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Physical Therapy after a Proximal Humeral Fracture

Rehabilitation of a Broken Shoulder

By

Updated March 31, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

A proximal humeral fracture is a broken bone that occurs near your shoulder joint. "Proximal" refers to being close to your body, and "humeral" refers to the arm bone known as the humerus.

Common Causes of a Proximal Humeral Fracture

A fracture to your proximal humerus usually involves significant trauma to your arm or shoulder. Situations that may cause a fracture here include, but are not limited to:

  • Falling onto your outstretched hand
  • A forceful pull to your arm and shoulder
  • Falling onto your side or shoulder

Signs and Symptoms of a Proximal Humeral Fracture

The typical signs and symptoms of a proximal humeral fracture inlude:

  • Shoulder pain or upper arm pain
  • Difficulty moving your arm and shoulder
  • Swelling around your shoulder
  • Bruising or discoloration around your shoulder and upper arm

If you suspect that you have suffered a proximal humeral fracture (or any other arm fracture) you must report immediately to your doctor or emergency department to manage your injury properly. Failure to do so may result in significant and permanent loss of function in your arm.

Initial Treatment for a Proximal Humeral Fracture

If your doctor suspects that you have fractured your proximal humerus, an x-ray will likely be taken to confirm the diagnosis. Occasionally more advanced pictures of your shoulder will be taken with a CT or CAT scan. These images help your doctor see the severity of your injury and help decide on the best way to manage your injury.

If a proximal humeral fracture is confirmed, the fracture may need to be reduced. Most often, the fractured pieces of bone are close together will not require much to reduce the fracture. For severe fractures where the bone pieces are far apart, a surgical procedure called an open reduction internal fixation (ORIF) may need to be performed. Your doctor will discuss with you your options and best treatment strategy for your specific condition.

Physical Therapy for a Proximal Humeral Fracture

In the Hospital
Your first encounter with a physical therapist may take place immediately after injury in the hospital. Most likely, you will need to wear your arm in a sling to help protect and immobilize your shoulder while it heals. You may meet with a physical therapist who can teach you how to properly wear your sling. He or she may also teach you gentle pendulum exercises to help keep your shoulder mobile as it heals. Your doctor will let you know if it is safe to perform these exercises.

In the Clinic
After four to six weeks of healing, you may be ready to attend physical therapy. If you are unable to drive or leave the home due to your injury, a physical therapist may come to your home for treatment.

Your physical therapist will evaluate your condition during your first appointment. He or she will ask you about your injury and take some measurements to get an idea of how you are doing. The evaluation also helps your physical therapist decide on the best treatment for you.

Common measurements taken after a proximal humeral fracture include:

After a thorough evaluation, your treatment will begin to help improve the function of your arm. Your physical therapist should provide you with insight about what to expect and what is expected of you. Most sucessful physical therapy programs require your active involvement, so be sure to ask a lot of questions to understand what is going on.

Some common impairments that you and your physical therapist will work on include:

Range of motion. After a proximal humeral fracture, you will most likely have decreased range of motion of your shoulder and elbow, and this loss of motion will make moving your arm difficult. Your physical therapist may prescribe exercises for you to do to help improve your range of motion.

Strength. Your shoulder will most likely be immobilized in a sling for four to six weeks after injury. This period of immobilization usually results in significant loss of strength (think "use it or lose it"). Strengthening exercises will most likely focus on muscles like the rotator cuff and the muscles in the arm like the biceps and triceps. Muscles that help support your shoulder blade may also be weakened, and exercises to help strengthen these muscles may be prescribed.

Pain. After a frature to any bone in the body there is usually quite a bit of pain. This is normal and expected. Your pain level should improve day by day after your injury, but you may still have pain once you begin physical therapy. Your physical therapist can help you manage your pain with exercise or with treatments like heat, ice, or TENS. Be sure to let your physical therapist know if your treatment is casuing too much pain so he or she can make adjustments to your care and provide you with appropriate pain control.

Scar mobility. If you required an ORIF procedure to help reduce your fractured humerus, you will most likely have a surgical scar on the front or side of your shoulder. Occasionally, small adhesions make the scar feel "stuck" and limit motion. Your physical therapist may perform scar massage and mobilization to help improve the mobility of your scar. He or she can also instruct you in self scar massage so you can do this at home.

Function. Your physical therapy program should focus on restoring normal function to your arm and shoulder. Your physical therapist can help you engage in functional activities to help improve the way your shoulder and arm moves so your injury does not limit your normal activities. Discuss with your physical therapist the things that are difficult (or impossible) because of your injury so he or she can tailor a suitable functional restoration program just for you.

Eight to twelve weeks after injury, your strength and mobility should improve enough to allow for normal function of your arm. Your pain level should be minimal as well. At this time, your physical therapy program may be discontinued. You may still be required to perform exercises at home for a few months to maximize mobility. Be sure to work closely with your doctor and physical therapist to understand exactly what to do and what to expect.

A proximal humeral fracure can be a painful injury that limits your ability to move your arm and shoulder. This can have significant impact on your ability to work, perform household duties, or enjoy recreational activities. A physical therapy program after a proximal humeral fracture can help you return to normal activity quickly and safely.

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