Treatment of a Proximal Humerus Fracture: What You Need to Know

Causes and symptoms of a proximal humerus fracture

How does a proximal humerus fracture occur?

A fracture of the humeral head, known medically as a proximal humerus fracture, is a common injury that can have a variety of causes. It frequently results from direct force to the shoulder, for example after a fall onto an outstretched arm or in a road traffic accident. Older people in particular are more susceptible to this type of fracture because of their declining bone density.

Cause – frequency (%)

• Fall onto an outstretched arm – 65
• Road traffic accidents – 15
• Sports injuries – 10
• Other – 10

Internal factors such as osteoporosis further increase the risk of a proximal humerus fracture. Sporting activities involving a high degree of physical contact, such as football or skiing, are also frequent causes. You will find further information on similar injuries in our article on bone fractures.

Which symptoms point to a proximal humerus fracture?

The symptoms of a proximal humerus fracture are often unmistakable, although their intensity can vary. Typical signs include severe pain in the shoulder that is made worse by movement, visible swelling and possibly bruising in the affected area. Those affected often find it difficult to lift or move the arm.

Symptom – description

• Pain – severe pain, made worse by movement
• Swelling – marked swelling in the shoulder region
• Bruising – visible discolouration of the skin caused by bleeding into the tissue
• Restricted movement – difficulty lifting or moving the arm

Palpation, meaning examination of the affected area by hand, can contribute to the diagnosis. In some cases a grating sensation or sound may also occur as the broken bone ends rub against one another. Possible long-term consequences such as shoulder osteoarthritis should also be taken into account.

For more detailed information on the diagnosis and treatment of shoulder pain, please see our article on shoulder pain.

Diagnosis of a proximal humerus fracture

How is a proximal humerus fracture diagnosed?

A proximal humerus fracture is diagnosed through a thorough clinical examination and various imaging procedures. The doctor begins with a detailed history in order to understand the circumstances of the injury as well as the pain and movement restrictions you are experiencing. The arm is examined for visible deformity, swelling and bruising. The doctor may also assess the mobility and function of the shoulder joint.

Diagnostic procedure – purpose

• Clinical examination – recording pain, swelling and restricted movement
• X-ray – visualising the fracture and its position
• CT scan – detailed imaging of complex or multi-fragment fractures
• MRI – assessment of soft tissue injuries and bone necrosis

Which examinations are necessary?

Several examinations are necessary in order to determine the exact type and severity of the proximal humerus fracture:

• X-ray: the primary imaging investigation is the X-ray. It usually shows the fracture clearly and establishes its position. It gives the doctor important information about how far the fracture is displaced and whether conservative or surgical treatment is required.
• CT scan: for more complex or multi-fragment fractures, a CT scan provides a more precise representation of the bone structure. These detailed images help the doctor to decide on the best treatment approach and to recognise possible complications.
• MRI: an MRI scan is often added in order to rule out soft tissue injuries such as damage to ligaments, muscles or cartilage. It is also useful for assessing the presence of bone necrosis, which can occur with more severe fractures.

These diagnostic procedures are decisive for an accurate diagnosis and for correct treatment planning. You will find further information on related topics on our pages about bone fractures and shoulder surgery.

Treatment options for a proximal humerus fracture

A proximal humerus fracture can be treated in a number of ways, depending on the severity of the fracture and your individual needs. The most important treatment methods are set out below.

Conservative treatment methods

Conservative treatment methods are used when the fracture is stable and the bone fragments are not displaced. These methods typically include:

• Immobilisation: the affected arm is supported in a sling or a special dressing to aid healing.
• Pain medication: painkillers are given to relieve the pain.
• Physiotherapy: gentle movements and exercises to maintain mobility and prevent muscle wasting. You can read more about this under physiotherapy and rehabilitation.

Treatment method – duration – aim

• Immobilisation – 4 to 6 weeks – stabilising the fracture
• Pain medication – as required – pain relief
• Physiotherapy – 6 to 12 weeks – maintaining mobility and muscle strength

Surgical procedures

Surgery is necessary when the fracture is unstable or the bone fragments are displaced. Various surgical techniques may be used:

• Screws and plates: this method fixes the bone fragments precisely and allows early mobilisation.
• Intramedullary nails: a metal rod is passed through the shaft of the bone in order to stabilise the fracture.
• Joint replacement: in severe cases an artificial shoulder joint may be required. You will find further information under artificial shoulder joint.

Surgical technique – indication – advantages – disadvantages

• Screws and plates – displaced fractures – precise fixation – invasive
• Intramedullary nails – unstable fractures – less soft tissue damage – possible revision surgery
• Joint replacement – severe fractures – good functional results – long rehabilitation period

The choice of the appropriate treatment method depends on many factors, including your age and general health as well as the type and severity of the fracture. An experienced orthopaedic surgeon will recommend the best approach in order to ensure optimal healing. You will find further detailed information in our articles on shoulder surgery and shoulder pain.

Rehabilitation and follow-up care

After treatment of a proximal humerus fracture, an important phase on the way to full recovery begins: rehabilitation and follow-up care.

What can you expect after treatment?

The phase following treatment of a proximal humerus fracture involves various stages of healing and adaptation. The arm is immobilised at first in order to promote bone healing. During this phase you can expect regular check-ups with the treating doctor to monitor the progress of healing.

Phase of follow-up care – content

• Immobilisation – resting the arm, regular check-ups
• Physiotherapy – initial mobility exercises
• Intensified rehabilitation – strengthening and mobility exercises

After the immobilisation phase, physiotherapy begins, concentrating at first on restoring mobility. Slow and controlled movements are important here. Intensive physiotherapy then follows to strengthen the musculature and improve mobility.

Physiotherapy and rehabilitation

Physiotherapy plays a decisive role in rehabilitation after a proximal humerus fracture. It helps to restore mobility and build up muscle strength so that the arm becomes fully functional again.

Stages of physiotherapy

• Passive exercises: to begin with, the therapists carry out passive movements in order to promote joint mobility.
• Active exercises: you perform simple movements yourself, which gradually become more complex.
• Strengthening exercises: specific exercises to strengthen the muscle groups around the upper arm and the shoulder.
• Functional exercises: exercises that simulate everyday movements and activities.

Pain management is also an important component of physiotherapy. Techniques such as manual lymphatic drainage, kinesiology taping and transcutaneous electrical nerve stimulation (TENS) support pain relief and reduce swelling.

Method – purpose

• Manual lymphatic drainage – reducing swelling
• Kinesiology taping – supporting muscles and joints
• TENS – pain relief and muscle stimulation

Once intensive rehabilitation has been completed, you are advised to integrate long-term preventive measures such as regular strength and mobility exercises into everyday life in order to avoid further injuries. Information on long-term care and the aspects to bear in mind can be found under what should you pay attention to in the long term?

Prognosis and long-term care

A proximal humerus fracture can have various long-term effects. The prognosis and long-term care depend on several factors, including the severity of the injury, the treatment carried out and individual healing processes.

What should you pay attention to in the long term?

After treatment of a proximal humerus fracture there are several important aspects to consider in order to ensure the best possible recovery and to avoid future problems. Some of the key points are:

• Regular movement: gentle physiotherapy exercises are decisive for restoring the mobility and strength of the arm. You will find information on this in our article on physiotherapy and rehabilitation.
• Pain management: you should monitor your level of pain and use painkillers only as directed by your doctor.
• Nutrition: a balanced diet rich in calcium and vitamins supports bone healing.
• Follow-up appointments: regular check-ups with the doctor are necessary in order to monitor healing and to recognise possible complications early.

Possible complications and preventive measures

A proximal humerus fracture can bring various complications with it. It is important to be aware of these risks and to take preventive measures:

Complication – description – preventive measures

• Delayed healing – healing of the bone can take longer than expected – regular follow-up care and adherence to medical instructions.
• Infections – infections can occur particularly after surgery – observe hygiene and take antibiotics as prescribed.
• Shoulder stiffness – restriction of movement in the shoulder joint – daily stretching exercises and physiotherapy.
• Chronic pain – pain can persist permanently – pain management and physiotherapy measures.
• Further fractures – increased risk of additional fractures – fall prevention and avoidance of risky activities.

Further information on specific postoperative complications can be found in our articles on acromioclavicular joint separation and artificial shoulder joint.

In the long term you will benefit from good cooperation with your treating doctor and, where appropriate, a specialist physiotherapist. Regular exercise, a healthy diet and a mindful lifestyle contribute considerably to recovery and to the prevention of future injuries.

Quality of life after a proximal humerus fracture

After a proximal humerus fracture the question often arises of how everyday life changes and which measures can be taken to avoid further injuries.

Coping with restrictions in everyday life

A proximal humerus fracture can lead to various restrictions in everyday life, particularly during the healing phase. You may have difficulty with simple movements of the arm or with activities such as getting dressed, lifting or carrying.

Activity – likely restriction

• Getting dressed – moderate to high
• Lifting objects – high
• Carrying loads – high
• Sleeping comfort – medium to high

In order to minimise these restrictions, you can apply the following strategies:

• Use of aids such as slings or specially made cushions.
• Regular physiotherapy to restore mobility and strengthen the musculature.
• Performing specific exercises at home in order to promote mobility and strengthen the muscles.

You will find further information on specific treatments under tendon therapy and shoulder arthroscopy.

Risk of further injury and prevention

The risk of a further injury after a proximal humerus fracture can be reduced by certain preventive measures. Particularly important here are:

• Regular strengthening exercises to stabilise the shoulder and upper arm musculature.
• Performing mobility exercises in order to maintain flexibility.
• Avoiding risk situations that could lead to falls.

Measure – effectiveness – description

• Strengthening exercises – high – strengthening the musculature
• Mobility exercises – medium – improving flexibility
• Fall prevention – high – avoiding risk situations

Additional preventive measures, such as the use of protective clothing during certain activities or seeking sports medicine advice, can also be helpful.

Through targeted rehabilitation and preventive measures you can considerably improve your quality of life after a proximal humerus fracture. Further information on possible complications and long-term care can be found under bone fractures and osteoarthritis treatment.