Proximal Humerus Fracture

Proximal Humerus Fracture

About

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 eg. Motor cycle accident or a sports related injury.

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.

Management

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.  For more details click here

• 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

Wrist flexion/ extension

Finger flexion/ extension

Elbow rotation

Elbow flexion/ extension

• 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

Assisted external rotation

Assisted Abduction

Assisted Flexion

• 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

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 professionals such as your GP, orthopaedic consultant or physiotherapist.