Proximal Humerus Fracture — Non-Operative

Mammoth Orthopedic Institute / Sierra Park PT · Dr. Timothy Crall MD (US Ski Team Physician); Bartlett White PA-C

Weight-Bearing

Sling at all times x 3 wks (or per MD); D/C sling at wk 3 if MD cleared; bike and treadmill walking in sling for cardio Phase I

Key Restrictions

No PT x 3 wks unless otherwise specified by MD; no cuff strengthening Phase I; ROM and WB limitations per MD; X-ray evidence of healing required to progress between all phases; MD clearance required to begin PT at wk 3; AAROM limited to FF ≤90 deg and ER ≤40 deg Phase II; no overhead exercises until Phase IV (if no impingement)

Timeline & Phases

4 phases: Phase I (wks 1-3, no formal PT — AROM cervical/elbow/wrist/hand + scapular clocks/shrugs/PNF + cardio in sling), Phase II (wks 3-6, PT 1-2x/wk: pendulums + AAROM FF ≤90 + ER ≤40 + submaximal RTC isometrics neutral), Phase III (wks 6-8, AROM begins supine then standing, pulleys with eccentric lowering, PNF, light jogging/swimming if MD cleared), Phase IV (wk 10+, isotonic RTC/scapular + theraband + prone T/Y/W + overhead if no impingement)

Notes

US Ski Team physician protocol; references St. Louis University (SLU) and Loma Linda/UoP DPT programs as source materials; X-ray evidence of healing explicitly required as progression criterion between all phases; eccentric lowering with pulleys Phase III; prone T/Y/W scapular strengthening Phase IV; overhead exercises Phase IV only if no impingement; cardiovascular exercise prescribed each phase; April 2016

Surgeon / Author

Dr. Timothy Crall MD (US Ski Team Physician); Bartlett White PA-C

Published

April 2016