Proximal humerus fracture

Contents
Overview

Management and self-help

Exercises

What to do if I am struggling?
Overview

The humerus simply refers to the long bone forming the top half of your arm. The top end of the
humerus forms the ball part of your ball and socket joint at the shoulder (Glenohumeral joint).
Humerus fractures are common and usually the result of a direct blow to the shoulder or a fall onto
an outstretched hand. Although the average age of a person with a humerus fracture is over 65
years, it can occur in younger people too; however, they are often associated with significant
trauma, for example, a motor cycle accident or a sports related injury.

Diagram
Image of orfracture
not found of proximal
type unknown humerus
Fracture of proximal humerus

Diagram
Image of orfracture
not found of the
type unknown humerus body
Fracture of the humerus body

Diagram
Image of orfracture
not found of the
type unknown distal part of the humerus
Fracture of the distal part of the humerus

Most humerus fractures (85%) do not require an operation and the bone will heal in 6 - 12 weeks.
You will often have a repeated x-ray within this time to check how the bone is uniting which is
conducted and overseen by the orthopaedic team. Although the bone is usually expected to heal in
12 weeks it is still common for individuals to experience some swelling and pain for 6 months or
more after the initial injury.

The vast majority of humeral fractures recover in a similar process (see outlined under
Management). However, not all patients will recover exactly as outlined and therefore it is crucial to
follow the advice your clinicians have provided. It should also be considered that after a humeral
fracture, the affected shoulder may never regain its full range of movement, whether treated
conservatively or surgically. The aim of your rehabilitation is to try and achieve the most optimal
function possible.
 Information:
References used in this resource

Bhattacharyya R. Edwards K, Wallace AW. Does arthroscopic sub-acromial decompression.

View Proximal humerus fracture on the Sussex Community NHS Foundation Trust website.
Management and self-help

Conservative treatment: For individuals who do not require an operation it is essential to rest from
aggravating activities to allow the healing to take place, especially in the first 6-8 weeks.

The success of your recovery is down to your body's own ability to heal as well as being diligent
with your rehabilitation as advised by your physiotherapist and orthopaedic team.

Surgical Treatment: For individuals who have had an operation to fix their humerus fracture follow
this link for more detailed information.

Your movements will initially be restricted by wearing a sling and any activities that increase pain or
place stress on the fracture should be avoided. This includes activities such as: lifting, pushing,
pulling, lying on the affected side or elevating the arm.

What can I do to help myself?

Pain relief medication

Over the counter painkillers may be helpful, such as paracetamol, ibuprofen or creams that you can
buy at the chemist. Your pharmacist/GP will be able to give you expert advice if you have any
concerns regarding medication. It should be considered that pain 'killers' are unlikely to take away
your pain completely but allow it to feel more settled.

Stop smoking

Not only is smoking detrimental for your general health but there is a large body of research that
shows that smoking can reduce the rate of bone healing, this can therefore lead to longer and less
optimal recovery. In some cases, smoking has been linked with failure for the bone to heal.

Rehab exercises

Your rehab exercises are outlined below which you should follow as a guide unless stated
otherwise by your orthopaedic or physiotherapy clinicians. The weeks correspond with time since
your initial injury.

Weeks 0-3

Wear the sling all the time, even in bed at night. Do the initial exercises shown stage 1.

View Management and self-help on the Sussex Community NHS Foundation Trust website
Exercises

Information:
Weeks 0-3

Wear the sling all the time, even in bed at night. Do the initial exercises shown stage 1.

Wrist flexion/extension
Place your injured hand flat on a table palm down. Ensure your hand is over the edge of the table.
Then using your other hand/fingers push the injured hand in a upwards motion causing flexion at
the wrist joint. Then repeat the exercise by bending the hand downwards over the edge of the
table.

Wrist flexion extension demonstration

Finger flexion/extension
Create a fist and squeeze holding for 3-5 seconds then open and fully extend your fingers. Repeat
the exercise for 30 seconds. The goal is to do 3 sets.

Finger flexion extension demonstration

Elbow rotation
Bend elbow to 90 degrees. Keep elbow at side and turn palm up using your unaffected hand. Hold
the stretch for up to 30 seconds. The goal is to repeat the exercise 3-5 times. Then repeat the
exercise by rotating the hand the opposite diection.
 Elbow rotation demonstration

Elbow flexion/extension
Either standing or seating start your affected elbow by your side. Then use your unaffected arm to
lift your affected arm. Try to bend/flex your affected elbow as much as possible whilst keeping it
close to your side. Hold the flexion for 5 seconds and then gently lower your arm before repeating
the exercise. Do this for 30 seconds. The goal is to do 3-5 sets. Then repeat the exercise by
straightening the elbow in the opposite direction.
 Elbow flexion extension demonstration

Information:
Weeks 3-6

Continue to wear the sling. Progress to the stage 2 exercises. Do not lift your elbow above
shoulder height as this may cause excessive pain.

Shoulder pendulum
Stand beside a table with the hand of your unaffected shoulder on the table and feet slightly wider
than shoulder-width apart. Bend at the hips approximately 75 to 90 degrees and let your affected
arm hang down toward the floor. Shift your weight forward and backward, letting your arm swing
freely front to back. Continue for 30 seconds. The aim is to do 3-5 times per day.
 Shoulder pendulum demonstration

Assisted external rotation

In the standing position, hold a pole/cane with both hands keeping your elbows bent. Move your
arms and wand/cane side-to-side. Your affected arm should be partially relaxed whole your
unaffected arm performs most of the effort. Repeat the exercise for 30 seconds. The goal is to do
3-5 sets.
 Assisted external rotation demonstration

Assisted abduction
While holding a pole/cane palm face up on the injured side and palm face down on the uninjured
side, slowly raise up your injured arm to the side. Repeat the exercise for 30 seconds. The goal is
to do 3-5 sets.
 Assisted abduction demonstration

Assisted flexion
In the standing position and holding the pole/cane horizontally by your side with both hands, raise it
up allowing your unaffected arm to push up your affected arm. Repeat the exercise for 30 seconds.
The goal is to do 3-5 sets.
 Assisted flexion demonstration

Information:
Weeks 6-12

The fracture should be healed. Try not to use the sling. Begin normal light activities with the arm
and shoulder. Increase movement using the stage 3 exercises. Increase day to day activities.
Heavy tasks may cause discomfort. Start to lift your arm overhead if possible.

Shoulder flexion
Standing your feet shoulder-width apart, arms by your sides with palms facing inwards. Raise your
arm infront of you keeping it straight. Go as far as you can with the aim to get your arm inline with
your head before gently lowering to the start position. Repeat for 30 seconds. The aim is to do 3-5
sets.
 Shoulder flexion demonstration

View Exercises on the Sussex Community NHS Foundation Trust website

What to do if I am struggling?

Review your medication

It is important to remember that a shoulder fracture is a significant injury and due to the healing
process that needs to occur, the shoulder may be painful and swollen for a number of months.
Recovery following a shoulder fracture can be painful and it is therefore important to make sure
that the correct type and amount of pain relief is being taken. If your pain is still not well controlled
despite the above strategies it is recommended you consult your GP/Pharmacist to review your
current medication.

Review with your physiotherapist

Should you continue to be significantly limited with your day-to-day activities or would like some
further advice please feel free to contact your physiotherapist who can expertly review your
rehabilitation options. It should be emphasised the best outcomes with humeral fractures are only
achieved with dedicated and consistent hard work with your rehab.

Serious complications with this type of injury are rare. However, it is important that if you
experience any unexpected symptoms such as changes in colour, sensation or control of your arm,
wrist, or hand that you contact a healthcare professional such as your GP, orthopaedic consultant,
or physiotherapist.

View What to do if I am struggling? on the Sussex Community NHS Foundation Trust website