Proximal Humerus Fracture: Non-Surgical

Physical Therapy Protocol

Overview

Nonoperative management of proximal humerus fractures typically begins with maximal support using a sling. The progression to motion and strengthening exercises is guided by patient comfort, fracture healing, and radiographic confirmation.

Summary of Phases

• Phase I (Weeks 0–3): Immobilization, pendulums, isometrics, sling use
• Phase II (Weeks 3–6): Active-assisted motion, therapy tools, light strengthening
• Phase III (Week 6 and beyond): Full AROM, progressive strengthening, functional return

Phase I – Immobilization Phase (Weeks 0–3)

Goals:

• Protect fracture site
• Minimize pain and inflammation
• Initiate early motion without compromising stability

Precautions:

• Full-time sling use, including during sleep, for 2–3 weeks
• Avoid active shoulder use; hand and wrist use encouraged
• Sleep in a reclined or upright position if uncomfortable

Therapeutic Activities:

• Pendulum exercises as tolerated
• Active hand and forearm use
• Isometric scapular and shoulder girdle exercises as tolerated

Monitoring:

• Obtain X-rays to rule out displacement

Phase II – Assisted Motion Phase (Weeks 3–6)

Goals:

• Begin active-assisted motion
• Maintain mobility and alignment
• Prevent stiffness

Therapeutic Activities:

• Active-assisted shoulder motion (flexion and abduction)
• Begin use of shoulder therapy tools if needed:
  • Exercise bar: Use opposite arm to guide passive motion
  • Pulley system: Allows passive forward flexion
• Continue isometric exercises and progress as tolerated

Phase III – Progressive Strengthening Phase (Week 6 and Beyond)

Goals:

• Restore full active range of motion (AROM)
• Improve strength and endurance
• Return to functional activities

Therapeutic Activities:

• Initiate isotonic strengthening as tolerated
• Focus on forward flexion before abduction against gravity
• Use elastic resistance bands, progressing to machines and free weights
• Monitor rotator cuff strength

Caution:

• Weakness or poor progression may indicate rotator cuff tear requiring further evaluation

Key Considerations

Pitfalls – Shoulder Stiffness:

• Discontinue immobilization early if appropriate
• Encourage pendulum exercises and assisted motion
• Initiate formal PT if progress stalls

Special Circumstances:

• Glenohumeral Dislocation: Sling and swath use may improve comfort and reduce redislocation risk
• Weight Bearing: Avoid until fracture healing is secure
• Implant Removal: Only indicated with symptoms like loosening or impingement