Shoulder Fracture Surgery (Proximal Humerus) Recovery
Proximal Humerus Fracture ORIF
What the operation does
The top of the arm bone has broken, usually into several pieces. The fragments are brought back into position and held with a metal plate and screws down the outer side of the bone, with strong sutures often used as well to pull the bony lumps where the rotator cuff attaches back into place.
Why passive movement only for six weeks
The most important instruction here, and the reason it looks like a rotator cuff repair. The bony lumps at the top of the bone — the tuberosities — carry the rotator cuff tendons, and they have been reattached. Contracting the cuff pulls on them directly, so someone else moving your arm, or your good arm moving it with a stick, is encouraged, while lifting the arm under its own power is not.
Why the tuberosities matter so much
They determine your final movement more than anything else. If they heal in the right place, the cuff works and the shoulder moves. If they pull off or heal displaced, the shoulder stays weak and stiff regardless of how well the rest of the bone healed. That is the single biggest determinant of the result, and it is why the early restrictions are enforced.
Why most of these are not operated on
Most proximal humerus fractures — particularly in older patients where they are commonest — heal acceptably in a sling without surgery. Fixation is chosen where the fragments are badly displaced, where the head is tilted, or in younger patients where restoring the anatomy matters more. If yours was fixed, it was because leaving it was judged likely to give a worse shoulder.
Blood supply to the head
The ball at the top of the arm bone has a delicate blood supply that can be disrupted by the fracture itself. Where it is lost, the bone can gradually collapse over the following year or two — avascular necrosis — causing pain and stiffness. It is uncommon, more likely with certain fracture patterns, and is one of the things follow-up X-rays are watching for.
Screws cutting through
In osteoporotic bone the screws can gradually migrate through the softened head, which shows on X-ray and may cause new pain. It is the commonest reason this fixation needs revising, and it is more likely where bone quality is poor. It is another reason early loading is restricted.
Stiffness is very common
More so than after most fractures. The shoulder is immobilised while the cuff attachments heal, and shoulders stiffen readily. Some permanent loss of movement — particularly rotation and reaching behind the back — is common after this injury, and doing the passive work faithfully in the first six weeks is what limits it.
Pain and the early weeks
The arm is sore and heavy for the first weeks, sleeping is awkward, and many people sleep propped up in a recliner. Bruising commonly tracks down the arm and even to the chest wall over the first fortnight, which looks alarming and is expected.
What you can use the arm for
The hand, wrist and elbow should move from the start, and using the hand at waist height with the elbow at your side is usually fine and encouraged. It is lifting the arm, reaching overhead, reaching behind, and carrying that wait.
If a replacement was discussed
For some fracture patterns, particularly in older patients where the pieces cannot be reliably fixed, a reverse shoulder replacement is chosen instead of fixation. If that was discussed and fixation was chosen, it generally reflects better bone or a more reconstructable pattern.
Recovery is slow, and that is normal
Worth setting expectations on. Meaningful improvement continues for a year and often longer after this fracture, and the shoulder at three months is a poor guide to the shoulder at twelve. People who expect a six-week recovery find this injury demoralising; people who expect a year usually find it manageable.
Bone health
In an older patient, a proximal humerus fracture from a simple fall is a fragility fracture, and it is a strong signal to have bone density assessed and treated. Doing so meaningfully reduces the chance of the next fracture, which is more likely to be a hip. It is worth raising if nobody has.
Driving and work
Driving generally waits until you are out of the sling and can control the wheel with both hands comfortably — commonly around eight weeks. Desk-based work is often possible within two to three weeks with the sling on. Work involving lifting or overhead reaching commonly waits four to six months.
How the first year usually unfolds
Six weeks in a sling with passive movement only. Six to twelve weeks the sling goes and you begin lifting the arm yourself. Three to six months brings strengthening in earnest. Six to nine months brings most everyday activity. Nine to eighteen months settles the final movement and strength, and gains in the second year are normal.
Staying in touch with your care team
The fracture pattern, bone quality, and how the tuberosities heal all change this recovery substantially. Your surgeon is following it on X-ray. If something about your recovery is worrying you or does not match what is described here — particularly new pain after a period of improvement — contact your care team rather than waiting.
Exercises for Shoulder Fracture Surgery (Proximal Humerus)
An illustrated, phase-by-phase exercise program for this procedure. View the Shoulder Fracture Surgery (Proximal Humerus) exercise program.
Recovery education · Condition guides · Exercise programs
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This guide is general education and doesn't replace evaluation by a licensed provider. Recovery and treatment vary by person — follow the guidance of your own surgeon or care team.