Proximal Humerus Fracture — ORIF

Sutter Health / Palo Alto Medical Foundation · Kevin Roth MD

Weight-Bearing

N/A (upper extremity)

Key Restrictions

Sling with abduction pillow wks 1-6 (remove for exercises/showering); transition away from sling wks 6-12; no AROM against gravity Phase I; no RC resistance exercises through wks 6-12 (Phase III); light RC theraband begins Phase IV when able to elevate without scapular hiking; biceps tenodesis modifier: no active elbow flexion until wk 3; throwing/tennis/volleyball at 8+ months with MD clearance

Timeline & Phases

Phase I (wks 1-3): sling with ABD pillow, no AROM against gravity, Codman's pendulums, scapular sets/shrugs/retraction-protraction, towel slides, ER with broom handle, supine active-assisted flexion, elbow/wrist/hand ROM | Phase II (wks 3-6): sling with ABD pillow, progress PROM, pool therapy for AAROM, supine AAROM, pulley exercises, light scapular strengthening, gentle joint/soft tissue mobilization | Phase III (wks 6-12): transition away from sling, NO RC RESISTANCE EXERCISES, supine → seated → standing AAROM, pool AAROM, progress to full AROM against gravity | Phase IV (wks 12-24): full AROM, light RC theraband when able to elevate without scapular hiking, lat/biceps/triceps/pecs/rhomboids/deltoids strengthening, sport/job-specific activities | Phase V (months 6-8): with MD clearance — weight training, skiing, golf, basketball, manual labor | Phase VI (8+ months): with MD clearance — throwing sports, tennis, volleyball

Notes

Published 2024; biceps tenodesis modifier throughout: no active elbow flexion until wk 3 Phase I; active elbow flexion against gravity at wk 3 (no strengthening until 8 wks) Phase II; NO rotator cuff resistance exercises through Phase III (wks 6-12); RC theraband begins Phase IV only when patient can elevate arm against gravity without scapular hiking; RTS weight training at 6-8 months, throwing/tennis/volleyball at 8+ months with MD clearance; Kevin Roth MD Orthopedic Sports Medicine, Palo Alto CA (650-853-2943)

Surgeon / Author

Kevin Roth MD

Published

2024