Posted on December 19, 2014
By Hunter Van Houten, PT, DPT
On November 16th, Bono, of the band U2, was involved in a high energy bicycle accident when he attempted to avoid another rider in Central Park in New York City. As a fellow cyclist, I understand that a crash is something that will inevitably happen, but his is a crash that will take some time to heal from, and he will not be rocking the stage anytime soon (as evidence by his absence on Monday Night Football). What is in store for him is a progressive and intense rehabilitation program for his left upper extremity.
For cyclists, fractures are most common in the hand, wrist, forearm, shoulder blade, collar bone, and humerus. They occur when the rider attempts to break his or her fall with an outstretched arm (e.g. Bono’s left arm). Over the next three blog posts, I will break down his injuries and the rehabilitation that will be required to return him to all things Bono.
As a result of Bono’s accident, he sustained:
· Left facial fracture involving the orbit of his eye
· Left shoulder blade fracture in three separate pieces
· Left compound distal humerus fracture where the bone of his humerus was driven through his skin and the bone was in six different pieces
· Fracture of his 5th finger
For this post, I will focus on the shoulder blade fracture. Bono underwent emergent orthopedic surgery to repair the fractured bones in a fashion that recreates its function as a solid support for the shoulder girdle to facilitate the return of pain-free range of motion, normal strength.
During the first 4-6 weeks after surgery, Bono will be immobilized and simple finger movements, elbow and neck range of motion exercises, as well as pendular exercises, will be his only exercises. Pendular exercises assist with pain, help to maintain some shoulder range of motion, and assist in preventing unwanted scar tissue forming in the joint. After that period, x-rays will be performed to determine if the humerus and scapula are healing well, and he will be able to initiate care with a physical therapist.
For the first phase of physical therapist care, gentle passive range of motion is performed to the scapula, also known as the shoulder blade. The scapula is a unique bone in that it articulates with the ribcage, the humerus (upper arm bone), and the collar bone. We perform passive range of motion to this joint to avoid the complication of a frozen shoulder. Many muscles of the neck and upper back connect to the shoulder, so Bono may also have some pain in these regions that will be treated through soft tissue mobilization and instrumented soft tissue mobilization techniques in order to ease movement of his entire upper body. Soft tissue massage and mobilization techniques for the neck, upper back, shoulder, elbow, forearm, or wrist may also help to improve tissue length and flexibility.
Because Bono’s injuries are not muscular in nature, he will have few restrictions on moving his shoulder blade. However, overhead and weight bearing activities would be prohibited as they require increased force and mobility through the scapula and its articulations. Shoulder shrugs, scapular squeezes, and shoulder rolls are examples of appropriate active range of motion exercises for his scapula.
The proprioceptive (sense of body position in space) control of the scapula on the rib cage (scapulothoracic motion) is especially important in being able to use your shoulder girdle and arm effectively without causing further injury. Normal scapulothoracic motion is particularly essential when using your limb near or above shoulder height (fist pumping to the crowd). For this reason, we would teach Bono how to properly control his scapula during everyday activities, as well as during his rehabilitation exercises. Regaining what is known as “scapulothoracic rhythm” has a substantial reward, as good scapulothoracic control is the key to regaining maximum shoulder girdle motion while avoiding further shoulder problems in the future.
Proprioceptive exercises might include activities such as rolling a ball on a surface with your hand, holding a weight up overhead while moving your shoulder, or push ups on an unstable surface. Advanced exercises may include activities such as ball throwing or catching overhead.
Generally, the strength and stiffness one experiences after a shoulder fracture responds extremely well to physical therapy. Since the normal load on the shoulder girdle is relatively light, Bono should be able to return to normal activities quite early. Weight bearing and overhead activities will be progressed later on in his rehabilitation.
Wishing Bono a speedy recovery, in the name of physical therapy. Until next time, Bono enthusiasts.