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Date issued: September 2022

Review date: September 2024

Ref: C-426/AH/Physiotherapy/Proximal Humerus Fracture v2

PDF:  Proximal humerus fracture final September 2022 v2.pdf [pdf] 574KB

Introduction:

This leaflet is aimed at providing you with advice and guidance to ensure you achieve the best possible outcome following your injury.

You may experience the following symptoms:

• Discomfort, stiffness, and reduced range of movement.

• Decreased strength and loss of muscle bulk.

• Swelling and bruising.

• Difficulty performing daily activities e.g. washing and dressing.

Sling Advice:

You will be given a sling to wear for comfort during the day/night for up to 6 weeks. At night you could also use pillows to help support the arm. During the day you can take the arm out of the sling to rest on your lap when sitting.

You will gradually start to wean out of the sling as comfort allows, this usually starts at around 2-3 weeks.

Sleeping:

You may find it more comfortable to sleep in a semi-reclined position. You can achieve this by propping yourself up with some pillows. It may not feel comfortable to sleep on your injured shoulder for a few months, once it has healed this is ok to do but may still feel uncomfortable. If it is uncomfortable to wear the sling at night you could wear a tight fitting t-shirt and/or rest your arm on some pillows.

Washing and dressing:

Washing

Initially it can be difficult and painful to wash your injured arm, it is particularly important to wash your armpit to stop it becoming sore. If you can have a shower or strip wash, try to let your arm relax by your side so you can wash your hand and arm. If you can, try to lean forwards whilst letting your arm relax by your side (as if you are doing your pendular exercises) and you will be able to wash under your arm effectively. Over time, as your movement improves, you will be able to use your arm during washing.

Dressing

Whilst wearing the sling you’ll find that loose fitting tops/button up shirts or blouses will be the easiest and most comfortable to wear. To dress your upper body, put your injured arm into the sleeve first and then you can manoeuvre your uninjured arm into the other sleeve afterwards, and then put your sling back on.

Healing timescales:

It will take approximately 6-12 weeks for your fracture to heal. The healing process continues for up to 12 months following the injury, and it is common for the shoulder not to feel or move as it did pre-injury. We aim to gain the most functional movement out of the arm, but in most cases it can be difficult to reach your arm up to top cupboards or behind your back fully.

Rehabilitation plan:

Rehabilitation plan

Weeks post injury	Rehabilitation aims
0-3 weeks	Wear your sling throughout the day and at night if needed for comfort. Remove your sling to wash/dress and complete your exercises 4 times a day. Start Stage 1 exercises as soon as possible.
3-6 weeks	You may be able to start to wean from your sling as comfort allows. Progress to stage 2 exercises.
6+ weeks	If you have not already you should be weaning out of your sling. Progress to stage 3 exercises. You may have an appointment with an outpatient physiotherapist who will progress your rehabilitation. You may start to use your arm in more functional activities. It is not advised to do any heavy lifting/pushing/pulling for at least 8-10 weeks following your fracture.

Exercises: Stage 1

0-3 weeks following your fracture (Exercises 1-8)

Exercise 1

Open and close the hand, making a tight fist and opening again.

Your fingers/thumb may be swollen so it is important to get your hand moving to help reduce swelling and prevent stiffness.

Repeat 10 x 4 daily

Exercise 2

 

Gently move your wrist up and down as shown in the picture.

Repeat 10 x 4 daily

Exercise 3

 

Gently turn your wrist so your palm faces up and down.

Repeat 10 x 4 daily

Exercise 4

 

Take your arm out of the sling. Gently bend your elbow so your hand moves towards your shoulder, then return to a straight position.

It is really important to let your elbow straighten fully. Wearing a sling can cause the muscles around the elbow to tighten up.

If this is sore you can use other hand to assist. Repeat 10 x 4 daily

Exercise 5 

Take your arm out of the sling. Allow your arm to rest by your side. Find a stable surface to lean on with your uninjured arm.

Let your injured arm dangle and gently move the arm in a circular pattern. Make sure the movement is coming from the shoulder.

Repeat 10 x 4 daily

Exercise 6 

Take your arm out of the sling. Allow your arm to rest by your side. Find a stable surface to lean on with your uninjured arm.

Let your injured arm dangle and gently move the arm in a sideways movement. Make sure the movement is coming from the shoulder.

Repeat 10 x 4 daily

Exercise 7 

Take your arm out of the sling. Allow your arm to rest by your side. Find a stable surface to lean on with your uninjured arm.

Let your injured arm dangle and gently move the arm in a forwards and backwards movement. Make sure the movement is coming from the shoulder.

Repeat 10 x 4 daily

Exercise 8

 

Take your arm out of the sling. Allow your arm to rest by your side.

Gently squeeze your shoulder blades together then relax.

Repeat 10 x 4 daily

Stage 2

3-6 weeks following your fracture (Exercises 9-12)

(Active assisted exercises)

Exercise 9  

In a sitting position, rest your injured arm on the table/worktop in front of you. Gently slide your injured arm forwards.

Then return to the starting position.

Repeat 10 x 4 daily

Exercise 10 

In a sitting position, rest your injured arm on the table/worktop in front of you. Gently slide your injured arm out to the side.

Then return to the starting position.

Repeat 10 x 4 daily

Exercise 11

 

In sitting or standing, support your injured arm with the other and gently lift up. Aim for shoulder height and further if possible.

Then return to the starting position.

Repeat 10 x 4 daily

Exercise  12

In a seated or standing position, hold a stick with both hands keeping your elbows bent. Move your arms and stick from side-to-side.  Your injured arm should be partially relaxed while your unaffected arm performs most of the effort.        

It is to keep your elbows tucked in by your waist as shown in the picture.

Repeat 10 x 4 daily

Stage 3

6+ weeks following your fracture (Exercises 13-17)

(Active exercises)

Exercise 13 

In a seated or standing position, gently raise your arm above shoulder height, reaching as high as you can.

Repeat 10 x 4 daily

Exercise 14 

In a seated or standing position, gently raise your arm out to the side reaching as high as you can.

Repeat 10 x 4 daily

Exercise 15

 

In a seated or standing position, gently move your arm behind your back.

Repeat 10 x 4 daily

Exercise 16 

In a seated or standing position, holding a stick raise your arms to shoulder height and gently push away from your chest then pull back in. 

Repeat 10 x 4 daily

Exercise 17

 

Lying on your unaffected side, tuck a towel just under your injured arm. Keep your elbow on the towel and lift and lower your forearm.

Repeat 10 x 4 daily

Smoking cessation

Evidence suggests that smoking can prolong fracture healing time. In extreme cases it can stop healing altogether. It is important that you consider this information with relation to your recent shoulder injury. Stopping smoking during the healing phase of your fracture will help ensure optimal recovery from this injury.

For advice on smoking cessation and local support available. Use the following contact information:

Free stop smoking advice line: 0300 123 1044

Stop smoking service for Plymouth: 01752 437177

Local online support: www.oneyouplymouth.co.uk or www.nhs.uk/live-well

Frequently asked questions

When can I drive?

There is no set timescale of when you can drive it is different for each individual. To drive you must feel in full control of the vehicle at all times and confident and safe to perform an emergency stop and able to use all your controls. Only you can make the decision of when to drive. You may need to inform DVLA of your injury.

When can I return to work?

You may need to take some time off work. The doctors in fracture clinic/G.P can sign you off. For manual work you may not return for 3 months but if you can perform light duties this may be from 6 weeks depending on discomfort and mobility in the arm.

When can I return to leisure activities?

This will vary dependent on your pain, range of movement and strength in your shoulder. You should avoid heavy lifting for approximately 8-10 weeks. You can return to sports with guidance from your Physiotherapist.

Further advice and useful links:

If you have not needed to be referred through to Physiotherapy but after 4 weeks you are struggling to regain function and range of movement you can

self-refer to physiotherapy using the following link or via your GP:

www.plymouthhospitals.nhs.uk/physio-self-referral-form

Further advice on health related issues can be found on the NHS Choices website:  www.nhs.uk/pages/home.aspx

With thanks, images from:

www.hep2go.com