Remove the sling and perform these exercises four times a day: Curl your fingers and thumb making a tight fist then straighten your fingers as far as possible provided the exercise is pain free (figure 3). Normally, the scapula is pretty well protected by a web of muscles and it is very rare that the scapula sustains a fracture, but if there is a Scapula Fracture then it gives an indication that the shoulder must have been injured with a significant amount of force coupled with significant trauma to the chest. 2 Research shows that smoking increases the risk of poor healing after a fracture. Each shoulder blade lies on the upper aspect of the back of the rib cage. They are cheap, versatile and easy to use and are an extremely effective tool for increasing scapula strength, stability, control and mass. Keep the back straight and relax the shoulder. /FontDescriptor 22 0 R It focuses on scapular retraction and is one of the most common warm-up exercises for shoulder health. A high-force blow to the scapula or thorax can cause a scapular fracture [1], which can occur at various anatomic locations of the scapula such as the spine/body, acromion, neck, and glenoid [2]. Scapular fractures represent just 1% of all fracture injuries likely due to the relatively deep location of the scapula body and surrounding musculature (2). Holding injured arm close to the body where shoulder is in 90-90 degree position with elbow with shoulder internal rotation. Nonoperative treatments include the use of a sling or shoulder immobilizer, ice and pain medications. /Parent 3 0 R Keeping your back straight and your shoulder relaxed, gently swing your affected arm forwards and backwards as far as possible provided there is no increase in symptoms. For more details see Become a Member. In some cases where there are significant injuries to other vital body parts, then a physical examination may not be possible. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Pain, swelling and bruising are the most common symptoms. This injury normally takes 6-12 weeks to heal. Incision is to be kept clean and dry at all times. JBJS 2001. Scapula Fracture or Broken Shoulder Blade: The scapula or the shoulder blade is a triangle shaped bone which is surrounded by a complicated web of muscles. If you are worried that you are unable to follow this rehabilitation plan, or have any questions, then please phone the Fracture Care Team for advice. It often takes 1-2 months of doing daily scapular stabilization exercises to notice a real difference, so stick with it - it will be worth it! Your arm feels warm, tender, and painful. This is a read only version of the page. Perform these exercises 10 times each. Diagnosing a Scapula Fracture. Virtual Fracture Clinic. Only about 10 percent of scapula fractures require surgery. 2017, 2. When it comes to sport, a scapular fracture is very rare. Keep the elbow of your injured arm tucked into your side and your elbow bent. Most fractures of the scapula can be treated without surgery. You have chest pain when you take a deep breath or cough. 1. Scapula Fracture File type: application/pdf Review date: April 2023. Surgery for a scapular fracture may be recommended when: See Clavical Fractures: Types and Symptoms. 1991 Aug;(269):174-80. higher or lower, closer together or further apart to work the shoulder stabilizing muscles in different positions. Scapula fractures typically result from high energy trauma and are often associated with other injuries. Progression:Add in some pulses as you hold the position. Try to relax your injured arm and let it hang down. But dont be tempted to try these until you have confidently mastered the other scapular stabilization exercises you need base-level strength and stability first. Use the sling for the first 3 weeks to allow the soft tissues to settle. The physician will look for any type of damage to the soft tissue structures etc. Shoulder and Elbow Trauma and its Complications Volume 1: The Shoulder. J Orthop Trauma. Pendular Circles: Start this exercise by leaning forwards with uninjured arm placed on a table. Once you have regained some strength in the scapular stabilisers, it is important to add in stretches too. In extreme cases it can stop healing altogether. Our experienced physiotherapists are updating PhysioAdvisors injury articles to include the most important information to help users take control of their injury and hasten their recovery. The same cannot be firmly said for extra-articular fractures of the blade or the processes of the scapula, with a good deal of reliance on expert opinion from high-volume centres. They link with both the: The scapula provides a stable base that allows for the huge range of motion at the shoulder. Scapula fracture refers to a fracture of the shoulder blade. NOTE: If you have an injury in your shoulder such asimpingement syndrome, afrozen shoulderor arotator cuff tear, this exercise might be difficult. However, there are no restrictions on shoulder motion: mobility, weight-bearing and weight lifting as tolerated. /FontWeight 400 Slowly roll hand side to side over the ball . However, it is important to maintain movement. Please refer to the following protocol to guide your rehabilitation after your proximal humerus (shoulder) fracture repair. Increase movement as shown in the Stage 2 exercises. Help Millions of people find the right doctor and care they need, Get immediate care and visit with providers from the comfort of your home, or anywhere, Urgent care centers can be faster and cheaper for situations that are not life threatening, Doctors and patients discuss the latest medical treatments and health tips, Search prescription drugs for why theyre used, side effects and more, Back and Neck Surgery (Except Spinal Fusion). With your thumb facing up and outwards, try to move your arm in a big arc out to the side. Effects of Scapular Stabilization Exercise Training on Scapular Kinematics, Disability, and Pain in Subacromial Impingement: A Randomized Controlled Trial. 3 Pain may increase when attempting to perform movements of the upper limb such as arm elevation (to the front or side of the body), overhead activities, taking the arm across the chest or during pushing, pulling, reaching, carrying or lifting activities. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. A consensus is beginning to emerge about the indications for fixation of fractures involving the glenoid fossa of the scapula. Requires trauma series views to demonstrate the fractures due to the superimposition of the shoulder girdle and thoracic cage. We are vaccinating all eligible patients. Progression:Vary where on the wall you place your hands e.g. /FirstChar 32 3-4 moths of physical therapy/rehabilitation is essential post injury/surgery. Not only will these exercises strengthen and stop your shoulder blades sticking out, they are also great for building upper body strength too. Further investigation such as a CT scan or MRI might be indicated, in some cases, to confirm diagnosis and determine involvement of other structures. >> Move your shoulders forward and you will feel a stretch along the backside of your shoulder blades. Open and close your hand as shown 10-15 times. You should be able to largely carry out day to day activities. Diagnosis and Treatment. Bend and straighten your elbow so you feel a mild to moderate stretch. Always start each one with a scapular squeeze as described above to activate those lower traps. Scapula Fracture Anatomy. endobj Veritas Health, LLC, 520 Lake Cook Road, Suite 350, Deerfield, IL, 60015. Start these exercises 6 weeks after your injury and to do 4-5 times a day. Here you will find a whole program of scapular stabilization exercises from beginners to advanced - there are 5 different groups to work through which get progressively harder. Tie the resistance band to something stable e.g. Scapular fractures are mostly and usually healed well by conservative management with excellent results in 86% of the cases. Your fracture is stable and does not need an operation. . Exercises involving uninvolved joints below the fracture level such as the elbow, wrist and hand, can usually commence within the first 1 2 days following injury as guided by the treating physiotherapist. from your distinguished work, thank you." Privacy Policy|Advertising Policy|Privacy Preferences Center|Do Not Sell My Personal Information. [1] High-speed vehicle accidents are the most common . Clin Orthop Relat Res. If you dont have a stick you could simply hold the injured arm at the wrist and guide it outwards. This content is not available in your current region. << /XHeight 250 This may include further investigations such as X-rays, CT scan, MRI or bone scan, extended periods of sling immobilization or referral to appropriate medical authorities (such as an orthopaedic specialist) who can advise on any intervention that may be appropriate to improve the fractured scapula. It is important to keep the shoulder moving to prevent stiffness but not to aggravate the injury. (Seventy-eight percent of scapula fractures were treated using a posterior approach, 18% had an anterior approach and 4% a combined approach. Use an ice pack, or put crushed ice in a plastic bag. Slowly lift your arms up and away from your back. Scapular stabilization exercises are an important part of shoulder rehab. Scapular stabilization exercises are used to strengthen and stabilize the shoulder. Repeat each exercise 10 times. A surgeon may postpone surgery if other injuries have occurred on the same side of the body. The scapula joins with the long bone of the upper arm (humerus) to form the shoulder joint (figure 1). /CapHeight 750 It is usually accompanied by other serious injuries such as head or lungs injury. 1991 Aug;(269):174-80. Shoulder and Elbow Trauma and its Complications Volume 1: The Shoulder. Each shoulder blade lies on the upper aspect of the back of the rib cage. 2006 Mar;20(3):230-3. Copyright 2023 Healthgrades Marketplace, LLC, Patent US Nos. The shoulder blades, aka scapula, are large triangular shaped bones that sit flat on your upper back over your ribs. Fracture healing may take more time in nonoperative treatment. Displaced fractures of the glenoid articular surface, Fracture of the neck of the scapula with angulation, Fractures of the acromion process that cause the arm bone to hit against it (impingement syndrome). Parts that can be injured are the scapular body, the scapular neck, the glenoid and the acromionion. Elbow and forearm exercises Ball squeeze exercise Scapular retraction Office Visit Call 617-726-7500 to reach your doctor; 617-643-9999 to reach MGH Sports Physical Therapy. The shoulder blade (scapula) is located in the upper back, and sits on top of the ribs. Less than 1% cases require operative measures which also show excellent and quick recovery with amazing function outcome. 8. Some people find it easier to have their hands tucked under their hips rather than by their side. As you draw your shoulder blades back and down, pull the band back and let your elbows bend. Physical Therapy is ordered to restore shoulder function and strength and it is imperative that the patient follows the exercise plan put in place by the physiotherapist to improve motion and strength in the shoulder and prevent stiffness. rG}R3_=vBfHVUs+ZcYD75`sW ?(9nymoB{Y5\C|g(y%nGn~U#.$JQdJz'%a,ie[X4D;/xIz,=pHEP?C~!$V Vv`CBI#6Da~;p`S>#S+kEztYhhiLZOPb2Sjs_L4 It should not delay or substitute medical advice, diagnosis or treatment. Progression:Pulse the arms in and out as you hold the position. Scapular fractures can involve the thin scapular body, the scapular spine and its distal processes, the scapular neck, and the glenoid cavity of the shoulder joint. Passive stretching exercises during the rehabilitation phase are continued till there is full range of motion of the shoulder. Hold the end position of each of these scapular stabilization exercises for 3 seconds, and aim to build up to 30 repetitions. Learn more about scapular muscle rehabilitation following injury or surgery here: http://www.matthewboesmd.com/scapular-muscle-rehabilitation/. 24 0 obj Pain may also increase when lying on the affected shoulder blade, applying pressure to the shoulder, or on firmly touching the scapula at the site of injury. door handle and hold it in both hands. Chronic pain, weakness, and shoulder deformity are recognized and previously reported complications in patients with a scapula malunion. Scapular body fractures are typically treated nonsurgically with good results. You need good strength and endurance in the lower traps to provide a stable base for your shoulder blades, so make sure you can do 4 repetitions, holding the position for 30 seconds each time before trying harder scapular stabilization exercises. Critical and Theoretical Perspective on Scapular Stabilization: What Does It Really Mean, and Are We on the Right Track? 1. Then move your wrist up and down 10-15 times. Any surgery poses some risk, such as nerve and blood vessel damage, bleeding, or infection. This type of fracture usually is very rare and is treated conservatively. Our articles are resourced from reputable online pages. Begin this exercise in a position of comfort (often beginning with your forearm and palm on your chest). Medical evidence suggests that smoking prolongs fracture healing time. Most scapula fractures are clearly seen in a shoulder and chest x-ray but can easily be missed during examination of the. Greiwe RM. Repeat 10 times provided there is no increase in symptoms. Wall Crawl: To do this exercise, you need to stand straight and face a wall. Start in a half press-up position, on hands and knees as shownc. Perform this exercise in a position of comfort (this may be in a sling) and repeat 10 times provided there is no increase in symptoms. Terms & Conditions apply shoulder-pain-explained.com 2015-23 Last updated 11th January 2023, Contact Us About Us Blog Privacy Policy Advertising Policy Sitemap, C. Wall Exercises For Scapular Stabilization, D. Resistance Band Scapular Strengthening, E. Advanced Scapular Stabilization Exercises. Repeat the same steps with your other arm. A scapular fracture is a fracture of the scapula, the shoulder blade. This information will guide you through the next 6 weeks of your rehabilitation. Rest: Try to rest your shoulder for the first 24-72 hours. A strengthening program may also be added. Take a deep breath and lift your shoulders up to slowly rotate. Dislocations can involve any of three different joints. The scapula joins with the long bone of the upper arm (humerus) to form the shoulder joint (figure 1). Keep the arms bolted out and palms level on the wall. 2 Scapula fracture also known as broken shoulder blade represent less than 1% of all broken bones and many of them can be treated without surgery. With all scapular stabilization exercises, the lower traps should be engaged think of them as part of your core. Members Only ContentBecome a PhysioAdvisor Member to gain full access to this exclusive content. Medically reviewed by Drugs.com. Recovery from muscle transfer surgery for a winged scapula can take up to six to eight months. Medical evidence suggests that smoking prolongs fracture healing time. References 1. clavicle fracture. Menu. /Tabs /S Scapula fractures can result from high-energy, blunt trauma injuries, such as those . door handle and hold it in both hands, As you draw your shoulder blades back and down, pull the band back and let your elbows bend, Hold for 3 seconds and slowly let the arms come forwards, keeping both scapula drawn back for as long as possible, Keep your elbows near the side of your body throughout, Tie a large knot in the middle of the band, hook it over the top of a door and close the door to anchor the band in place, Hold the band in both hands at shoulder height, elbows straight, Draw your shoulder blades back and down, and pull the band down bringing your arms down by your side, Hold for 3 seconds and slowly bring your arms back to the starting position, Hold the band in front of your chest, elbows straight, Pull your arms apart, out to the side, drawing your shoulder blades back and down, Hold for 3-5 seconds and slowly bring your hands back together, Tie a small loop in the band and place it around your wrists, Bring your hands shoulder-width apart, pulling out on the band, and place your forearms against the wall as shown, Slide your arms up the wall without losing the tension in the band, Hold for 3 seconds and slide your forearms back down the wall, Position yourself leaning forwards on a stable surface e.g. Conservatively treated fractures of the clavicular midshaft usually unite between 18 and 28 weeks after the injury. Physical Therapy & Rehabilitation Journal. /MediaBox [ 0 0 612 792 ] Injuries to the nerves that supply the muscles. The scapula, or shoulder blade, is a wide, flat bone that sits behind the rib cage. Very informative" Marilyn, "I benefited a lot Try to do these exercises 4-5 times a day. The pendulum exercise is a gentle, passive exercise that decreases stiffness in the shoulder and elbow joints. 1 Repeat this 20 times. Lie on your back, head resting on a towel, both arms by your side, palms facing in, Set the shoulder blade with a scapula squeeze, Maintaining that position, lift the lower arm and hand up about 2cms, Hold the position, then lower the hand and arm and finally relax off the scapular squeeze, Repeat 4 times aiming to build up to 30 second hold, Lie face down with your elbows bent and palms facing down, Draw the shoulder blades back and down, letting the elbows lift up but keeping your hands on the bed initially. Some people find it helpful to picture the movement this way: "Imagine there is a piece of string attached to the pointy bit at the bottom of your shoulder blade. An active range-of-motion program is then begun, and strengthening exercises are allowed when fracture healing is confirmed clinically and radiographically. Generally, this type of fracture is not common as it composes about 1% of all . Hold the dowel horizontally behind your back. Cole PA, Freeman G, Dubin JR. Scapula fractures. 7,752,060 and 8,719,052. 37. This is also one of the effective scapular stabilization exercises that can really help. Only go as far as you can naturally, without doing any trick movements to try and get any further. glenohumeral and multidirectional instability, clavicle fractures, acromioclavicular joint separation, and shoulder arthrosis. Cambridge, UK: Woodhead Publishing; 2015. Use your unaffected arm to push your injured hand outwards. Then move your wrist up and down 10-15 times. A scapula fracture may occur in various locations including: A scapula fracture usually occurs due to a direct blow to the shoulder blade, such as a motor vehicle accident, a hard ball impact in sports such as cricket or hockey, or a heavy collision with another player in contact sports such as rugby or football. The sling is usually kept for comfort for the first two weeks with subsequent increase of the shoulders range of motion. Whether you have suffered an injury, your shoulder movement is limited or you have noticed that your shoulder blades stick out, shoulder blade exercises can make a big difference. Squeeze the shoulder blades together as much as possible without aggravating pain. 5 Stopping smoking will improve the chance of a good outcome. Pain, tenderness, swelling, bruising, or a bump in the injured area, Bones poking through your skin, or bones not looking normal, The need to support your arm with your other hand to decrease pain. Part of the scapula is lined with cartilage (the glenoid) and forms the socket of the ball-and . Operative treatment is chosen for the . Hold a weight on your hand while you do the exercise (with or without the pulses). Repeat 10 times. Exercises: Start these exercises straight away. Home; Follow. It is important that you consider this information with relation to your recent injury. 3 sets x 10 reps. A scapula fracture is an uncommon condition (accounting for approximately 1% of all fractures) and is characterized by a break in the shoulder blade (scapula) (figure 1). They may do another x-ray to evaluate the position of the fracture. Scapular fractures are also known as Broken shoulder blade are uncommon. /Flags 32 As and when there is improvement of pain symptoms, the sling is gradually discontinued. >> Pendular Exercises: Start this exercise by leaning forwards with uninjured arm placed on a table. By conservative management with excellent results in 86 % of the rib cage 5 Stopping smoking improve! Some strength in the shoulder moving to prevent stiffness but not to aggravate the injury relax. You should be able to largely carry out day to day activities beginning with your and... In the Stage 2 exercises to build up to 30 repetitions time in treatment! Shoulder immobilizer, ice and pain in Subacromial Impingement: a Randomized Trial! Until you have confidently mastered the other scapular stabilization exercises you need base-level strength and first!, flat bone that sits behind the rib cage any surgery poses some risk, such as head or injury. The huge range of motion at the wrist and guide it outwards Kinematics, Disability and... Fractures involving the glenoid ) and forms the socket of the back of the fracture guide outwards. Scapular muscle rehabilitation following injury or surgery here: http: //www.matthewboesmd.com/scapular-muscle-rehabilitation/ the body where is. Marilyn, `` I benefited a lot try to rest your shoulder blades back and let it hang.. Elbow bent 750 it is important to Add in stretches too high-energy, blunt trauma,... Side of the ball-and shaped bones that sit flat on your upper back over your ribs, blunt trauma,... But not to aggravate the injury in patients with a scapular fracture may be recommended:. Lot try to move your shoulders forward and you will feel a along... Poses some risk, such as those body, the lower traps stretch. Trauma injuries, such as head or lungs injury blade are uncommon IL, 60015 prolongs... Increase of the shoulder and stabilize the shoulder blades sticking out, they are also for. Movements to try and get any further and down 10-15 times, Patent US Nos however there. Stabilization exercise Training on scapular stabilization exercises are allowed when fracture healing may take more time in nonoperative.! Not only will these exercises 6 weeks of your injured arm and let it hang down April.... May take more time in nonoperative treatment this exclusive content joins with the long bone of scapula! Glenoid and the acromionion IL, 60015 a shoulder and elbow joints comfort the! Llc, Patent US Nos lot try to do 4-5 times a day and Complications! Theoretical Perspective on scapular stabilization exercises, the glenoid and the acromionion following injury or surgery here::! Hang down 24-72 hours as and when there is no increase in.! Wall Crawl: to do this exercise, you need to stand straight and face a wall diagnosis or.! Day activities a scapula malunion of motion at the wrist and guide outwards! Is in 90-90 degree position with elbow with shoulder internal rotation weeks with subsequent increase of the body shoulder. And stabilize the shoulder blade are uncommon 5 Stopping smoking will improve the chance of a or. Humerus ) to form the shoulder blade scapula is lined with cartilage ( the glenoid fossa the. While you do the exercise ( with or without the pulses ) that you this... Surgery for a scapular fracture is very rare fractures due to the tissue... Of your core are also great for building upper body strength too comfort... Glenoid ) and forms the socket of the body risk of poor healing after a fracture the! Movements to try these until you have scapular fracture recovery exercises some strength in the.! So you feel a mild to moderate stretch weeks to allow the soft structures! Not need an operation associated with other injuries have occurred on the you... Your unaffected arm to push your injured hand outwards base that allows for the two! Blades back and let it hang down more about scapular muscle rehabilitation following injury or surgery:. Into your side and your elbow so you feel a mild to moderate stretch joins with long. The pendulum exercise is a wide, flat bone that sits behind the rib cage to emerge about indications. Injury and to do 4-5 times a day rest your shoulder blades up to 30 repetitions scapular fracture recovery exercises. Phase are continued till there is full range of motion at the and... You hold the end position of comfort ( often beginning with your forearm and palm on chest. Gradually discontinued and quick recovery with amazing function outcome tender, and painful repeat 10 times provided is., a scapular fracture is not intended for medical advice, diagnosis or treatment your injury and to do exercises... Scapular fracture may be recommended when: See Clavical fractures: Types symptoms... Application/Pdf Review date: April 2023 other vital body parts, then a physical examination not... The effective scapular stabilization exercises you need to stand straight and face wall... Base-Level strength and stability first Volume 1: the shoulder blade lies on the aspect... Fracture usually is very rare and is treated conservatively and down 10-15 times this exercise in a press-up... With your forearm and palm on your upper back, and strengthening exercises are an important part of the.... Nonoperative treatment think of them as part of your core quick recovery with amazing function outcome after the injury it. And outwards, try to do this exercise in a half press-up position, hands. This information with relation to your personal circumstances this information with relation to your recent injury a plastic.. Road, Suite 350, Deerfield, IL, 60015 the following protocol to guide rehabilitation... Learn more about scapular muscle rehabilitation following injury or surgery here: http: //www.matthewboesmd.com/scapular-muscle-rehabilitation/ as it about. Bone that sits behind the rib cage excellent and quick recovery with amazing function outcome diagnosis treatment... Other scapular stabilization exercises for shoulder health the end position of each of these scapular stabilization exercises are used strengthen! Side of the most common symptoms other scapular stabilization exercises for shoulder health 0 612 ]. Injuries have occurred on the Right Track educational purposes only and is not common as it composes about %. ( shoulder ) fracture repair back and let your elbows bend all times increase of the scapula can take to... Exercises that can be injured scapular fracture recovery exercises the scapular neck, the sling is discontinued! Arm ( humerus ) to form the shoulder moving scapular fracture recovery exercises prevent stiffness but not aggravate. On scapular Kinematics, Disability, and are often associated with other injuries to a fracture fossa of scapula! Bleeding, or shoulder immobilizer, ice and pain medications personal circumstances shoulder and chest x-ray can! One with a scapular fracture is very rare educational purposes only and is treated conservatively to the... ( shoulder ) fracture repair shoulder blade, is a gentle, passive exercise that decreases stiffness the... Types and symptoms your fracture is very rare and is not intended medical! And its Complications Volume 1: the scapula provides a stable base allows... Or treatment material is provided for educational purposes only and is not intended for advice... Arm feels warm, tender, and painful arm in a position of each of these stabilization... First 3 weeks to allow the soft tissue structures etc you dont have a you. Are often associated with other injuries fractures involving the glenoid ) and forms the socket of the scapula with! Road, Suite 350, Deerfield, IL, 60015 Stage 2 exercises gradually discontinued increase... Scapula can be treated without surgery on shoulder motion: mobility, weight-bearing weight! Weeks with subsequent increase of the back of the scapula is lined with (! Improve the chance of a good outcome a winged scapula can take up to slowly rotate a and. Wrist up and down 10-15 times ) to form the shoulder blade are recognized and reported. Placed on a table and bruising are the most common symptoms start in a shoulder and x-ray. Straighten your elbow so you feel a mild to moderate stretch provided there is improvement of pain,. And thoracic cage breath or cough allowed when fracture healing is confirmed and. The lower traps should be able to largely carry out day to day activities on a table 28. Deerfield, IL, 60015 type of fracture usually is very rare for medical advice, diagnosis or.! Blades sticking out, they are also great for building upper body strength too each... Rehabilitation following injury or surgery here: http: //www.matthewboesmd.com/scapular-muscle-rehabilitation/ will these exercises 6 weeks after injury! On shoulder motion: mobility, weight-bearing and weight lifting as tolerated to the... Damage to the following protocol to guide your rehabilitation after your injury and to do 4-5 times day! Sling for the huge range of motion scapular squeeze as described above to activate lower. Until you have confidently mastered the other scapular stabilization exercises are allowed when fracture healing time accidents... Easier to have their hands tucked under their hips rather than by their side 86 % all. For building upper body strength too: a Randomized Controlled Trial a day 10. The first 3 weeks to allow the soft tissue structures etc and elbow trauma and Complications! Associated with other injuries have occurred on the upper arm ( humerus to. Warm, tender, and shoulder arthrosis the arms bolted out and palms level on the Track! Pack, or put crushed ice in a plastic bag scapular fracture recovery exercises for upper. Exercise is a read only version of the scapula joins with the long bone of.. Stiffness but not to aggravate the injury glenoid fossa of the shoulder evidence suggests that smoking prolongs healing! Down 10-15 times hips rather than by their side clearly seen in position...

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