 108–110 [Dunaj O. G., Suvorov O. E., Markin G. A., Nechiporenko P. I. Lechenie perelomov proksimal′nogo otdela plechevoj kosti . Travma. 2014; 4: 108–110 (In Russ.)].

7. Rath E., Alkrinawi N., Levy O., Debbi R., Amar E., Atoun E. Minimally displaced fractures of the greater tuberosity: outcome of non-operative treatment. J. Shoulder Elbow Surg. 2013; 22: 10: e8–e11. https://doi.org/10.1016/j.jse.2013.01.033

8. Gumina S., Carbone S., Postacchini F. Occult fractures of the greater tuberosity of the humerus. Int. Orthop. 2009; 33: 171–174. https://doi.org/10.1007/s00264-007-0512-9

9. Wilcox R., Arslanian L., Millett P. Management of a Patient With an Isolated Greater Tuberosity Fracture and Rotator Cuff Tear. J. Orthpaed. Sports Phys. Ther. 2005; 35 (8): 521–530. https://doi.org/10.2519/jospt.2005.35.8.521

10. Parsons J., Marcer N. Osteopathy: Models for Diagnosis, Treatment and Practice. Churchill Livingstone, 2006: 299–303.

11. Younis F., Sultan J., Dix S., Hughes P. The range of the Oxford Shoulder Score in the asymptomatic population: a marker for post-operative improvement. Ann. Royal College Surg. England. 2011; 93 (8): 629–633. https://doi.org/10.1308/003588411X13165261994193

12. Мохов Д. Е., Белаш В. О., Кузьмина Ю. О., Лебедев Д. С., Мирошниченко Д. Б., Трегубова Е. С., Ширяева Е. Е., Юшманов И. Г. Остеопатическая диагностика соматических дисфункций: Клинические рекомендации. СПб.: Невский ракурс, 2015. 90 с. [Mohov D. E., Belash V. O., Kuzmina Yu. O., Lebedev D. S., Miroshnichenko D. B., Tregubova E. S., Shiryaeva E. E., Yushmanov I. G. Osteopaticheskaya diagnostika somaticheskix disfunkcij: Klinicheskie rekomendacii. SPb.: Nevskij rakurs, 2015. 90 s. (In Russ.)].

13. Баскевич М. Я. Вопросы регенерации, остеорепарации и лечения переломов (теоретические аспекты фрактурологии). Тюмень: Тюмен. мед. акад., 1999. 175 с. [Baskevich M. Ya. Voprosy regeneracii, osteoreparacii i lecheniya perelomov (teoreticheskie aspekty frakturologii). Tyumen: Tyumen. med. akad., 1999. 175 s. (In Russ.)].

14. Байдалина Н. Ю., Кузнецов Н. И. Динамика минеральных нарушений и кровообращения при регенерации различных переломов длинных трубчатых костей. Закономерности морфогенеза опорных структур позвоночника и конечностей на разных этапах онтогенеза: Межвузов. темат. сб. Ярославль, 1982: 138–139 [Bajdalina N. Yu., Kuzneczov N. I. Dinamika mineralnyh narushenij i krovoobrashheniya pri regeneracii razlichnyh perelomov dlinnyh trubchatyh kostej. Zakonomernosti morfogeneza opornyh struktur pozvonochnika i konechnostej na raznyh etapah ontogeneza: Mezhvuzov. temat. sb. Yaroslavl, 1982: 138–139 (In Russ.)].

15. Потехина Ю. П. Патогенез соматических дисфункций (локальный и региональный уровни). Российский oстеопатический журнал. 2016; 3–4 (34–35): 91–104 [Potekhina Yu. P. Pathogenesis of Somatic Dysfunctions (Local and Regional Levels). Russian Osteopathic Journal. 2016; (3-4): 91–104 (In Russ.)]. https://doi.org/10.32885/2220-0975-2016-3-4-91-104

16. Потехина Ю. П., Мохов Д. Е., Трегубова Е. С. Этиология и патогенез соматических дисфункций. Клиническая патофизиология. 2017; 4 (23): 16–26 [Potekhina Yu. P., Mokhov D. E., Tregubova E. S. Etiology and pathogenesis of somatic dysfunctions. Clinical Pathophysiology. 2017; 23 (4): 16–26 (In Russ.)].

17. Белаш В. О., Мохов Д. Е., Трегубова Е. С. Остеопатическая коррекция в комплексной терапии и реабилитации пациентов с синдромом позвоночной артерии. Вопросы курортологии, физиотерапии и лечебной физической культуры. 2018; 95 (6): 34–43 [Belash V. O., Mokhov D. E., Tregubova E. S. The use of the osteopathic correction for the combined treatment and rehabilitation of the patients presenting with the vertebral artery syndrome. Problems of Balneology, Physiotherapy and Exercise Therapy. 2018; 95 (6): 34–43 (In Russ.)]. https://doi.org/10.17116/kurort20189506134

18. Potekhina Yu. P., Tregubova E. S., Mokhov D. E. Osteopathy is a new medical specialty. Assessment of clinical effectiveness of osteopathic manipulative therapy in various diseases (Review). Medical News of North Caucasus. 2018; 13 (3): 560–565. https://doi.org//10.14300/mnnc.2018.13105