Humerus Fracture ORIF

Intramedullary Nail Fixation

Physical Therapy Protocol

Phase I – Protection and Early Motion (Weeks 0–6)

Goals:

• Prevent stiffness
• Decrease swelling and inflammation
• Protect rotator cuff

Precautions:

• Sling use for a minimum of 2 weeks; may discontinue after 2 weeks if comfortable
• Weight bearing/lifting restriction: no more than 5 lbs with the operative upper extremity

Range of Motion (ROM):

• Forward elevation: limit to 90°
• Abduction: limit to 45°
• External rotation: limit to 30°
• Passive, active-assisted, and active ROM all allowed within limits
• Encourage elbow, wrist, and hand ROM
• Perform gripping exercises regularly

Therapeutic Modalities:

• Electrical stimulation, cryotherapy, and swelling control modalities as needed

Mobility:

• May begin immediate use of a walker using the operative upper extremity if necessary

Phase II – Progressive Range of Motion and Early Strengthening (Weeks 6–12)

Goals:

• Improve swelling and pain
• Restore full ROM
• Initiate strengthening

Precautions:

• Sling should be fully discontinued by this phase

Range of Motion:

• Progress as tolerated in all planes

Strengthening:

• Begin periscapular and rotator cuff strengthening gradually

Weight Bearing:

• Weight bearing as tolerated; no specific lifting restrictions but avoid sudden or excessive loads

Home Program:

• Emphasize consistency with home exercise program (HEP)

Modalities:

• Continue as needed for swelling, pain, and muscle stimulation

Additional Therapy Options:

• Aquatic therapy permitted if accessible

Phase III – Functional Strengthening and Return to Activity (Weeks 12+)

Goals:

• Restore strength across all planes
• Return to prior functional level, work, or sport

Activities:

• Continue strengthening in all directions
• Incorporate functional training and sport/work-specific exercises
• Address any deficits in daily living activities

HEP:

• Transition to a long-term home program upon discharge from PT