Proximal Humerus Fracture Surgery (ORIF)

Physical Therapy Protocol

Phase I – Immobilization and Early Motion (Weeks 0–3)

Goals:

• Protect fracture fixation
• Minimize pain and inflammation
• Initiate gentle motion without stressing surgical repair

Precautions:

• Sling or immobilizer use for 2–3 weeks
• Avoid external rotation for first 6 weeks

Therapeutic Exercises:

• Pendulum exercises
• Gently assisted range of motion (AROM and AAROM as tolerated)
• Emphasize hand, wrist, and elbow mobility

Phase II – Assisted and Functional Motion (Weeks 3–9)

Criteria to Begin:

• Radiographic and clinical evidence of healing
• Fragments moving as a unit, no displacement on x-ray

Goals:

• Improve range of motion
• Initiate functional use within limits of healing

Therapeutic Exercises:

• Active-assisted forward flexion and abduction
• Gentle functional use (weeks 3–6) — avoid abduction against resistance
• Gradually decrease assistance with ROM starting at week 6

Phase III – Strengthening Phase (Weeks 9 and Beyond)

Goals:

• Restore full active range of motion
• Improve shoulder strength and endurance

Therapeutic Exercises:

• Add isotonic, concentric, and eccentric strengthening
• If stiffness persists despite bone healing, begin passive stretching under therapist supervision