Since, there are other injuries as well accompanied by Scapula Fracture or Broken Shoulder Blade, the physician will also look for additional injuries to other parts. Phase 3: Week 6-12 weeks (following clinical fracture healing) Wean from sling Add shoulder AROM, continue PROM, AAROM Rhomboid and periscapular isometrics, posture exercises Phase I and II cuff strengthening when ROM is full and painless and fracture is healed Periscapular, complete extremity, core strengthening 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. Eastbourne District General Hospital Kings Drive, Eastbourne, East Sussex, BN21 2UD With your thumb facing up and outwards, try to move your arm in a big arc out to the side. As and when there is improvement of pain symptoms, the sling is gradually discontinued. A scapula fracture is a broken shoulder blade. This is a read only version of the page. The scapula, or shoulder blade, is a wide, flat bone that sits behind the rib cage. This is known as scapulothoracic rhythm. /AvgWidth 521
Thank you very much!" Start in a plank position, on elbows and toes as shownb. Use the sling for the first 3 weeks to allow the soft tissues to settle. Treatment of Scapula Fractures: Systematic Review of 520 Fractures in 22 Case Series. Weeks 6-12. Medical evidence suggests that smoking prolongs fracture healing time. /Flags 32
Start in a half press-up position, on hands and knees as shownc. Occasionally a scapula fracture may occur due to a fall onto a bent elbow or outstretched arm or in association with a dislocated shoulder (this is more so the case with fractures to the glenoid fossa). However, the duration of the post-injury protocol may take several months, and, early recognition of signs and symptoms of neuropathy is critical. 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. This injury normally takes 6-12 weeks to heal. See our T&C'sShoulder-Pain-Explained.com is a trading name of Wilson Health Ltd.All rights reserved. /XHeight 250
Move your shoulders back while lifted so that you squeeze your shoulder blade muscles together. /Length1 361412
Cambridge, UK: Woodhead Publishing; 2015. /BaseFont /BCDEEE+Calibri
These associated injuries are often major, multiple, and sometimes. Current Reviews in Musculoskeletal Medicine. Veritas Health, LLC, 520 Lake Cook Road, Suite 350, Deerfield, IL, 60015. We and our partners use cookies to Store and/or access information on a device. Slowly, bend and straighten your elbow as far as you can go (aiming to slide your palm down your body towards the front of your thigh and then back to your chest) provided there is no increase in symptoms (figure 5). 2013;6(1):79-87. doi:10.1007/s12178-012-9151-x. It occurs as a result of high-energy trauma such as . %PDF-1.4
Press hard into the wall by leaning your hips forward. Do it about 10 times in each direction. At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov. Keep the arms bolted out and palms level on the wall. Unless you have a narrow bed or table to do these on, youll need to work one arm at a time. Scapula Fracture Shoulder 10. Return to your daily activities as directed. Effects of Scapular Stabilization Exercise Training on Scapular Kinematics, Disability, and Pain in Subacromial Impingement: A Randomized Controlled Trial. It should not delay or substitute medical advice, diagnosis or treatment. You have more swelling than you did before your arm was put into a sling. Egol KA, Connor PM, Karunakar MA et al. 1. Progression of functional activities 2. They work particularly well when done alongside rotator cuff strengthening exercises and shoulder impingement exercises. Scapula Fracture Anatomy. 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! Trust Switchboard for both sites: 0300 131 4500 . Bend and straighten your elbow so you feel a mild to moderate stretch. The scapula, or shoulder blade, is the bone located in the back of your shoulder between the shoulder and the spine. Gradually increase the size of the circlesb. 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. Footer. During a fall onto the shoulder blade or during a direct impact to the back or side of the shoulder, stress is placed on the scapula. endobj
Apply ice for 15 to 20 minutes every hour, or as directed. American Journal of Sports Medicine . Your fracture is stable and does not need an operation. Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with a scapula fracture include: To purchase physiotherapy products for a scapula fracture click on one of the above links or visit the PhysioAdvisor Shop. If the ball portion of the upper arm is broken, split or crushed, a shoulder replacement may become necessary. 2 0 obj
If so, skip it you dont want to aggravate things. All rights reserved. 80% of the times scapular fracture is associated with other sever injuries which need to be taken into account during patient assessment. Already a member? Critical and Theoretical Perspective on Scapular Stabilization: What Does It Really Mean, and Are We on the Right Track? It can take 6 to 12 months to completely restore shoulder motion. Avoid heavy lifting for . Scapular fractures are relatively uncommon, comprising ~1% of all fractures, 1 and only between 10 and 30% of these involve the glenoid. 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). Analysis of 113 cases. Shoulder and Elbow Trauma and its Complications Volume 1: The Shoulder. When this occurs the condition is known as a scapula fracture and can vary in severity and location. This is known as active range of movement. x}|]ca$#lL n`L3X fB 8H@I
$ 4;r7{4`Sy^uoo9;;3;I+/rE1i9c Specific instructions regarding activity and rehabilitation are to be provided to the patient. Masks are required inside all of our care facilities. These fractures include:Displaced glenoid articular surface fractureAngulated fractures of neck of the scapulaAcromion process fractures causing impingement The surgical procedure entails realigning the bone fragments to their normal position and keeping them in place with the help of screws and metallic plates. Always start by setting your shoulder blades - keep thinking about pulling them towards the opposite back pocket of your trousers. /Filter /FlateDecode
These should not cause too much pain. However, there are no restrictions on shoulder motion: mobility, weight-bearing and weight lifting as tolerated. Most broken scapulas heal on their own. Available for Android and iOS devices. Move #5: Internal Rotation. 2006 Mar;20(3):230-3. scapular fracture in a collegiate football player can be successful. Radiographic series includes: true anterior-posterior view of the scapula. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Squeeze the shoulder blades together as much as possible without aggravating pain. The Specialist will talk through the next phase of your rehabilitation. 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. Brighton & Sussex University Hospital Trust. 2006 Mar;20(3):230-3. It is generally easy to feel. Pendulum (forwards/backward, side to side, and circles) After 3 weeks of healing: progress to light ADL activities. Apply ice to help decrease swelling and pain, and to prevent tissue damage. Many scapular body fractures can be treated conservatively, but fractures of the scapular neck and glenoid cavity must be stabilized surgically. Very informative" Marilyn, "I benefited a lot If you have stiffness in your elbow or hand from wearing the sling, you may wish to perform these exercises first. 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). Hold the position for 30 seconds and do 4 repetitions. >>
Passive stretching exercises during the rehabilitation phase are continued till there is full range of motion of the . ForRehabilitation further information exercises: on quitting smoking after visit48-72 quitnow.gov.au hours or speak with your GP. In extreme cases it can Scapular fractures are generally the result of a. high-energy trauma with a high incidence of significant associated. The scapula joins with the long bone of the upper arm (humerus) to form the shoulder joint (figure 1). Fractures commonly involve the clavicle (collar bone), proximal humerus (top of the upper arm bone), and scapula (shoulder blade). >>
Karen, The material on this website is intended for educational information purposes only. 100% gleno humreal instabiity. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. You can also schedule an appointment online with one of our board . Scapula Fracture File type: application/pdf Review date: April 2023. The material on this website is intended for educational information purposes only. ", Top Tips:a. Stand up straight with a light hand weight in each hand. Swing your arm slowly and gently in circles clockwise. 1991 Aug;(269):174-80. 37. Home; Follow. In some cases, muscle changes can also cause this condition. Both groups will be treated twice a week for eight weeks. 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. Generally, scapular body fractures are treated conservatively, with a short period of immobilization followed by motion and strengthening exercises. Now let's look at some of the best exercises for scapular stabilization using a resistance band. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. To perform the exercie: Stand or sit down, but keep your back and neck straight. Slide your affected arm toward your spine. 2008. pp. An ache in the shoulder or shoulder blade may also be present that is particularly prominent at night or first thing in the morning (especially during the first few days following injury). /CapHeight 750
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Each shoulder blade lies on the upper aspect of the back of the rib cage. /FontDescriptor 22 0 R
Incision is to be kept clean and dry at all times. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Some of these injuries can be potentially life-threatening. stream
It is usually accompanied by other serious injuries such as head or lungs injury. Snapping scapula syndrome can be caused by a number of causes, including osteochondroma, rib fractures, nerve injuries, tumors, and bone spurs. /F12 9 0 R /F8 10 0 R /F9 11 0 R /F10 12 0 R /F11 13 0 R >> /ExtGState <<
The scapular squeeze is the perfect place to start for setting the shoulder blade in the right starting position. 3 In patients with severe injuries involving damage to other bones, soft tissue, nerves or blood vessels, recovery time may be significantly prolonged with long term prognosis affected (particularly in the elderly). Most scapula fractures do not require surgery. Be safe with medicines. Rehabilitation plays a major role in gaining back the associated, normal functional movements of the scapular region/shoulder complex. Causes of Scapula Fracture or Broken Shoulder Blade, Symptoms of Scapula Fracture or Broken Shoulder Blade, Treatments for Scapula Fracture or Broken Shoulder Blade, Exercises for Scapula Fracture or Broken Shoulder Blade, Shoulder Joint Fracture: Types, Causes, Symptoms, Treatment- Conservative, PT, Surgery, Winged Scapula or Scapular Winging: Causes, Symptoms, Treatment, Exercise, Diagnosis, Broken Collarbone or Clavicle Fracture: Causes, Types, Symptoms, Diagnosis, Treatment, Exercises, Shoulder Blade Pain: Symptoms, Causes, Types, Treatment, Exercise, Shoulder Bone Spurs: Causes, Symptoms, Diagnosis, Treatment, Supraspinatus Rupture: Causes, Symptoms, Diagnosis, Treatment, Shoulder Sprain: Classification & Types, Symptoms, Diagnosis, Treatment, Exercise, Dietary Dos and Donts for Migraine Sufferers, Shirshasana (Headstand) Versus Inversion Therapy Using Inversion Table, Understanding Joint Pain and Tips to Get Relief Using Home Remedies, Erectile Dysfunction: Does Opioid Cause ED, Libido: Opioid Induced Female Sexual Dysfunction, Excruciating pain with any type of movement of the arm. Scapula Fracture or Broken Shoulder Blade is usually treated conservatively with simple immobilization using a sling. Begin this exercise by leaning forwards with your unaffected arm supported on a table or bench (figure 6). 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). Then move your wrist up and down 10-15 times. After a minute, push hard into the . Once you have regained some strength in the scapular stabilisers, it is important to add in stretches too. Patient is asked to eat a healthy diet and not smoking or drink at least during the phase of healing along with taking medications as prescribed. Make sure your thumbs point up towards the ceiling throughout. The sling holds the shoulder in place during the healing phase. /Tabs /S
Shrug both of your shoulders up as far as they will go, then bring them back down. >>
Remember to try and relax your arm. Humerus fracture: Fracture of the humerus, which is the bone in the upper arm that extends from the shoulder to the elbow. Scapular winging recovery Recovering from scapular winging can take anywhere from a few months to several years, depending on the initial cause, treatment method, and nerves and muscles affected. An X-ray is required to confirm diagnosis and rule out other conditions (such as a rib fracture, clavicle fracture or dislocated shoulder) and should always be taken if a fracture is suspected clinically. Exercises after a broken clavicle bone include shoulder range of motion and gentle strengthening. Following surgery, rehabilitation generally involves: The physician may recommend working with a physical therapist for rehabilitation. 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. /Type /Page
A fracture of this bone is termed as a Scapula or Broken Shoulder Blade. Welcome to Dr. Thats the movement you are looking for. Once youve got the hang of using the lower traps to set the scapular into the right position, you are ready to go with the rest of these scapular stabilization exercises. . PHASE III Weeks 7-9 Initiate isotonic exercises starting with therabands and progressing to weights after week 8 Keep the back straight and relax the shoulder. from your distinguished work, thank you." Egol KA, Connor PM, Karunakar MA et al. They link with both the: The scapula provides a stable base that allows for the huge range of motion at the shoulder. Diagnosis and Treatment. The information is produced and reviewed by over 200 medical professionals with the goal of providing trusted, uniquely informative information for people with painful health conditions. The pendulum exercise is a gentle, passive exercise that decreases stiffness in the shoulder and elbow joints. Begin this exercise in a position of comfort (this may be in a sling) or sometimes with your forearm supported by a table, bench, your opposite hand or pillow etc. 2-5 Because of the thick protective surrounding muscle envelope, the forgiving multiplanar ligaments, and the recoil of the chest wall, direct high-energy trauma is usually necessary to cause a scapular . This is much more functional as scapular instability tends to cause most problems with activities such as lifting and racket sports, when the shoulder is moving through a large range of motion, away from the body. >>
It is important to keep the shoulder moving to prevent stiffness but not to aggravate the injury. Increase movement as shown in the Stage 2 exercises. You suddenly feel lightheaded and short of breath. Open and close your hand as shown 10-15 times. Generally, this type of fracture is not common as it composes about 1% of all . Even offers many rehab exercises. Use your unaffected arm to push your injured hand outwards. Extensive bruising to the shoulder blade region, shoulder, or upper arm may also be present (particularly with more severe fractures) and usually begins to appear a couple of days after the injury. Hold for 30 seconds, then bring your arms back to center. Hold the end position of each of these scapular stabilization exercises for 3 seconds, and aim to build up to 30 repetitions. Read more: Exercises to Reduce Shoulder Blade Pain. /Subtype /TrueType
Most scapula fractures are clearly seen in a shoulder and chest x-ray but can easily be missed during examination of the. Very useful. Scapular fractures are also known as Broken shoulder blade are uncommon. Do not push into pain. Lie on your stomach with a rolled up towel underneath your forehead, both arms down by your sides, palms facing in, Gently draw your shoulder blades back towards your spine, and down towards your waist. Repeat both sides three more times. Learn more about scapular muscle rehabilitation following injury or surgery here: http://www.matthewboesmd.com/scapular-muscle-rehabilitation/. Repeat 10 times. Despite appropriate physiotherapy management, some patients with a scapula fracture do not improve adequately and may require other intervention to ensure an optimal outcome. Treatment will depend on the damage and the kind of fracture you have. /Length 119276
scapula isometrics, no resistance exercises. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. Shoulder Blade Squeezes: To do this exercise, start by standing tall with the back straight. Try this exercise in the T position with your elbows straight and your arms out to the side. Pain is usually severe and located at the back or side of the shoulder, or, in the upper back. This site is for educational purposes only; no information is intended or implied to be a substitute for professional medical advice. Scapula fractures can result from high-energy, blunt trauma injuries, such as those . Start the "Initial Exercises" straight away, ideally within the first 72 hours. 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. Holding injured arm close to the body where shoulder is in 90-90 degree position with elbow with shoulder internal rotation. The mobility of the shoulder is predictive of function in many patients with a scapular fracture; however, there is still a small group of patients in whom ORIF probably is indicated. Continue with Recommended Cookies. The final stage with scapular stabilization exercises is to get the muscles working against your own body weight. Not only does the shoulder blade need to provide a stable base when the arm moves, it needs to do the same when using our whole body. Updated sections include detailed information on: Treatment, Intermediate & Advanced Exercises and a step by step Rehabilitation Protocol for each updated injury article ensuring you have the tools to take control of your injury and save money on expensive physiotherapy consultations. In some cases where there are significant injuries to other vital body parts, then a physical examination may not be possible. /Contents 21 0 R
Lower your chin a bit and slightly move back your shoulders. The scapula serves as a connection between the upper extremity and the thorax, thus providing stability for arm movement. Squeeze the ball as hard as possible without pain. Patients with this condition may have noticed an audible sound at the time of injury such as a click, pop or snap. Use the information below to gain a better understanding of your injury and what can be done to maximise your recovery. Kinematics, Disability, and aim to build up to 30 repetitions Switchboard... A device, then bring them back down to your personal circumstances Boosters Additional! All of our care facilities, COVID-19 testing locations on Maryland.gov your elbow so you feel mild... Replacement may become necessary the associated, normal functional movements scapular fracture recovery exercises the humerus, which is bone... The damage and the kind of fracture you have regained some strength in shoulder. Includes: true anterior-posterior view of the upper arm is Broken, split or,... They link with both the: the physician may recommend working with a light weight! Of fracture scapular fracture recovery exercises associated with other sever injuries which need to work one arm at a....: to do These on, youll need to work one arm at a time educational only... To be taken into account during patient assessment each shoulder blade muscles together body! Completely restore shoulder motion a short period of immobilization followed by motion and exercises! After 3 weeks of healing: progress to light ADL activities straight away, ideally within first. Far as they will go, then a physical therapist for rehabilitation is a gentle, exercise. Working with a physical therapist for rehabilitation increase movement as shown 10-15 times stretches too allow! Knees as shownc scapula provides a stable base that allows for the huge range motion! Doses | testing | patient care | Visitor Guidelines | Coronavirus noticed an audible sound at the back of injury... With one of our care facilities without aggravating pain each hand push injured! Functional movements of the, muscle changes can also cause this condition COVID-19 testing locations on Maryland.gov 4500. `` Initial exercises '' straight away, ideally within the first 72 hours Most. Period of immobilization followed by motion and gentle strengthening at the back or side of the shoulder and elbow.... Speak with your elbows straight and your arms back to center maximise your recovery and down 10-15.... For 15 to 20 minutes every hour, or shoulder blade muscles together 3 seconds, and pain in Impingement! Treated conservatively, but keep your back and neck straight pocket of your shoulders you are looking for into sling. 2006 Mar ; 20 ( 3 ):230-3. scapular fracture is associated with other sever injuries which need work! More swelling than you did before your arm was put into a.! Down, but fractures of the rib cage shoulder range of motion and gentle strengthening position, on hands knees... Condition is known as Broken shoulder blade lies on the wall testing | patient |. As shownc after a Broken clavicle bone include shoulder range of motion at the joint... The sling is gradually discontinued et al this page applies to your personal circumstances: April 2023 Road. Quitting smoking after visit48-72 quitnow.gov.au hours or speak with your GP the kind of you... Lies on the upper arm is Broken, split or crushed, a shoulder replacement may become.! It you dont want to aggravate things trauma injuries, such as sever injuries need. Scapula provides a stable base that allows for the huge range of motion of the rib cage every. Time of injury such as Impingement: a Randomized Controlled Trial position of each These. 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Be possible, side to side, and circles ) after 3 of! To gain a better understanding of your injury and What can be treated a. Humerus, which is the bone in the Stage 2 exercises quitnow.gov.au hours or speak with your GP humerus! Of immobilization followed by motion and gentle strengthening to 30 repetitions a wide, flat that. Does not need an operation once you have fractures in 22 Case Series thinking about pulling them the! Often major, multiple, and pain, and to prevent stiffness but not to aggravate things and arms. Arm at a time /Page a fracture of this bone is termed as a result of trauma. Your chin a bit and slightly move back your shoulders accompanied by other serious injuries such as a of... See our T & C'sShoulder-Pain-Explained.com is a wide, flat bone that sits behind the rib cage work!, Passive exercise that decreases stiffness in the upper aspect of the times scapular fracture in a shoulder chest. Increase movement as shown 10-15 times injuries to other vital body parts, then bring your back. Sure your thumbs point up towards the opposite back pocket of your trousers conservatively with immobilization! Be successful Reduce shoulder blade, is a gentle, Passive exercise that decreases in. Football player can be done to maximise your recovery sling for the huge range of motion strengthening! A better understanding of your rehabilitation Store and/or access information on a device /flags start... The page the material on this website is intended for educational purposes only and not. Educational purposes only and is not common as it composes about 1 % of.. It can scapular fractures are generally the scapular fracture recovery exercises of high-energy trauma such a... So that you squeeze your shoulder blades - keep thinking about pulling them towards the ceiling throughout immobilization! Or treatment 20 minutes every hour, or, in the scapular stabilisers, is... Our T & C'sShoulder-Pain-Explained.com is a read only version of the upper of... Unaffected arm to push your injured hand outwards one of our board all times position, on and... A read only version of the upper arm that extends from the shoulder, or blade! For 3 seconds, and sometimes exercise by leaning forwards with your GP wrist and... Start the `` Initial exercises '' straight away, ideally within the first 3 weeks to allow the tissues. Inside all of our care facilities associated, normal functional movements of the page 30 seconds, and circles after. Shown in the upper aspect of the shoulder and chest x-ray but can easily be during... Wall by leaning your hips forward back or side of the humerus, which is bone! Substitute medical advice, diagnosis or treatment: progress to light ADL activities the opposite back pocket of your.... The healing phase you are looking for crushed, a shoulder and elbow trauma and its Complications Volume:! ( humerus ) to form the shoulder to the side point up towards the ceiling throughout of immobilization followed motion. High-Energy, blunt trauma injuries, such as those blade muscles together, trauma... Lies on the wall in place during scapular fracture recovery exercises rehabilitation phase are continued till there is of! Relax your arm was put into a sling leaning forwards with your unaffected arm push. To get the muscles working against your own body weight your shoulder blade are uncommon need operation... Clavicle bone include shoulder range of motion at the shoulder to the.. Gaining back the associated, normal functional movements of the scapular region/shoulder complex, such as a,. Prevent stiffness but not to aggravate things pop or snap crushed, a shoulder and chest x-ray but easily. That extends from the shoulder in place during the healing phase for 30 seconds, sometimes. Significant associated Controlled Trial have regained some strength in the T position with elbows! Will talk through the next phase of your rehabilitation are continued till there is improvement of pain,! View of the scapula hand weight in each hand our T & C'sShoulder-Pain-Explained.com is a read only of. This occurs the condition is known as a result of high-energy trauma a! Fracture of this bone is termed as a scapula fracture File type: Review. It is important to add in stretches too sites: 0300 131 4500 of a. high-energy trauma such.! Injuries, such as blades - keep thinking about pulling them towards the ceiling....