Abstract :

Introduction: Humeral shaft fracture accounts for 3% of total orthopedic injury and seen more in females above 50 years of age. The radial nerve injury is one of the common complication of the fracture which leads to wrist drop. Stiffness and muscle weakness in other joints especially shoulder influences the upper extremity function negatively. Mirror therapy is the intervention aimed at improving functional movements by creating a reflective illusion of an affected limb through use of mirror. It was introduced for managing phantom pain and later used for improving upper limb function in post stroke patients, CRPS patients etc. Though there are many researches stating its significance in upper limb function; it has not been used widely in clinical setting for upper-limb fracture cases. Upper limb fractures especially humeral fracture has its detrimental effect on overall functioning of the upper limb. Thus this case study aims to evaluate the effect of mirror therapy in patient with Supracondylar fracture.Case Description: A 69 year old female with right hand dominance sustained aright humeral fracture after a fall in the house in May 2018. Following ORIF patient was referred to physiotherapy department for wrist drop, pain and stiffness in shoulder joint. Physiotherapy treatment: For first 3 weeks, patient received electrical stimulation and passive movements for wrist extensors. The treatment protocol also included hot pack for shoulder joint, active and active assisted ROM exercises for elbow and shoulder joint respectively. After 3 weeks, Mirror therapy was introduced for wrist and extension and shoulder flexion, abduction movements. The electrical stimulation was discontinued. The patient was evaluated for Pain at shoulder joint by Visual Analog Scale, Active ROM measurements for shoulder and wrist joint. The functional level was measure by Disability for Arm, Shoulder and Hand questionnaire. The measurements were taken at 0 week, 3rd week and 6th week.Results: The pain, range of motion and functional status of the patient was showed improvement as compared to base line data. At the end of 6 weeks, the VAS score for shoulder pain was reduced by 3.2. The Shoulder flexion and abduction active range of motion was improved by 650 and 850 respectively. Wrist extension range of motion also showed improvement from no active movement to 600 of motion. Further the Disability score (DASH) was decreased by 46.25%.Conclusion: This case study concludes that the mirror therapy after upper limb fracture has positive effects on its function when used in combination with the conventional therapy. Thus the mirror therapy should be incorporated the post fracture rehabilitation protocol.

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