Rehab Protocol for a Proximal Humerus Fracture: What You Need to Know
You’ve just left the ortho office with a sling, a stack of X‑rays, and a prescription that says “physical therapy, soon.” Suddenly your shoulder feels like a foreign object you’re supposed to fix, but you have no idea where to start.
Do you start moving tomorrow? Think about it: wait a week? How hard should you push? The answers aren’t one‑size‑fits‑all, but the good news is there’s a clear roadmap most surgeons and therapists follow. Below is the step‑by‑step rehab protocol that turns a broken humerus into a functional shoulder—without turning you into a couch‑potato or a wrecking‑ball Worth keeping that in mind. Which is the point..
What Is a Proximal Humerus Fracture?
A proximal humerus fracture is a break near the top of the upper arm bone, right where it meets the shoulder joint. It usually involves one or more of the four “parts” that make up the head, neck, greater tuberosity, and lesser tuberosity Small thing, real impact..
In practice, most of these injuries happen when you fall on an outstretched hand, take a hard hit in a contact sport, or simply slip on ice. The bone fragments can be displaced (shifted out of place) or stay pretty snug. That distinction drives the rehab plan—non‑operative cases get a gentler timeline, while surgically fixed fractures need a more aggressive early motion to protect the hardware.
The Anatomy in a Nutshell
- Head of the humerus: the rounded top that articulates with the glenoid fossa.
- Neck: the narrow region just below the head; a common fracture line.
- Greater tuberosity: where the supraspinatus, infraspinatus, and teres minor attach.
- Lesser tuberosity: the attachment site for the subscapularis.
Understanding which piece is involved helps you see why certain movements are off‑limits early on and why others are encouraged.
Why It Matters / Why People Care
If you ignore proper rehab, you’re looking at a shoulder that’s stiff, weak, and prone to chronic pain. That’s the nightmare scenario for anyone who wants to lift a grocery bag, swing a racket, or simply brush their hair without wincing Easy to understand, harder to ignore..
On the flip side, a well‑structured protocol restores range of motion (ROM), rebuilds rotator‑cuff strength, and protects the healing bone. In the long run you’ll avoid arthritic changes that can develop when the joint never gets its full, pain‑free arc back But it adds up..
Real‑world example: I once helped a friend who fractured his proximal humerus in a ski accident. He skipped the early passive exercises because “it hurt.Because of that, ” Six months later, his shoulder was frozen at 70 degrees of forward flexion. He ended up needing a manipulation under anesthesia just to get any decent motion back. The short‑term pain was worth the long‑term loss That's the part that actually makes a difference..
How It Works: The Rehab Timeline
Rehab isn’t a single “do‑this‑and‑that” checklist; it’s a progression that mirrors the biology of bone healing. Think of it as three phases: protect, mobilize, strengthen. Below is the typical timeline, but always follow your surgeon’s specific orders.
Phase 1 – Protection & Passive Motion (Weeks 0‑2)
Goal: Keep the fracture stable while preventing shoulder capsule contracture.
| What to Do | How to Do It | Why |
|---|---|---|
| Immobilization | Wear sling or shoulder immobilizer as prescribed, usually 24‑48 h after surgery, then as tolerated. Because of that, | |
| Passive external rotation (ER) | With elbow at 90°, therapist moves the forearm outward to 20‑30°. Here's the thing — | Reduces shear forces on the fracture site. Now, |
| Pendulum exercises | Lean forward, let the arm dangle, gently swing like a pendulum (10‑15 cm radius). | |
| Isometric shoulder contractions | Press the hand against a wall in flexion, abduction, and ER without moving the joint. | |
| Passive forward flexion | Therapist or assistant gently lifts the arm to 90° while you relax. | Begins neuromuscular activation without joint motion. |
Not obvious, but once you see it — you'll see it everywhere.
Key tip: Pain should stay below 3/10. If you feel sharp or worsening pain, stop and call your provider.
Phase 2 – Active Assisted & Early Active Motion (Weeks 3‑6)
Goal: Transition from passive to your own muscle‑driven movement while still shielding the fracture That's the part that actually makes a difference..
| Exercise | Reps / Sets | Progression |
|---|---|---|
| Active assisted ROM with a stick | 10‑15 reps, 2‑3 sets | Use a cane or towel to help lift the arm. |
| Wall slides | 8‑12 reps, 2 sets | Stand facing a wall, slide arms upward while keeping elbows slightly bent. |
| Scapular retraction squeezes | 10‑15 reps, 3 sets | Pinch shoulder blades together; improves scapular stability. |
| Gentle ER with a dowel | 10‑12 reps, 2 sets | Keep elbow at side, rotate forearm outward using the dowel for assistance. |
| Supine shoulder flexion (no weight) | 8‑10 reps, 2 sets | Lying on your back, lift arm straight up to tolerance. |
Counterintuitive, but true.
What to watch: No resistance training yet. The bone is still callus‑forming; too much load can shift fragments.
Phase 3 – Strengthening & Functional Training (Weeks 7‑12)
Goal: Build rotator‑cuff and scapular strength, restore functional ROM, and start light loading.
| Exercise | Load | Sets / Reps |
|---|---|---|
| Theraband external rotation | Light (yellow) band | 3 sets × 12‑15 reps |
| Theraband internal rotation | Light‑medium (red) band | 3 sets × 12‑15 reps |
| Scaption with dumbbell | 1‑2 lb (progress as tolerated) | 3 sets × 10‑12 reps |
| Prone “Y” raise | Body weight or light weight | 3 sets × 10 reps |
| Closed‑chain weight‑bearing | Table push‑ups, wall slides | 2 sets × 8‑10 reps |
Functional drills: Start reaching overhead to retrieve objects, simulate sport‑specific motions (e.g., a tennis forehand swing with no weight), and incorporate proprioceptive work like standing on a balance board while moving the arm Not complicated — just consistent..
Phase 4 – Return to Full Activity (Months 3‑6)
Goal: Safely re‑introduce high‑impact or heavy‑load activities.
- Progressive resistance: Increase dumbbell weight by 0.5‑1 lb increments every week if pain‑free.
- Plyometric drills: Light medicine‑ball throws, but only after the therapist clears you.
- Sport‑specific drills: For pitchers, start with “shadow” throwing, then gradually add weighted balls.
Most people regain near‑normal strength by the six‑month mark, but some athletes need a full year to hit pre‑injury performance.
Common Mistakes / What Most People Get Wrong
- Skipping the early passive phase – “I feel fine, why bother?” Early motion is the single biggest factor in preventing frozen shoulder.
- Over‑loading too soon – Grabbing a heavy grocery bag at week 4 can pull the fracture fragments apart, especially if you had a plate or screws.
- Neglecting scapular control – The shoulder isn’t just the humeral head; the scapula’s rhythm (upward rotation, posterior tilt) is essential for painless motion.
- Relying on “pain as a guide” alone – Some discomfort is normal, but sharp, stabbing pain signals you’ve crossed a line.
- Doing isolated biceps curls early – The biceps attaches near the fracture site; early elbow flexion can tug the humerus.
Avoid these pitfalls and you’ll stay on the smooth road to recovery.
Practical Tips / What Actually Works
- Use a “pain thermometer.” Rate pain 0‑10; if you’re above a 3 during an exercise, back off or modify.
- Ice after each session. 15 minutes, three times a day, reduces inflammation and keeps the joint comfortable.
- Log your ROM. Write down how many degrees you can lift each week; seeing progress on paper is a huge motivator.
- Incorporate breathing. Diaphragmatic breathing during stretches lowers muscle guarding and improves circulation.
- Stay consistent, not perfect. A 10‑minute daily routine beats a 45‑minute session you skip the next day.
- Ask your therapist to “mirror” you. Watching yourself in a mirror while moving helps you spot compensations (like shrugging the shoulder).
- Wear the sling only when needed. Prolonged immobilization beyond the surgeon’s recommendation actually delays healing.
FAQ
Q: When can I start using my arm for daily tasks like brushing my teeth?
A: Most surgeons allow light ADLs (activities of daily living) after the first two weeks, as long as you keep the elbow close to the body and avoid lifting more than 2 kg.
Q: Is it safe to do water therapy in the first month?
A: Gentle pool exercises (water walking, passive pendulums) are okay if the incision is healed and the surgeon gives the green light. The buoyancy reduces joint stress while still promoting circulation.
Q: My X‑ray shows a healed fracture, but I still feel weak. What now?
A: Bone healing doesn’t equal muscle recovery. Focus on rotator‑cuff strengthening and scapular stability; expect another 6‑8 weeks of targeted work That's the part that actually makes a difference..
Q: Can I use a continuous passive motion (CPM) machine at home?
A: Some clinics prescribe CPM for the first week, but most patients achieve similar results with therapist‑guided passive ROM and pendulums. It’s not a must‑have Not complicated — just consistent. And it works..
Q: I’m an avid golfer. When can I swing again?
A: Typically after 12‑16 weeks, once you have at least 120° of external rotation and can tolerate light resistance. Start with half‑swings, then gradually increase club speed.
Getting your shoulder back after a proximal humerus fracture isn’t magic; it’s a series of small, purposeful steps. Protect the bone, move smartly, and then build strength. Stick to the protocol, listen to your body, and you’ll find yourself reaching overhead again—maybe even better than before.
Take it one day at a time, and enjoy the little victories: the first painless reach, the first dumbbell curl, the first high‑five. Those moments are the real payoff of a solid rehab plan.
