Proximal Humerus Fracture Surgery

Physical Therapy Protocol

Goals of Rehabilitation

• Promote Bone Healing: Protect the surgical repair to allow proper bone and soft-tissue healing.
• Restore Function: Gradually regain shoulder range of motion (ROM), strength, and functional use.
• Avoid Complications: Minimize stiffness, pain, and improper loading during recovery.

General Guidelines

• Rehabilitation is divided into three phases.
• Early gentle motion is encouraged to avoid stressing the repair while maintaining mobility.
• Resistance exercises are typically delayed until the bone and soft-tissue healing is secure, which is usually around 6 weeks.
• Adjustments to the protocol may be necessary based on individual patient needs and progress.
• Pain Management Tips:
  • Apply ice packs for 15–20 minutes every 2–3 hours during the first week to reduce swelling and discomfort.
  • Please follow Dr. Trevor's pain medication instructions provided. For full details, see DrTrevor.com/pain.
  • Avoid activities that cause sharp or increasing pain. Report persistent or severe pain to your surgeon.
  • Incorporate deep breathing or relaxation exercises to reduce tension and improve comfort.

Phase 1: Immobilization and Gentle Motion (Approximately First 3 Weeks)

Goals:

• Protect the repair to promote healing.
• Initiate gentle motion to prevent stiffness and maintain circulation.

Restrictions:

• Immobilization or support of the shoulder for 2–3 weeks.
• Avoid external rotation for the first 6 weeks.

Activities:

• Pendulum exercises: Perform daily to maintain shoulder mobility.
• Gentle assisted motion: Initiate pain-free movements as tolerated.
• Scapular shrugs and pinches: To maintain scapular mobility and posture.
• Posture correction: Emphasize maintaining good alignment to avoid compensatory movement patterns.
• Avoid heavy lifting, pushing, or pulling (nothing heavier than a glass of water).

Phase 2: Active-Assisted Motion (Weeks 3–9)

Goals:

• Progress to active-assisted and functional use of the shoulder.
• Gradually reduce dependence on assistance for ROM.

Restrictions:

• No abduction against resistance until after 6 weeks.

Activities:

• Active-assisted forward flexion and abduction: Gradually increase range as tolerated.
• Gentle functional use: For basic activities of daily living from weeks 3–6 (e.g., dressing, eating).
• Reduce assistance during ROM exercises: Start gradually reducing assistance from week 6 onward.
• Posture and scapular stabilization exercises: Continue to strengthen scapular support during shoulder motion.
• Incorporate heat therapy before exercises to loosen tight muscles and ice after exercises to minimize inflammation.

Criteria to Progress:

• Clinical evidence of bone healing.
• Fragments move as a unit without displacement on x-rays.

Phase 3: Strengthening and Functional Recovery (After Week 9)

Goals:

• Restore full range of motion.
• Build strength, endurance, and functional capacity for daily activities.

Activities:

• Isotonic strengthening exercises: Add concentric and eccentric strengthening to build muscle endurance and power.
• Progressive resistance exercises: Begin light resistance (bands or weights) and increase gradually as tolerated.
• Functional strength training: Focus on activities relevant to the patient’s daily life or occupational needs.
• Passive stretching: If joint stiffness persists, incorporate stretching by a physiotherapist.
• Incorporate balance and proprioception exercises, such as ball tosses or closed-chain activities, to restore coordination.

Criteria to Progress:

• Evidence of solid bone healing on x-rays.
• Pain-free performance of strengthening exercises with controlled form.

Additional Notes:

• Communication with the Patient: Ensure the patient understands the importance of avoiding overstressing the shoulder in early phases to protect the surgical repair.
• Pain and Swelling: If pain or swelling increases, reduce the activity level and consult the surgeon or therapist for guidance.
• Progress Monitoring: Include regular x-rays and clinical evaluations to confirm healing progress.
• Patient Education: Encourage patients to maintain compliance with home exercises and provide clear instructions with visuals when possible.
• Provide a contact point for patients if they have questions or experience unexpected issues during recovery.