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A proximal humerus fracture is a serious injury to the humerus bone in the shoulder joint. This type of fracture accounts for 5% to 6% of all fractures in adults. It most often occurs in people over age 65. This injury requires immediate treatment to preserve shoulder function. Surgery may be needed depending on the location and type of fracture. Physical therapy is essential to safely restore shoulder function, whether surgery is needed or not.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.

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What Is a Proximal Humerus Fracture?

The humerus is the long bone of the arm located between the shoulder and the elbow. The proximal, or top, end is part of the shoulder joint. A proximal humerus fracture is a concern due to its closeness to other essential structures, including the:

  • Rotator cuff muscles.
  • Brachial plexus (a web of nerves from the neck that supplies the arm).
  • Major arteries and veins of the arm.

Proximal humerus fractures typically occur as the result of a trauma, such as a:

  • Fall where a person lands directly on the shoulder.
  • Forceful collision.
  • Car accident.

The arm and body position at the time of the injury determines how the bone fractures. People with osteoporosis (low bone density) may have an increased risk of fracture. However, a bone fracture can happen at any age.

How Does It Feel?

You may experience the following symptoms right after a proximal humerus fracture:

  • Pain.
  • Swelling.
  • Bruising.
  • Severely restricted movement of the shoulder.
  • Numbness and tingling in the arm, forearm, or hand.
  • Deformity (an unusual appearance) of the upper arm.

How Is It Diagnosed?

Proximal humerus fractures are diagnosed by a physical exam and an X-ray. Your doctor may order an MRI or CT scan to see if any additional structures are also injured.

There are generally two types of fractures to the proximal humerus. They include:

  • Nondisplaced. Pieces of bone separate at the fracture site but are not out of position. This type of fracture may not require surgery.
  • Displaced. Pieces of bone at the fracture site separate and shift out of position. This type of fracture typically requires surgery.

Surgery involves realigning and fixing the fractured bone segments using screws, plates, or rods. If there is more severe damage to your shoulder joint, your surgeon may perform a more advanced procedure. If you need surgery, your surgeon will review your case and discuss a surgical plan with you.

How Can a Physical Therapist Help?

A physical therapist guides an older adult male through shoulder strengthening exercises

Physical therapy after a proximal humerus fracture is crucial to restore the proper function of your shoulder and arm. If you have surgery, you likely will begin physical therapy one to four weeks after surgery. The timing of your physical therapy program will depend on the type of surgery you have.

If you do not have surgery, your doctor and physical therapist will work together to determine when you should start physical therapy. The timing will be based on your symptoms and how your bone is healing.

After a fracture, your movement will be limited to allow time for your bone to heal. During this time, most people lose strength and range of motion (the measurement of how far a joint can move in a given direction). They also often develop different movement patterns caused by limitations from their injury.

The goals of physical therapy are to:

  • Reduce pain.
  • Improve movement, strength, flexibility, and endurance.
  • Help you get back to doing the things you need or love to do.

Your physical therapist will design a personalized treatment plan that may include:

Range-of-motion exercises. Due to limited movement following a proximal humerus fracture, you may lose range of motion in your shoulder. This can lead to stiffness of the shoulder joint. Your physical therapist will assess your shoulder motion compared to your noninjured arm and the expected range of motion. They will lead you through prescribed exercises to restore shoulder function.

Strengthening exercises. The muscles around the shoulder will weaken during the time needed for the bone to heal. When the bone has healed enough, it is crucial to regain the strength of all the shoulder and upper back muscles. This will protect the shoulder joint and allow it to move efficiently. Restoring muscle strength after a fracture can take weeks to months. Your physical therapist will develop a strengthening program that is safe and comprehensive. It will include many exercises to help you regain strength in each of these crucial muscles.

Manual therapy. Your physical therapist may provide manual (hands-on) therapy to gently move your shoulder joint and surrounding muscles. This treatment helps restore movements that you may find difficult to do on your own. It also can improve shoulder function and flexibility so you can begin doing exercises to build back muscle strength.

Modalities. Your physical therapist may recommend treatments such as ice and heat to aid pain management and reduce swelling.

Functional training. Physical therapists are experts in assessing movement quality, especially for the specific activities that are important to your life. Improper movement patterns that may develop after a fracture can lead to other injuries if not addressed. Your physical therapist can point out and correct any faulty movements to help you regain use of your shoulder and maintain pain-free movement.

Can This Injury or Condition Be Prevented?

You cannot directly prevent unexpected traumatic events that cause fractures. However, you can take certain precautions to decrease your risk of injury. For example:

  • For older adults or people with known balance problems, remove fall-risk hazards in the home, such as loose rugs. Use handrails, assistive devices, and proper shoes. Regular physical activity that incorporates balance exercises can reduce your risk of falling.
  • Athletes who participate in contact sports should always use proper protective equipment for their specific sport.
  • People with osteopenia should ensure they get the right vitamins and minerals, such as calcium and vitamin D, for bone health.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat various conditions, such as proximal humerus fractures. You may want to consider:

  • A physical therapist who is experienced in treating people with orthopedic or muscle, bone, and joint injuries.
  • A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic or sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can search for physical therapists in your area who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association.

General tips when you're looking for a physical therapist (or any other health care provider):

  • Get recommendations from family, friends, or other health care providers.
  • Ask about the physical therapist's experience in helping people with proximal humerus fractures when making an appointment.
  • Be prepared to describe how your injury occurred and your symptoms in as much detail as possible.

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The American Physical Therapy Association believes that consumers should have access to information that can:

  • Help them make health care decisions.
  • Prepare them for a visit with their health care provider.

The following articles provide some of the best scientific evidence for the treatment of proximal humerus fracture. The articles report recent research and give an overview of the standards of practice in the United States and internationally. The article titles link either to a PubMed* abstract of the article or to the free full text to read or bring with you to your health care provider.

Lapner P, Sheth U, Nam D, et al. Management of proximal humeral fractures in adults: a systematic review and meta-analysis. J Orthop Trauma. 2023;37(2):e80–e88. Article Summary in PubMed.

Handoll HH, Elliott J, Thillemann TM, et al. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2022;6(6):CD000434. Article Summary in PubMed.

Yahuaca BI, Simon P, Christmas KN, et al. Acute surgical management of proximal humerus fractures: ORIF vs. hemiarthroplasty vs. reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2020;29(7S):S32–S40. Article Summary in PubMed.

Rangan A, Handoll H, Brealey S, et al. Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial. JAMA. 2015;313(10):1037–1047. Article Summary in PubMed.

*PubMed is a free online resource developed by the National Center for Biotechnology Information. PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine's MEDLINE database.