Understanding Proximal Humerus Fracture
If you’ve experienced a sudden, severe pain in your upper arm or shoulder after a fall (especially onto an outstretched arm), or a direct blow, you might have a broken upper arm bone, known as a Proximal Humerus Fracture. This is a common injury, particularly among older adults, and it can significantly limit your ability to move your arm.
What’s Going On with Your Proximal Humerus?
Your humerus is the long bone of your upper arm. The proximal humerus refers to the upper part of this bone, closest to your shoulder joint. This is the “ball” portion of your shoulder’s ball-and-socket joint. This area is critical because it connects your arm to your shoulder, allowing for a wide range of movements.
A proximal humerus fracture occurs when this upper part of the arm bone breaks. These fractures can vary greatly in severity:
- Non-displaced fractures: The bone is cracked but the pieces remain in their correct position.
- Displaced fractures: The bone pieces have moved out of alignment.
- Comminuted fractures: The bone has broken into multiple pieces.
- Fractures can also involve the “surgical neck” (just below the ball) or the “anatomical neck” (right at the ball’s surface).
These fractures commonly result from:
- Falls: Especially falling directly onto the shoulder or onto an outstretched arm, common in older adults with osteoporosis (weak bones).
- High-energy trauma: Such as car accidents or sports injuries in younger, more active individuals.
When the proximal humerus breaks, you’ll typically experience immediate, intense pain, swelling, bruising (which can extend down to your elbow or hand), and significant difficulty moving your arm. You might also notice a deformity or inability to use your arm.
How is a Proximal Humerus Fracture Managed?
The treatment for a proximal humerus fracture depends heavily on the type and severity of the break, as well as your age, activity level, and overall health.
- Non-Surgical Management: Many proximal humerus fractures, especially those that are non-displaced or minimally displaced, heal well without surgery. This typically involves:
- Immobilization: Using a sling, shoulder immobilizer, or brace to support your arm and keep the broken bone stable while it heals.
- Pain Management: Medications to control pain.
- Rest: Limiting activities that could disrupt healing.
- Surgical Management: Surgery might be recommended for fractures where:
- The bone fragments are significantly displaced or rotated.
- The fracture extends into the joint surface.
- The bone has broken into many pieces (comminuted).
- The fracture is open (bone piercing the skin). Surgical options can include:
- Open Reduction Internal Fixation (ORIF): The surgeon makes an incision, realigns the bone fragments, and secures them with metal plates and screws.
- Intramedullary Nailing: A rod is inserted down the hollow center of the bone to hold it together.
- Shoulder Replacement (Arthroplasty): In very severe cases, especially in older adults with complex fractures involving the joint surface, a partial (hemiarthroplasty) or total shoulder replacement might be necessary.
Life After a Proximal Humerus Fracture (and Repair):
Whether your proximal humerus fracture is managed non-surgically or with surgery, physical therapy is absolutely essential for a successful recovery and to regain the full use of your arm and shoulder. Your physical therapist will guide you through a structured and progressive rehabilitation program, which typically includes:
- Protecting the Healing Bone: Initially, you’ll need to protect the fracture site, often with continued sling use, to allow the bone to mend.
- Gradual Movement Restoration: Once your doctor clears you, you’ll begin very gentle, controlled exercises to slowly regain the range of motion in your shoulder, often starting with passive movements (where the therapist moves your arm) and progressing to active movements. This is crucial to prevent stiffness.
- Progressive Strengthening: Your therapist will introduce strengthening exercises for your shoulder muscles (rotator cuff, deltoid, and shoulder blade muscles) and eventually your entire arm, to rebuild power and stability.
- Functional Return: As you progress, your therapist will help you gradually return to your daily activities, work tasks, and sports, ensuring proper body mechanics and a safe progression back to full function.
Recovery from a proximal humerus fracture is a significant process that requires patience and dedication, often taking many months to a year for a full return to demanding activities. Following your physical therapist’s instructions closely and being patient with the healing process are crucial for achieving the best possible outcome and safely returning to your desired activities with a strong, pain-free shoulder.