Proximal Humerus Fracture — Non-Operative Proximal Humeral Fracture Rehabilitation

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

Sling worn at all times except to exercise Week 1; sling weaning implied through Phase II as AROM progresses

Key Restrictions

No shoulder extension or IR until wk6 post-injury (non-displaced defined as <1cm displacement and <45 deg angulation); bony healing typically 6-8 wks in adults; return to normal function/motion may require 3-4 months

Timeline & Phases

Phase I, Early Motion Phase (0-5 wks): increase ROM while protecting fracture site, control pain/swelling, frequent gentle exercise to prevent adhesions; wk1: sling at all times except exercise, hand/wrist/elbow/cervical AROM, grip/wrist strengthening, PROM supine flexion to 90 deg and very gentle ER, modalities PRN; wk2: hot packs before exercise, pendulum (Codman) exercises with circles, soft tissue mobilization, supine ER with stick to 30 deg (elbow on folded towel, shoulder 15 deg abduction), scapular clocks and retractions (no shoulder extension); wks3-5 (begin AAROM when pain diminishes): continue above, gentle AAROM flexion to 140 deg if stable (supine cane flexion, supine AAROM with therapist/hands clasped), pulley for flexion to tolerance, submaximal isometrics ER/flexion (wks3-4), flexion/abduction on slide board or table to tolerance; Phase II, Active Motion Phase (6-12 wks): wks6-8 establish full PROM, begin AROM (supine flexion to tolerance progressing to seated/standing flexion with stick, seated flexion with elbow bent close to body, ER/abduction with hands behind head, side-lying ER, serratus punches), begin extension and IR (PROM/AROM/isometrics), multi-angle isometrics, gentle self-stretching wks7-8 (flexion via wall/door, ER via door jam twist, IR pulling with good arm); wks8-10 early resisted ROM: theraband for IR/ER/flexion/abduction/extension, supine IR/ER with 1lb (arm supported 15 deg abduction, pain-free), UBE no resistance, prone extension/abduction pain-free, progress weight only if pain-free, biceps/triceps dumbbell strengthening; Phase III, Aggressive Stretching and Strengthening (from wk12): isotonic strengthening with weights all directions, increase theraband/rubber tubing resistance, increase door and prone stretches, begin functional or sport activity for strength gain

Notes

OSMS Rehabilitation Guidelines; for non-displaced proximal humeral fractures (<1cm displacement, <45 deg angulation); extension and IR withheld until wk6 to protect fracture healing; source PDF page footers are mislabeled 'Non-Operative Posterior Shoulder Instability Protocol' (a copy-paste artifact) despite content being entirely about proximal humeral fracture