“DR. TREVOR” STEFANSKI, M.D.
Minimally Invasive Specialist
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Proximal Humerus Fracture (Non-Op)

Physical Therapy Protocol

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Proximal Humerus Fracture: Non-Surgical Physical Therapy Protocol

Proximal Humerus Fracture:
Non-Surgical Physical Therapy Protocol

Initial Precautions

  • Range of Motion: Limitation of 0–90° for the first 6 weeks. Start progressing range of motion 10 to 15 degrees per week, with a goal of full range of motion by 10 weeks.
  • Weight-Bearing Status: Toe-touch weight-bearing until the 6-week appointment. Progress weight-bearing by approximately 25% per week after that.

Phase 1: Immobilization and Initial Exercises (0 to 3 Weeks)

  • Goals: Protect fracture site and allow initial healing. Control pain and swelling.
  • Immobilization: Sling worn continuously for 2–3 weeks. Sleeping in a preferred sitting position if comfortable.
  • Therapeutic Exercise: Pendulum exercises as pain allows. Active hand and forearm exercises. Begin isometric exercises for the shoulder girdle and scapular stabilizers.
  • Precautions: Avoid external rotation for the first 6 weeks.

Phase 2: Active Assisted Range of Motion (Weeks 3 to 9)

  • Goals: Progress ROM. Promote fracture consolidation.
  • Active Assisted Exercises: Begin active-assisted flexion and abduction as comfort allows. Gradually reduce assistance starting at week 6.
  • Functional Milestones: Gradual return to basic ADLs (e.g., dressing, light lifting) starting at week 6 as tolerated.
  • Special Considerations: X-ray evaluation to confirm healing before progressing.

Phase 3: Strengthening and Progression (Week 9 and Beyond)

  • Goals: Strengthen shoulder muscles. Regain full function.
  • Therapeutic Exercise: Begin isotonic strengthening exercises (concentric and eccentric). Use elastics and resistance machines for strengthening.
  • Functional Milestones: Gradual return to basic daily tasks (light lifting, reaching overhead) starting at weeks 9–12. Avoid strenuous activities until cleared for higher-level movements.
  • Red Flags: Report pain, swelling, or instability that worsens. Monitor for joint instability (clicking or grinding).
  • Special Considerations: Avoid overhead activities and lifting >5–10 lbs until cleared for full functional use.

Additional Considerations:

  • Wrist Fracture Modifications: Gentle weight-bearing as tolerated for the wrist after 6 weeks of healing, in a brace if needed. Wear brace for lifting over 5 lbs.