You have just fractured your proximal humerus, and you have many questions about treatment and the healing time? I answer the most common questions frequently asked by internet users.
As a diagnostic radiographer I x-ray so many fractured humerus and I answer your questions based on my experience and of course medical publications.
Happy reading!😃
Any questions? remarks? Let’s meet in the comments section at the end of this article.🙏
Last updated: May 2024. Written by Juliet Semakula, a diagnostic radiographer.
Disclaimer: no affiliate links.
Summary: Proximal humerus fractures are common fractures often seen in older patients with osteoporotic bone following a ground-level fall on an outstretched arm. Sometimes they are caused by trauma such as accidents and sports injuries.
▶️What are the common types of humerus fractures?
There are three common types of humerus fracture, depending on the location of the break:
1️⃣Proximal: A proximal humerus fracture is a break in the upper part of your humerus near your shoulder. Which can be composed of the greater or lesser tuberosity or the surgical neck?
2️⃣Mid-shaft: A midshaft humerus fracture is a break in the middle of your humerus.
3️⃣Distal: A distal fracture at the far end of the humerus near the elbow.
Humerus fracture can break in different places. When your fracture is confirmed, your medical notices may describe the type of fracture you have had.
For example:
🔵Displaced or non-displaced, meaning the broken pieces are either far apart or almost touching.
🔵You may have a comminated fracture where the bone is broken into many small pieces.
🔵Or open fractures where the skin is also broken near the fracture which can increase the risk of infection.
Proximal humerus fractures are common fractures often seen in older patients with osteoporotic bone following a ground-level fall on an outstretched arm (Schumaier 2018)
In young adults and children, it can be due to trauma such as accidents, falls and sports injury.
▶️Diagnosis is made with imaging radiography of the shoulder.
🟨 X-ray
Your doctor will send you for x-ray to have some images taken to confirm if there is a fracture and to see the extent of the damage.
🟨 CT scan
A CT scan will be used for preoperative planning greater tuberosity position to help give a detailed picture of your bones and the surrounding tissue than an X-ray.
🟨MRI
Magnetic Resonance Imaging (MRI): is very useful to identify associated rotator cuff injury.it gives a complete picture of the damage to your bones and any damage to the surrounding tissue.
▶️ What are the treatment options for a broken humerus?
Before any treatment there are different variables to consider before deciding which option to use.
🟥You age group will determine the treatment options.
🟥what kind of fracture type you have got
🟥How bad is your fracture displacement.
🟥Bone quality, old age bones are more osteoporosis than young bones.
🟥Your general medical condition
🟥Other associated injuries
There are three main treatment approaches which may be combined or used individually.
Most proximal humerus fractures are treated:
1) Nonoperatively with a sling
2) Surgical treatment.
3) Rehabilitation.
1️⃣ Nonoperatively with a Sling
Most proximal minimally displaced fractures are treated by a sling immobilisation.
Especially fractures that are minimally displaced surgical and anatomic neck fractures, greater tuberosity fracture displaced < 5mm.
Your medical team will tell you:
♦️How to put it on correctly
♦️How long to wear it
♦️ When you can take it off.
The sling has two objectives:
1)To facilitate consolidation by limiting elbow and shoulder movements.
2)To relieve pain
You are advised to wear the sling 24/7 even at night. You can only take it when having a shower and during physical therapy sessions.
Most fractures involve a short period of immobilisation, this is usually worn for 3 – 6 weeks depending on your fracture.
Early exercises of the shoulder mobilisation are important to increase your function and prevent long-term stiffness.
You may begin this when advised to do so, usually around 2-3 weeks after your fracture. you will be referred to physiotherapy.
The physiotherapist will guide your movements and activities and may make changes to your exercise programme depending on your individual needs. It is important to continue regular pain medication to allow gentle movement.
Note: Immediate physical therapy is required for better results in faster recover
2️⃣Surgical treatment options after a broken humerus.
Different surgical operation methods are used for example.
Closed reduction percutaneous pinning (CRPP) usually used on 2-3,4-part surgical necks.
ORIF operation of head and greater tuberosity displaced > 5mm displaced 2,3,3 -part fractures in younger patients.
Intramedullary nailing for surgical neck fractures or 3-part greater tuberosity fractures, proximal humerus, and humeral shaft fractures
It was not easy to have high quality information on whether operating on a displaced humerus fracture increases the chance of better recovery or quality of life. (Cochrane 2022)
What are the complications and long-term effects of humerus fractures?
♦️Avascular necrosis
♦️Nerve injury
♦️Screw cut-out
♦️Malunion and non-union
♦️Rotator cuff injuries and dysfunction
♦️Tendon injuries
♦️Infection
♦️Post traumatic arthritis.
These are truly extremely rare situations, occurring in people with severe fractures and other risk factors related to their health.
▶️Rehabilitation physical therapy exercise after a broken humerus.
Usually after your treatment you will have a routine appointment in the fracture clinic 1 to 2 weeks after your injury.
At this point you may have another x-ray to assess your shoulder humerus and guide the next stage of your treatment.
Remember it takes between 6 to 12 weeks to unite (heal), and once the fracture begins to heal it is important to keep the shoulder moving to avoid stiffness but not to aggravate it.
The shoulder joint does not respond well to being injured and longstanding stiffness is almost inevitable.
Following this type of injury, you may never be able to fully lift the arm straight up in the air again. The main aim is to regain enough movement to perform day to day activities.
Stages of management and rehabilitation plan shown below are retrieved from the NHS shoulder rehabilitation patient guide.
| Weeks since injury | Rehabilitation plan |
| 3 weeks | Wear the sling all the time, even at night in bed because it limits arm movement and reduces the risk of being awakened by pain. |
| 3-6 weeks | If you have been advised to do so, you should continue to wear the sling and progress to the hand simple movement exercise. |
| 6-12 weeks | You may start to discard the sling. Begin normal light activities with the arm and shoulder. Start to lift your arm overhead if possible. |
| 12 weeks | If you are still experiencing significant pain and stiffness, then please contact your doctor |
| Step | Recovery time range |
| You have less pain | From a few days to a few weeks |
| Completely consolidated or underway | 6 weeks to 3 months |
| No longer have swelling or edema | From few days to a few a few weeks |
| You no longer need the brace sling to mobilise | 3 weeks after mobilisation or longer From a few days to weeks |
| You can drive again | From 2 to 4 months (It will depend on how you feel |
| Able to carry heavy things like bags | From 2 to 5 months |
| Resume all physical activities | From 3 to 8 months |
▶️Recovery after humerus fracture surgery
Patients I see recovering from a proximal humeral fracture always appear to be enhanced by overcoming fears of movement or reinjure the shoulder within a week after injury.
You must develop a greater self-efficacy to develop resilience and more effective coping strategies to allow a safe and quick recovery.
Simple exercises you can try at home: Recommended by the NHS.
Repeat all of these 3 exercises 10 times each, 4-5 times a day. Only go as far as you can naturally, without doing any trick movements to try and get further. This will increase over time and should not be forced.
This information is for guidance purposes only and is not provided to replace your doctor’s advice. Use it as it so fits. Rehabilitation Images from Master Patient Information Document (esht.nhs.uk)
▶️Broken humerus in the elderly: what is the recovery time.
I have seen the rise with the increasing elderly rate of proximal humerus fractures in x-ray.
And the main cause is when you grow old your bones are prone to have osteoporosis and have poor neuromuscular control mechanisms.
Elderly patients usually continue to have shoulder problems because of the fracture for 2 years or more after the injury.
Rehabilitation is sought to be the central to addressing the problems caused by the fracture and the timeline is the same though it may take longer.
▶️How long do the pain of humerus fractures last?
It’s common to experience pain in the days following the fracture, even in the weeks that follow.
You may feel some mild discomfort during these exercises but if you feel a significant increase in pain then stop doing that exercise until you can seek advice from your physiotherapist.
Pain does not mean there is a complication or that you are not still consolidating.
You can take these measures to help ease your pain.
🟣Apply cold to the painful area.
🟣Take painkillers prescribed by your doctor.
🟣Find a more comfortable position and take it easy.
▶️Sleeping with a broken shoulder?
In the first two weeks of your injury you may find it easier to sleep more upright than usual, using pillows to prop you up in bed or in a reclining armchair.
Some patients often find sleeping with the upper body propped with pillows behind and underneath your forearm helps to alleviate pain and the arm is supported to avoid pulling down on your shoulder.
Sleeping on the side where you have discomfort, there is no evidence that it could worsen the injury so if it’s your preferred position you do not necessarily change it.
The pressure on the shoulder will not worsen the fracture. Its only strong impact or large movements that can do that.so you can sleep on it even before complete healing.
Sleeping with a sling on a broken humerus (on the back, operated arm on the cushion)
Your shoulder will be very sore in the first few weeks and you are likely to need to take painkillers, both sleeping and getting out of bed are going to be difficult.
▶️How to get out of bed with a broken humerus/ shoulder.
🟪Use a bed rail or transfer bar to help you get out of bed safely.
🟪Slide your body to the edge of the bed, keeping your legs extended and use the good arm to help.
🟪Roll onto your uninjured side once you are close to the edge of the bed.
🟪Push yourself up in a seated position if struggling, seek assistance and take it easy.
We have come to be end of this article, I hope I have answered some of the common questions. Wish you a quick recovery🙋
This article may also be useful to you check it out
How long does it take to recovery from a dislocated shoulder ▶️
📚Sources.
Jayakumar P, Teunis T, Williams M, Lamb SE, Ring D, Gwilym S. Factors associated with the magnitude of limitations during recovery from a fracture of the proximal humerus: predictors of limitations after proximal humerus fracture. Bone Joint J. 2019 Jun;101-B(6):715-723. Doi 10.1302/0301-620X.101B6.BJJ-2018-0857.R1. PMID: 31154836.
Hodgson S. Proximal humerus fracture rehabilitation. Clin Orthop Relat Res. 2006 Jan;442:131-8. PMID: 16394751.
Schumaier A, Grawe B. Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient. Geriatr Orthop Surg Rehabil. 2018 Jan 25;9:2151458517750516. doi: 10.1177/2151458517750516. PMID: 29399372; PMCID: PMC5788098.