Therapeutic gymnastics in the physical rehabilitation program for injuries of individual nerves of the upper extremities. Traumatic injury to the median nerve

Antipyretics for children are prescribed by a pediatrician. But there are emergency situations with fever when the child needs to be given medicine immediately. Then the parents take responsibility and use antipyretic drugs. What is allowed to be given to infants? How can you lower the temperature in older children? What medications are the safest?

Fracture is called a complete or partial violation of the integrity of the bone. Depending on how damaged the skin is, fractures are divided into closed and open.

For broken bones The following phenomena are observed: pain, bruising and deformation, shortening of the limb, abnormal mobility, bone crepitus, and most importantly, dysfunction that occurs immediately after the injury. Among other things, any fracture is accompanied by injury to adjacent tissues, swelling, hematomas, and often damage to muscles, ligaments, joint capsule, etc.
It should be noted that no one is immune from fractures and injuries of the upper extremities. And if such a situation arises, you should immediately contact a traumatologist. The doctor will apply a plaster cast. If the case is severe, then treatment can be very long, and surgery may even take place.

Tasksrehabilitation for fractures of the upper limbs are: preserving the life of the victim, the desire to achieve in the shortest possible time complete and durable fusion of bone fragments in their normal position, restoring the normal function of the injured limb and the working ability of the victim.

Treatment includes general and local procedures. To achieve proper fusion of bones during a fracture, the fragments of the damaged bone should be placed in the desired position and held in this position until complete fusion. If the fracture is open, then primary surgical treatment of the wound should be performed before immobilization.
For normal fracture healing in the shortest possible time, it is necessary that the fixation of the reduced fragments be strong and reliable. In order to achieve immobility at the fracture site, it is necessary to provide this place with a plaster cast, as well as constant traction, osteosynthesis or compression-distraction devices.
In order to restore the functions of the limb, as well as the patient’s ability to work, functional treatment methods are used, such as Exercise therapy for a fracture of the upper extremities, training on exercise machines, exercises that promote tension and stretching of muscles. Therapeutic gymnastics for fractures of the upper limbs, massage, physiotherapy and hydrotherapy are also widely used. If physical therapy is used in the early stages of treatment, this will help eliminate symptoms such as pain, swelling, hemorrhage, etc. Among other things, physiotherapy accelerates the formation of callus, restores limb function, and also prevents postoperative complications.
On the second or third day after the fracture, UHF or inductothermy, UV irradiation, laser therapy, electrophoresis with calcium and phosphorus, massage, as well as physical therapy for injuries of the upper extremities are prescribed.
If muscle atrophy occurs, in such cases it is necessary to resort to electrical stimulation (with preliminary administration of ATP), vibration massage, stretching exercises, isometric exercises, training on machines, running and gymnastics in water, swimming, cycling, walking are also necessary skiing, various games.
In the presence of joint contractures, doctors recommend electrophoresis with lidase, phonophoresis with lazonil, arthrosenex, mobilate, as well as LH for fractures of the upper extremities, which is carried out in water. Patients are recommended to exercise on exercise machines, cryomassage, sauna and swimming in the pool.
In the presence of a plaster cast or compression osteosynthesis devices, such as the Ilizarov-Gudushauri, Dedova, Volkov-Oganesyan apparatus, etc. Moreover, from the first days of injury, exercise therapy for healthy limbs is included in the treatment process, which includes breathing exercises, general developmental and isometric exercises, stretching .

After the plaster cast and devices are removed, the patient is recommended to walk, and the use of axial load on the limb is also important.
In case of fractures of the bones of the upper limb, PH is included in the rehabilitation process for injuries of the upper limbs, which helps to prevent contractures and stiffness of the finger joints, as well as preserve the ability to grip. After the plaster cast is removed, massage and occupational therapy of the injured limb are included; exercises that promote the acquisition of self-care skills are especially important.
Therapeutic exercise and therapeutic exercises for fractures and injuries of the upper extremities are aimed at restoring the full range of motion in the joints and strengthening the muscles. Very often, exercise therapy for injuries of the upper extremities is prescribed to the patient immediately from the first days after receiving the injury. Moreover, light exercises are first used, the purpose of which is to reduce swelling and hematomas, as well as improve blood circulation. Later, exercises that help strengthen muscles are added to the complex of exercise therapy and physical therapy for fractures of the upper limbs. Then, exercises with resistance, weights and using various objects are gradually included.

Set of exerciseswith a fracture of the upper limbs (very important - when performing these exercises, make sure that there is no pain in the injured arm):
Starting position - standing or sitting.
1. Perform circular movements with your shoulders, while swinging your affected arm. Raise your shoulders up.
2. Bend your arms at the elbows with tension, perform circular movements in the shoulder joint.
3. Raise your arms up to your sides, then lower them. Raise your arms forward and up, lower.
4. Place the sore hand on the healthy one, raise both hands up.
5. Perform a movement simulating chopping wood from the shoulder of the affected arm to the opposite knee.
6. Raise the sore hand up and stroke the hair.
7. Raise the affected arm up and touch it to the opposite shoulder.
8. Fold your hands into a “lock” and straighten your arms forward.
9. Bend your arms at the elbows. Then touch your shoulders with your hands, while bringing your elbows together.
10. Lower your arms along your body. Perform sliding movements with the hands up to the armpits along the side surface of the body.
11. With straight arms, clap your hands, first in front of you, and then behind you.
12. With straight, relaxed arms, perform circular movements.

Next a set of exercises for upper limb injuries performed from a standing starting position, holding a gymnastic stick in hands:
1. Raise your arms straight with the stick up.
2. Take the stick in one hand, extend the arm with the stick in front of you (the stick is in a vertical position). Transfer the stick from one hand to the other, while using your free hand to move to the side, up and in front of you.
3. Place the stick with one end on the floor, holding the other end with your sore hand, and move the stick like a lever.
4. Hold the stick in front of you with both hands extended forward and perform circular movements.
5. Put your hands down, holding a stick. Perform pendulum movements in one direction and the other.
6. Hold the stick in front of you with outstretched arms. The brushes should be brought together. Turn the stick in your hands like a “mill”, while moving your fingers.
7. Take a stick with your sore hand and move it back and forth (movements imitating a steam locomotive).

Lying position

1. I. p. - lying on your back, the healthy arm is brought under the sick one, bending the arms at the shoulder joints (4-5 times).

2. I. p. - lying on your back, arms bent at the elbow joints, leaning on the elbows, slight bending in the thoracic spine with the shoulders apart - inhale, return to i. n. - exhale (3-4 times).

3. I.p. — lying on your back, the sore arm resting on a plastic panel. Retraction of a straight arm along a polished surface with a horizontal position and an inclined position of the panel (4-6 times).

As mentioned above, in order to achieve a full recovery faster, you should not neglect exercise therapy. Therapeutic exercise and therapeutic exercises for fractures and injuries of the upper extremities are aimed at restoring the full range of motion in the joints and strengthening the muscles.
Very often, exercise therapy for injuries of the upper extremities is prescribed to the patient immediately from the first days after receiving the injury. Moreover, light exercises are first used, the purpose of which is to reduce swelling and hematomas, as well as improve blood circulation. Later, exercises that help strengthen muscles are added to the complex of exercise therapy and physical therapy for fractures of the upper limbs. Then, exercises with resistance, weights and using various objects are gradually included.
Exercise therapy begins on the first day of injury when severe pain disappears.
Contraindications to the use of exercise therapy: shock, large blood loss, danger of bleeding or its appearance during movements, persistent pain.
Throughout the entire course of treatment, general and special problems are solved when using exercise therapy.
During exercise therapy in case of bone fractures and joint injuries, significant pain should not be allowed - this is not only very unpleasant for the patient, but can lead to fainting and even painful shock due to the presence of a large number of painful nerves in the muscle tissue and, especially in the periosteum receptors. It is necessary to accurately dose the load, which should not be excessive (risk of secondary injury) or insufficient (lack of training moment and problems with restoring limb function). Based on the provisions of biomechanics, the following principles should be observed in exercise therapy:
- apply efforts on the longest possible arm of the bone lever; as a result, a greater moment of force arises, the magnitude of which will be less than when acting on the short arm of the bone lever; the result is greater efficiency and comparative safety;
- avoid regular overstretching, which can interfere with the rapid fusion of bones, and also creates conditions for the formation of a larger than required gap between the articular surfaces of the bones; this can lead to excessive freedom of movement in the joint; the consequence of this is a violation of the accuracy of movements; when overstretching, there is also a high possibility of muscle microtraumas and hemorrhages, which, of course, delays the process of restoring the functions of damaged areas of the body;
- take into account the composite nature (composite levers) of biokinematic links and be sure to influence the bone pairs interacting with the affected bone link;
- use, at certain times, weight-bearing exercises to strengthen joints, as well as to increase the volume and traction force of atrophied muscles.
Only under the influence of systematic physical activity in the early stages can it be possible to eliminate the complications of injuries that have arisen (muscle atrophy, contractures), improve tissue metabolism, normalize the supporting function of the limbs, and thereby prevent loss of performance and disability.
Early functional loading of the limb with stable and rigid fixation of bone fragments helps restore active muscle function, improve blood supply to the bone, and restore joint function, which significantly reduces the time for complete rehabilitation of the patient.
Once again it is appropriate to recall the importance of a comprehensive treatment principle using all possible means.

3. Physical therapy for fractures of the upper limbs

Clavicle fracture. Physical therapy begins on the second day after the injury, and the first period lasts from the moment the fracture is fixed until the splint is removed (approximately 3 weeks).
The complex includes breathing, general developmental, and special exercises for the fingers.
A set of special exercises for a clavicle fracture
in the first period
1. Spread your fingers apart, then connect them again (Fig., a). Repeat 6-10 times.
2. Bend your fingers into a fist - thumb on top, straighten your palm, then squeeze again - thumb inside the fist (Fig. b). Repeat 6-10 times.
3. Connect the tip of each finger to the end of the thumb, forming a ring (Fig. c). Repeat 6-10 times with each finger.

4. Click with each finger (Fig. d). Repeat 6-10 times with each finger.
5. Bend the nail and middle phalanges of all fingers (“claws”) (Fig. e). Repeat 6-10 times with each finger.
6. Circular movements with each finger clockwise and counterclockwise (Fig. e). Repeat 6-10 times.
7. Lower the brush down and raise it. Repeat 3-4 times.
8. Move the brush from right to left and vice versa. Repeat 3-4 times in each direction.
9. Circular movements with the brush clockwise and counterclockwise. Repeat 6-10 times in each direction.
Perform all exercises at a slow pace 6-8 times a day.
After a week, remove the scarf and begin exercises for bending and extending the arm at the elbow: when the arm is bent, perform movements in the shoulder joint 8-10 times (move the elbow up and away from an angle of 80 degrees, then lower and connect the shoulder blades). This exercise is done 4-6 times a day.
In the first period, moving the arm forward, abducting it at the shoulder joint by more than 80 degrees, and turning the arm palm down are contraindicated, as this leads to displacement of the fragments.
The second period begins after the formation of a callus (which is confirmed by x-ray), when the splint is removed, approximately 3 weeks after the injury. During this period, it is important to restore the function of the shoulder joint. The exercises are performed synchronously with the healthy arm.

Lying position

1. I. p. - lying on your back, the healthy arm is brought under the sick one, bending the arms at the shoulder joints (4-5 times).

2. I. p. - lying on your back, arms bent at the elbow joints, leaning on the elbows, slight bending in the thoracic spine with the shoulders apart - inhale, return to i. n. - exhale (3-4 times).

In case of injuries, it is necessary, since prolonged restriction of movements in injured patients causes a number of disorders of both the musculoskeletal system and internal organs.

What changes in the body when treating injuries?

Long-term use of bed rest, forced positions, traction and immobilization slow down the regeneration processes and make them less complete. In the absence or insufficient axial load, the epiphyseal ends of the bones undergo rarification. The nutrition of cartilage carried out by osmosis and diffusion sharply deteriorates. The elasticity of cartilage decreases. In areas where there is no contact and mutual pressure of the articular surfaces, gradation of cartilage is formed. In places of intense mutual pressure of cartilage, bedsores may appear. The amount of synovial fluid produced decreases. In areas of duplication of the synovial membrane, its gluing occurs. Subsequently, fusion of the articular cavity with the formation of connective tissue adhesions, even ankylosis, is possible. In the joint capsule, elastic fibers are partially replaced by collagen. Immobilized muscles undergo atrophy.

The benefits of exercise therapy for injuries

Immobilization with plaster, ensuring retention of fragments, maintaining immobility in the joints, faster healing of the wound, does not at the same time exclude the possibility of straining the muscles under the cast, performing various movements with the immobilized limb, early starting axial load when walking in a plaster cast, and thereby helping to improve regeneration processes and restore function .

The tonic effect of exercise therapy for injuries becomes of great importance. It is especially important in conditions of bed rest, as it ensures the activation of all vegetative functions and processes of cortical dynamics, prevents the development of various complications (congestive pneumonia, atonic constipation) and mobilizes the body's defensive reactions. It should be taken into account that when protective inhibition manifests itself, for example after a shock, even small muscle loads can be excessive and cause its deepening. The tonic effect of exercise in these cases should be used with caution.

In the presence of a cast (traction), systematically carried out movements under the cast reduce the degree of inhibition in the nerve centers of the muscles and balance the inhibitory-excitatory processes in them. Under the influence of muscle contractions in the damaged area, metabolic processes in tissues are gradually normalized. It should be noted that if exercises are used too early after an injury, they can worsen tissue trophism. Contraction of the symmetrical muscles of a healthy limb can to some extent influence the improvement of trophic processes in tissues subjected to injury.

The stimulating effect of exercise therapy exercises for injuries on regeneration processes is reduced to improving metabolism in the regeneration zone and ensuring the formation of a complete structure of regenerating tissue. By selecting exercises in accordance with the characteristics of clinical manifestations, it seems possible to interfere with the course of regeneration processes, for example, by turning off or changing the nature of the load on the callus depending on the location of the fracture and the position of the fragments. Excessively early and powerful functional irritation can slow down or distort the regeneration process.

When using influence on trophic processes after reconstructive ones, functional stimulation is very important, commensurate with the progress of adaptation of the morphological structures of tissues to new conditions of function. Excessively early and strong load, for example, during arthroplasty, can lead not to the transformation of tissue interposed between the articular surfaces into articular cartilage, but to its partial death and the development of arthrosis.

Restoration of impaired functions using exercise therapy for injuries

Gradually increasing impulses to tension in damaged muscles help restore their full active contraction. A full plaster cast, traction, or sutures placed on the damaged muscle or tendon provide a faster recovery of this ability. In case of a poorly immobilized fracture or in case of violation of fixation of one of the ends of the muscle, for example. tendon rupture or rupture, it becomes very difficult or impossible to restore the tension.
The physiological patterns of “transfer” of strength, speed of movement and endurance of the muscles of a healthy limb to the damaged one that increase as a result of exercise begin to appear somewhat later.
To normalize muscle function, restoring the ability to relax is very important. Special exercises used for these purposes help to simultaneously increase the range of motion.

For contractures caused or accompanied by pain, it is advisable to first relieve pain through blockades, after which the range of movements can be significantly increased using the usual training method. In addition to relieving pain, this effect is also due to the infiltration of the anesthetic solution into the altered tissues, leading to an increase in their ability to stretch.

Immediately after removal of plaster immobilization or traction, the ability of the muscles to tense is significantly reduced. This is caused by a change in the nature of muscle-articular and skin-tactile impulses from a limb freed from fixation and the appearance of pain when moving it.

It should be noted that when using exercise therapy for injuries, muscle strength increases much faster than atrophy is eliminated. This is explained by the fact that physical exercise, improving the cortical regulation of movements, ensures in a short time the restoration of the maximum functional mobilization of all tissue elements of the muscles when it is tense.

To preserve everyday and industrial motor skills, their early use, at least in a modified and simplified form, during the period of immobilization is of utmost importance. This applies to walking, movements when eating, when writing.

Normalization of autonomic functions (especially the vascular system, respiratory organs, digestion) should be ensured in cases where they are persistently altered under the influence of injury, bed rest, forced positions, and plaster immobilization.

Formation of compensation using exercise therapy for injuries

The formation of temporary compensations in the treatment of a traumatic disease concerns unusual motor skills (standing up in the presence of a cast). If a new movement, for example, walking with crutches in a plaster cast, temporarily replaces the usual motor act, one should strive to preserve the basic structure of the latter (for example, avoid walking with a leg sharply rotated outward, or walking with an extended step). Once the need to use temporary compensation has passed, one should strive to restore the full technique of the motor skill that was compensated. In some cases (for example, during muscle transplantation), a movement that is old in external form can essentially be a permanent compensation, requiring the formation of a new complex structure for controlling it.

Combination of exercise therapy with other methods

The use of exercise therapy for injuries should be combined with all other treatment methods. When combined with therapeutic regimens, careful dosage of stimulating functional stimulation on regeneration processes through exercises and movements performed in the process of everyday self-care, for example, when using therapeutic walking and walking associated with self-care, is especially important.

The use of exercise therapy for injuries before surgery can prepare the tissues in the area of the intended intervention for it, mobilizing their mobility, improving elasticity and blood supply. Therapeutic physical education can contribute to the psychological preparation of the patient for the upcoming operation.

In the postoperative period, therapeutic physical culture should facilitate the rapid elimination of acute manifestations of the traumatic disease that developed after surgery, and then more rapid and complete implementation of the morphological and functional results of the operation.

The use of exercise therapy for injuries is widely combined with non-bloody methods of orthopedic treatment in the form of one-stage and staged redressal, traction, and fixation devices.

The combination of exercise therapy for injuries with physiotherapeutic treatment is carried out taking into account their joint stimulating effect on regeneration processes, the elimination of contractures and the restoration of joint mobility.

The combined use of exercise therapy exercises for injuries and natural or preformed natural factors is carried out in the form of air baths during exercises at room temperature and at low air temperatures, by conducting exercises with solar insolation (it is possible to use artificial sources of ultraviolet radiation) and by conducting exercises in water (in the bath, in the form of bathing and swimming).

Indications and contraindications for exercise therapy for injuries

Indications for the use of physical exercises for injuries are as follows:

damage to the skin, ligamentous-articular apparatus and muscles caused by mechanical (bruises, ruptures and tears, wounds and crushing), thermal (burns and frostbite) and chemical (burns) agents; bone fractures;
surgical interventions on soft tissues (skin and tendon plastic surgery, skin grafts); on bones (osteotomies, osteosynthesis and bone grafting, resections, amputations and reamputations) and on joints (arthrotomies, plastic surgery of the ligamentous apparatus, surgical reduction of dislocations, removal of menisci and intra-articular bodies, resections, arthrodeses, arthroplasties).

Temporary contraindications to exercise therapy for injuries are as follows:

condition after shock, large blood loss, the presence of severe reactions to infection in the area of injury or to a generalized infection;
risk of bleeding due to movements;
foreign bodies in tissues and bone fragments located close to large vessels, nerves, and important organs;
presence of severe pain.

Taking into account the influence of physical exercise should reflect changes in both general manifestations and the course of local processes during a traumatic disease.

Results of exercise therapy for injuries

With pronounced general manifestations of a traumatic disease, the beneficial effect of exercise therapy for injuries is manifested in a change in the indifference to exercises to a positive one, in a decrease in motor and speech inhibition, in the appearance of more mobile facial expressions and greater sonority of the voice, in an improvement in the course of vegetative reactions (improved filling and slowing of the pulse with tachycardia, deepening and slowing of breathing, decreasing pallor or cyanosis).

With moderate general manifestations of a traumatic disease, the general tonic effect of fully carried out exercise therapy complexes for injuries is reflected in improved well-being and mood, slight pleasant fatigue, a positive verbal assessment of the impact of exercises, the establishment of good contact with those conducting the exercise, an increase in pulse pressure, slight changes in the increase in heart rate and respiration . The beneficial tonic effect of the exercises continues to be felt for several hours (improved well-being, decreased irritability and complaints about the interfering bandage and the inconvenience of the forced position, smooth, not rapid breathing, good filling and moderate pulse rate).

When assessing the effect of exercise therapy for injuries on local processes and the state of function of the damaged musculoskeletal system, the tension of the muscles under the bandage (determined by palpation or tonometer), the degree of displacement of the patella when the quadriceps extensor of the tibia is tense, and the ability to raise the injured limb in a plaster cast are taken into account. , the amount of pressure (in kilograms) that causes the appearance of pain during load along the axis of the limb, pain and its intensification during exercise, the time during which the pain lasts after exercise, the range of movements in individual joints in degrees, the strength of individual muscles, the ability to perform individual integral movements (putting on clothes, combing one's hair) and the nature of adaptive compensations (walking with an extended step, raising the shoulder when moving the hand). Clinical data are taken into account (according to the characteristics of the injury): the intensity of development and quality of granulations, the progress of epithelization, the nature of the wound discharge, the progress of callus formation (clinical and radiological data), the severity of secondary changes (atrophy, limited mobility, vicious positions).

In accordance with the data obtained and their dynamics, the selection of exercise therapy exercises for injuries and the training methods are changed, the intensity of the load is reduced or increased, and sometimes classes are temporarily canceled.

The article was prepared and edited by: surgeon

This information is intended for healthcare and pharmaceutical professionals. Patients should not use this information as medical advice or recommendations.

Special therapeutic exercises for injuries and diseases of the upper extremities

G.E. Egorov, T.N. Zaitseva, L.K. Burchik, G.I. Avsievich
Novokuznetsk City Medical and Physical Education Dispensary, Department of Physical Therapy, Physiotherapy and Balneology of Novokuznetsk GIDUV.

Damage to bones, joints and soft tissues of the upper extremities is very common. To treat damage, you have to resort to fixing the joints with a plaster cast or surgery. With subsequent fixation. Some of them require a significant period of fixation to restore the anatomical integrity of damaged tissues. In such cases, the restriction of movement in the joints is severe, and long-term and patient treatment using physiotherapeutic procedures, therapeutic exercises and massage is required to restore range of motion in the joints of the damaged limb.

This leaflet contains special physical exercises used for contractures in the joints of the upper limb. Performing them in combination with general strengthening exercises helps to more quickly restore range of motion in the joints of the injured limb.

SPECIAL EXERCISES USED FOR INJURIES OF THE SHOULDER JOINT

After removing the plaster cast, the hand is placed on a scarf. The first 4 exercises are performed on a headscarf.

1. Tilt the body forward, the relaxed hand on the scarf is moved away from the body.

2. Tilt of the torso towards the relaxed sore arm.

3. In the same position, slightly rock the relaxed arm back and forth.

4. Slightly swing the arm to the side.

5. Rocking the sore arm without a scarf back and forth with the torso tilted towards the sore arm.

6. Pendulum-like movements of the arms forward, backward and to the sides with the body tilted forward.

7. When bending the torso forward, hands “locked”, swinging your arms up and down.

8. The affected arm is bent at the elbow joint; with the support of the healthy arm, the injured arm is moved to the side.

9. Hands to the shoulders, moving the elbows to the sides.

10. Hands in front of the chest, moving the elbows back, connecting the shoulder blades.

II. Hands “locked” below. Raise your arms up, bend them behind your head, straightening your arms up, palms up, return to i. P.

12. Hold the stick horizontally at the bottom, shoulder-width apart, raise your arms up and down.

13. The stick is horizontally at the bottom, gripping the ends, moving the sore arm to the side, pushing it with the healthy hand using the stick.

14. Stick horizontally at the bottom, turn the stick to a vertical position, injured arm at the top.

15. The stick is horizontal at the bottom, lift the stick up, put it on the shoulder blades and return to i. P.

16. The stick is horizontally below the back at the width of the pelvis, move your arms back, return to i. P.

Exercises on the gymnastic wall.

17. Standing facing the gymnastic wall, alternately grab your hands up onto each bar, return to i. P.

18. Standing facing the wall, hands at shoulder level with an overhand grip, half-squat and squat.

19. Standing with your back to the wall, hands with an overhand grip at the level of the pelvis, bend over and extend your arms.

Exercises with dumbbells (0.5-1 kg)

20. Flexion and extension of the arms at the elbow joints.

21. Bend your arms at the elbows at a right angle, the elbows are pressed to the body, supination and pronation.

Hands down, slowly raise your arms to the sides and slowly lower them down.

Exercises with a ball (volleyball or rubber)

23. Hands with the ball below, throws forward and upward with straightened arms.

24. Arms bent at the elbows, the ball touches the chest, throws forward and upward.

25. Hands below, raise your arms up from behind, bending at the elbows, try to touch the ball to the shoulder blades, and then throw over your head forward - up.

26.Standing with your back to your partner, hands with the ball below, throw back over your head with straight arms.

Exercises with a ball for an injured hand

Throws forward and upward;

the arm is bent at the elbow (the ball is at the shoulder), extending the arm;

pushes forward and upward;

standing sideways to your partner (on the side of your healthy arm);

the sore arm below, with the torso tilted towards the healthy arm, throwing the ball over the head.

27. Throwing a tennis ball at the wall and catching it with an underhand and overhand grip.

Lying on your back (on a couch or floor)

28. Arms bent at the elbows, arms moving to the sides (sliding along the surface of the couch, floor).

29. Abduction of straight arms to the sides.

30. Straight arm abduction with dumbbells (0.5-1 kg) or rolling a medicine ball weighing 1 kg.

31. Hands “locked”, raise your hands up and lower down.

32.With a gymnastic stick, raise the stick up and lower it down.

33. With a gymnastic stick and an additional dumbbell weighing 0.5-1 kg in your hands, lift the stick with dumbbells up and lower it down.

Exercises with a block

34. Standing facing the block, with your back, flexion, extension and abduction in the shoulder joints (start movements with your healthy arm).

Relaxation exercises

35. Free, relaxed swinging of the arms while bending the torso.

SPECIAL EXERCISES FOR HUMOMOSCULAR PERIARTHRITIS

Sitting on a chair

Exercises for hands and wrist joints.

Forearm rotation.

Flexion at the elbow joints.

Raising and lowering your shoulders (hiding your head in your shoulders).

Hands “clasped” on your knees, raising your arms forward and up..

Hands “locked”; bending the arms at the elbow joints, place the hands on the chest, on one, then on the other shoulder.

Hands “locked” on the chest, stretch your arms with your palms outward, forward and down, forward and up.

Rocking the sore arm, lowered along the body and relaxed, forward, backward and in a small circle.

Hands on knees, circular movements with shoulder blades in both directions.

Sit on the edge of a chair, move your healthy hand up the back of the chair, and do the same with your bad hand,

Sitting on a chair with a gymnastic stick

11. Hold the stick by the ends with an overhand grip, place it on your chest and lower it into the i. P.

12. The same holds the stick with an underhand grip.

13. Taking the stick to the side.

14. The stick is installed vertically on a chair between the knees; lift, intercepting, the hands up the stick and lower it down.

15. Holding the stick by the ends, move it over your head to the right and left.

16. Stick behind your head and onto your shoulders, alternately straighten your arms to the sides, “saw the neck.”

17. Holding the stick by the middle with your hand extended, forward, turn it inward and outward.

Standing with a gymnastic stick

18. Stick behind your back, pull the stick to your shoulder blades at different grip widths with your hands and with different grips.

19. Stick behind your back, hold it by the ends, move the stick to the right and left.

Standing with rubber

20. The rubber is tied to a stick by the ends, and the middle is tied to any stable object (imitation of rowing on a kayak, on a boat).

21. The rubber band is tied to the gymnastics wall at shoulder level (imitation of the hammer throwing movement with a 360° body rotation in both directions).

22. A rubber band is tied to a gymnastics stand - flexion, extension, abduction and adduction, circular movements in the shoulder joint, standing with your face, side and back to the wall.

Lying on your back

23. Relaxing the hand with light shaking.

24. Bending at the shoulder joints (arms “locked” or with a gymnastic stick).

25. Shoulder abduction.

Lying on your stomach (on the couch)

26. Arm lowered from the couch, arm swaying with relaxation.

On all fours

27. Stretch your arms forward and place them on the floor. With springy movements, try to sit on your heels without moving your arms.

At the gymnastics wall

28. Standing facing the wall, intercepting the slats, raise your arms up to the limit and lower them down to chest level.

29. Squat, holding the bar with a straight hand at different heights.

30. Standing with your back to the wall, squat, holding the bar at waist level.

31. Standing with your side to the wall, move your hand to the side, intercepting from rail to rail.

Exercises with a rocker

32. Abduction and adduction; circular movements forward and backward.

Exercises for neck muscles

33. Lateral head tilts, forward and backward bends, head turns, circular movements.

Resistance exercises for neck muscles

34. Hands on the back of the head “locked” (leaning forward and backward); hands on temples, side tilts of head.

Ball exercises

35. Various throws to a partner, at the target, with one and two hands, on the spot and in motion.

36. Throwing the ball into a basketball hoop with two and one hands.

Note. In all cases of restoration of range of motion in the shoulder joint, it is necessary to strive to perform isolated movements in this joint. For this purpose, it is recommended to fix the scapula with special belts (the belt is placed over the sore shoulder girdle) and use such starting positions when the scapula is less involved in the movement of the shoulder.

A SET OF BASIC EXERCISES AFTER REDUCTION OF TRAUMATIC SHOULDER DISLOCATION

1. I. p. - o. With. Raise your shoulders - inhale; lower - exhale (3-4 times). .

2.I. n. - the healthy arm is brought under the large arm, half bent at the elbow joint, the body is slightly tilted. Slowly bend the arm at the shoulder joint and return to the starting position (4-5 times).

3. I. p. - o. With. Simultaneously bending the arms at the elbow joints and returning to i. p. (6-8 times).

4. I. p. - hands on the belt, slightly bending the spine in the thoracic region, pull the elbows back - inhale, and. p. - exhale (3-4 times at a slow pace).

5. I. p. - standing with a gymnastic stick in hands down. Raise the stick forward with outstretched arms and return to I. p. (4-6 times).

6. I. p. - a stick in hands down. Retracting the stick towards the sore arm and returning to the i. p. (4--6 times).

7. I. p. - o. With. The body is slightly tilted forward. Slowly moving the straight arm to the side and returning to the i. p. (3-4 times).

8. I. p. - hands to shoulders. Taking your shoulders to the sides - inhale, return to i. p. - exhale (3-4 times).

Lying position

9. I. p. - lying on your back, the healthy arm is brought under the sick one, bending the arms at the shoulder joints (4-5 times).

10. I. p. - lying on your back, arms bent at the elbow joints, leaning on the elbows, slight bending in the thoracic spine with the shoulders apart - inhale, return to i. p. - exhale (3-4 times).

11. I.p. - lying on your back, the sore arm rests on a plastic panel. Retraction of a straight arm along a polished surface with a horizontal position and an inclined position of the panel (4-6 times).

12. I. p. - lying on your back, gymnastic stick in your lowered hands. Raising the stick forward - up at a slow pace, returning to i. p. (4-5 times).

13. I.p. - lying on your back, arms along your body, palms down. Turn your arms outward with your palms up - inhale, with your palms down - exhale (3-4 times).

SPECIAL THERAPEUTIC GYMNASTICS EXERCISES USED FOR ELBAR FRACTURES

1. I. p. - standing. Free, relaxed swinging of the arms while bending the torso.

2. The healthy hand is brought under the sick one. Raise the affected arm, bent at the elbow joint, above the horizontal level and lower it with the healthy arm (3-4 times).

3.Clenching your fingers into a fist.

4. Raise your shoulders up and down.

5.Bending at the elbow joints, sliding your palms along the body, reaching the armpits.

6. Hands “locked” behind the back, reach the shoulder blades, sliding movements.

7. Hands to shoulders, circular movements in the shoulder joints.

8. Free swing of arms to the sides.

9. “Running with your arms” (imitation of arm movements when running).

10. Hands “locked”, raise your hands up, behind your head, lift up and lower down.

Exercises with a gymnastic stick

11. Bending your arms, lift the stick up and lower it down with straight arms.

12. Stick behind your back, get your shoulder blades.

13. Holding the ends of the stick, resting your palms, raise your arm to the side with the help of your healthy arm.

14..The “wash your back with a washcloth” movement.

15. The stick stands on the floor, circular rotation of the upper end of the stick.

16. “Kayak rowing” movement with torso rotation.

Exercises with clubs

17. Freely swing in front of you to the sides and crosswise while bending forward.

18. Swing in one direction and the other with both hands.

19. Swing forward and backward, simultaneously and alternately (towards).

20. Movements to the side, one hand forward, the other behind the back.

21. Hands back, crossed, reach the shoulder blades.

Exercises while sitting

22. I. p. - hand on the plane of the table. Actively bend and straighten your arm at the elbow joint, sliding along the table surface (4-6 times).

23. Hand on the plane of the table. Active movements in the elbow joint with rolling over a smooth surface of a light gymnastic stick or roller cart.

24. Hands rest on the table, fingers intertwined. Flexion and extension of the elbow joint with the healthy arm.

25. Support the shoulder on the back of the chair, lower the forearm, weigh the arm down with a load (up to 500 g), swing the arm in the elbow joint (6-8 times).

26. With shoulders resting on the plane of the table: gymnastic stick in hands. Extension of the arms at the elbow joints, trying to stretch them. Hand on a plastic surface, rubbing the surface of the plastic with circular movements of the hand, 4-6 movements in each direction.

27. The hand is on the surface of the table, the fingers hold the gymnastic stick hanging over the edge of the table, the healthy hand fixes the shoulder of the affected hand. Rock the stick, pronating and supinating the forearm, 6-8 times.

Exercises with a volleyball ball

28. Raising the ball up.

29. Tossing the ball with clapping in front and behind.

30. Passing the ball around the body.

31. Throwing the ball from one hand to the other.

32. Reaching the shoulder blades with the ball.

33. Throwing the ball to a partner: from below, from behind the head, from the chest, from the shoulder with one hand, catch the ball with both hands.

34. Throwing the ball into a basketball hoop.

35. Exercises with a block, standing facing the block, sideways, back (flexion and extension at the elbow and shoulder joints).

Exercises at the gymnastic wall

Squatting, bending and straightening your arms. In the absence of a polished plane or carts in the exercise therapy room, the exercise is performed on a regular surface. Most of these exercises can be performed in water (water temperature 36-37°). The condition for using this or that exercise is the absence of pain when performing it.

SPECIAL THERAPEUTIC PHYSICAL EDUCATION EXERCISES FOR RADIAL FRACTURES IN A TYPICAL LOCATION IMMOBILIZATION PERIOD

Exercises while standing

In the position of tilting towards the affected arm, swing the affected arm forward, backward, to the side with the help of the healthy arm.

Raising the affected arm forward and up, then lowering it down and back.

Retracting the arm to the side up and lowering it behind the back.

In a half-tilt, circular movements of the sore arm in the shoulder joint clockwise and counterclockwise.

When releasing the elbow joint from the plaster - flexion and extension at the elbow joint.

Tense flexion and extension of the fingers.

Matching 1 finger alternately with the rest.

Spreading your fingers and then clenching them into a fist.

Small swinging movements of the sore limb to relax the muscles.

EXERCISES AFTER REMOVAL OF IMMOBILIZATION

Exercises for flexion and extension in the wrist joint, in the i. n. sitting at the table

Forearm on the table, wrist extension.

The forearm with the elbow surface on the table, the hand sliding on the table when flexing and extending in the l/z. joint

The hand hangs over the edge of the table, flexing and extending the hand.

Forearm and hand on the table, alternately raising and lowering the forearms with the hand motionless.

The palm of the affected hand is on the edge of the table - fixed on top with the healthy hand, the elbow hangs down, the forearm of the affected arm is raised and lowered to the maximum.

The forearm is vertical, supported by the elbows, flexion and extension of the hands at the left joint.

Support on the elbows, palms together, alternate flexion and extension at the hip joint with careful pressure with the healthy hand on the palm of the patient.

Support your hands on your elbows, palms together, slowly sliding your elbows along the table, spread them to the sides, trying to put your forearm on the table, without lifting your palms from each other and without bending your fingers.

Support your hands on your elbows, fingers “in the back”, flexion and extension in the left side. joint

Exercises with a stick

10. Standing, stick with an overhand grip, arms concave at the elbow joints at a right angle, flexion and extension at the hip joint, forearms motionless.

11. Standing, grip the stick from above, horizontally below, “twisting and unwinding” the stick.

12. Standing, stick on the table, roll the stick with your palms on the surface of the table, do not bend your elbows.

Exercises with a mace

13. Standing, the arm is lowered down, the head of the club is held between the 2-3 or 3-4 fingers, swing the club back and forth by flexing and extending the l/z joint.

Ball exercises

14. Sitting at the table, palm on the volleyball, fingers spread, rolling the ball toward you, without lifting your palm and fingers from the surface of the ball.

EXERCISES IN ABDUCEMENT AND ADJECTION OF THE BRUSH WHILE SITTING AT A TABLE

15. Forearm on the table, palms down, abduction and adduction of the hand at the l/z joint.

16. The forearm is vertical, supported by the elbows, fingers straightened, abduction and adduction of the hand.

17. The forearm is vertical, supported by the elbows, palms connected, abduction and adduction of the hand.

The forearm is vertical, supported by the elbows, fingers interlocked, abduction and adduction of the hand.

Exercises with a mace

19. Standing, the club in the hand lowered down, the index finger along the club, abduction and adduction of the hand with the club with a stationary forearm, for a sweep of swing movements

Ball exercises

20. Sitting, hand on the ball, “twisting” the ball towards the little finger and “twisting” towards the thumb, without lifting the palm from the ball.

EXERCISES IN CIRCULAR MOTION OF THE BRUSH

21. Forearm vertical; rest on the elbows, fingers clenched into a fist, circular movement of the hand clockwise and counterclockwise. 22. Forearm on the table, hand hanging, circular motion of the hand, fingers straightened or clenched into a fist.

Exercises with a mace

23. Standing, the arm with the mace is lowered or bent at the elbow joint at a right angle, circular movements of the hand with the mace in the l/z. joint, the forearm is motionless.

Exercises with the ball

24. Sitting, palm, sore hand on the ball, fingers spread, rolling the ball in a circular motion of the hand in one direction and the other, without lifting the palm from the ball.

EXERCISES AIMED AT RESTORING PRONATION AND SUPINATION OF THE FOREARM

25. Forearm on the table, supination and pronation, without lifting your elbows from the table.

26. Forearm vertical, resting on the elbow, fingers straight, supination, pronation.

27. Support both arms on the elbows, palms together, supination and pronation

28. Support on the elbows, fingers clasped together, supination, pronation of the forearm.

Exercises with a stick

29. Standing, arms bent at the elbows at right angles, grip the stick in the middle with one hand from above, the other from below, supination and pronation of the forearm.

30. Standing, arms bent at the elbows at right angles, grip the stick vertically at the upper end, or grab the lower end, pendulum-like swing of the stick to the right and left.

Exercises with clubs

31. Standing, arms bent at the elbows at right angles, grip of the club behind the head, body of the club at the top, pronation, supination of the forearm.

32. I. p. the same, grip of the club behind the head, body of the club below, supination and pronation of the forearm.

EXERCISES AIMED AT RESTORING MUSCLE STRENGTH OF THE FLEXORS AND EXTENSORS OF THE HAND AND FINGERS DURING THE RECOVERY AND TRAINING PERIOD

33. Flexion and extension of fingers with maximum muscle tension. Alternate with muscle relaxation:

a) resting the forearm on the table;

b) support on the elbows.

34. Forearm on the table, fingers squeezing a rubber ball, sponge or wrist expander.

Exercise with a stick

35. Standing, arms bent at the elbows at right angles, a stick with a load tied to a rope horizontally, slowly twisting the stick with a rope with a load wound around it and slowly unwinding it back.

Medicine ball exercise

36. Standing, arms down with a medicine ball, passing the medicine ball around the body from the affected arm to the healthy one.

SPECIAL PHYSICAL EXERCISES USED FOR DAMAGE TO THE FINGER TENDONS

Exercises used primarily for damage to the finger flexor tendons during the recovery and training period. I. p. - sitting at the table.

1. Hands on the table surface. Active flexion of the joints of the injured finger with fixation of the proximal phalanx with the fingers of the healthy hand (6-8 times).

2. Hands on the table surface, palm down. Using your fingers, gather the scarf lying on the table into folds.

3. Hands on the table surface, palm down. Bending the fingers while sliding along the table surface (5-7 times).

4. Hands on the table surface, palm down. Squeezing a cotton roll or sponge with your fingers.

5. Hands on the table surface, forearm in the middle position between pronation and supination. Bend the finger while slightly resisting the movement.

6. Hands on the table surface. Moving projectiles of different shapes and sizes.

Hand on the table surface. Curling your fingers into a fist.

8. Rotation of the ball towards the thumb and little finger, assembly and disassembly of simple parts.

9. I. p. - standing. Throwing and catching a small rubber ball in various ways.

SPECIAL EXERCISES USED FOR DAMAGE TO THE FINGER EXTENSOR TENDON

1. I. p. - sitting at the table. Active extension of the fingers with fixation of the proximal phalanx.

2. Rotate the wooden cylinder clockwise and counterclockwise with your fingers.

3. An attempt to grasp, spreading your fingers as wide as possible, a large-diameter cylinder.

4. Alternating and simultaneous raising of the fingers from the table surface (forearm and hand in a pronated position).

5. Promoting a wooden projectile weighing 100-250 g along the table surface with an extension movement of the finger.

6. Finger extension with slight resistance (resistance from the instructor’s hand).

7. Rolling along the plane of the table with the straightened fingers of a gymnastic stick.

8. Grabbing and moving large wooden objects (cylinders, cubes) across the table surface.

9. I. p. - standing. Throwing a medium-sized soft rubber ball with your healthy hand, catching it with the fingers of your affected hand.

SPECIAL EXERCISES USED AFTER CONSOLIDATION OF FINGER PHALANX Fragments

1. I. p. - sitting at the table. Hand on the table surface, palm down. Active flexion and extension of the fingers while sliding them along the table surface.

2. Active flexion and extension of the fingers sequentially in the first and second interphalangeal joints with fixation of the proximal phalanx with the fingers of the healthy hand.

3. Squeezing a cotton roll or sponge with your fingers.

4. Hand on the table, a pencil is placed under the interphalangeal joint of the injured finger. Finger bending with support on a pencil.

5. Flexion and extension of fingers with self-help.

6. The hand of the affected hand rests with its palmar surface on a rubber ball. Rotate the ball with your fingers clockwise and counterclockwise.

7. The sore arm rests on the table surface. Grasp small objects of various shapes with your fingers, trying to press them with the tip of your finger into your palm.

Special exercises aimed at restoring the function of damaged fingers are closely combined with exercises in the joints of other fingers and alternate with movements of the fingers of the healthy hand, as well as with exercises in the shoulder, elbow, and left hand. joints and general strengthening and relaxing exercises. In parallel with such gymnastics, the patient performs exercises in warm water - squeezing a sponge, squeezing a rubber ball, sorting small objects (balls, buttons) in water, bending (extending) fingers with self-help, etc.