Immediate care includes applying an ice pack wrapped in a towel to control pain and swelling. Immobilize and elevate the arm and get to an emergency room as soon as possible.

Non-operative

Certain proximal humerus fractures can be treated without surgery. Your surgeon will prescribe a splint or a sling for up to six weeks. Physical therapy to maintain shoulder range of motion begins as soon as the patient can tolerate it. This prevents stiffness in the shoulder. Periodic X-rays will be obtained to be sure the fracture is healing.

Operative

Certain proximal humerus fractures that cannot be treated with non-operative management are treated depending on how the bone is fractured. Restoring the function of your shoulder after proximal humerus fracture is accomplished by one of five surgeries: percutaneous pinning, open reduction internal fixation (ORIF), partial shoulder replacement (aka-hemiarthroplasty), full shoulder replacement (total shoulder arthroplasty) or reverse total shoulder replacement. Your surgeon will determine the best course of action based on the fracture pattern, the ability of your bones to heal and the function you wish to achieve after surgery. See the animations on this page for in-depth descriptions of each of these surgeries.

WHY IS MY ARM SO DARK AND SWOLLEN?

When you break your shoulder, the broken bones bleed internally for a few days. Driven downhill by gravity, this blood will slowly percolate through your arm and forearm, all the way to your fingers. The swelling and the ‘black and blue’ color that you associate with a bruise progresses just the same. Most people are quite surprised by how swollen their arm gets, and they often think that perhaps they have a ‘missed injury’ at the elbow or the forearm. While this is rarely the case, the swelling itself can cause stiffness at the elbow and hand. Additionally, depending upon the fracture, some of the blood will fall to the near side of the armpit, and work its way down through the chest wall. For this reason, it is common with proximal humerus fractures to develop ‘black and blue’ areas of the breast and chest wall. 

WILL I NEED THERAPY TO GET BETTER?

Not everyone needs formal therapy following a shoulder fracture, though it is commonly used. Those that do need therapy often have much stiffness, and are having difficulty getting back their range of motion and function of their hand and fingers. 

WHAT ABOUT THE SLING? SHOULD I USE MY ARM WHILE IT'S IN THE SLING?

When the sling is in place, it should be loosely fitted, allowing the arm to hang down under the effect of gravity. The arm should not be ‘cinched-up’ against the chest. Hemiarthroplasty (shoulder replacement for fracture) Proximal Humerus Fractures Page 4 It is very important to use your hand and fingers even while you are wearing a sling. While we do not recommend that you lift anything heavier than a coffee cup or a telephone receiver, use of your fingers and hand will help prevent stiffness. Additionally, make sure that you take your arm out of the sling at least twice daily to allow the elbow to completely straighten. This is very important to prevent permanent stiffness to your elbow. 

AM I NOW MORE LIKELY TO GET ARTHRITIS?

Unless the proximal humerus fracture has cracks that involve the joint itself, or unless the fracture heals in such a position to significantly change the alignment of the shoulder, you are not likely to get arthritis in the shoulder after healing of the fracture. 

WHEN WILL MY SHOULDER STOP HURTING?

Most shoulder fractures will hurt severely for the first two weeks. After that, the pain lessens until healing occurs. At about one to three months, the pain is often low-level, worse with activity and with changes in the weather. It may stay this way for one to two years. 

WHY ARE MY FINGERS SO STIFF?

When the humerus is broken, the rest of the shoulder usually swells. This restricts blood flow back from the hand and arm to the heart, much as an accident on the highway in one lane will block flow of traffic past the area. This leads to swelling and stiffness. Additionally, blood and fluid from the fracture migrates towards the fingers, until the body reabsorbs it. Compounding the stiffness from the swelling, some people have arthritic joints in their fingers, even if they have never had any pain or dysfunction. Anybody with arthritis in the fingers is far more likely to develop permanent stiffness if he or she does not keep moving. This is only one reason why we are so insistent that you work on the motion of your fingers. 

WHAT CAN I EXPECT WHILE MY FRACTURE IS HEALING?

For the first one to two weeks, your shoulder will be very painful, and you may even feel “like the bones are moving”. Your arm and hand will likely become swollen, and it may become difficult to move your fingers. Working on elbow, wrist, finger, and thumb motion is key for a good result. Expect your fingers to be cool, and even bluish in color, but they should always retain sensation, and not become “numb”. We advise sleeping upright in a chair or on the couch, keeping the sling loose so that the arm ‘hangs’ from the shoulder. As time passes, the pain will go down. Once out of a sling, you can work on more motion, including that at your shoulder itself, and you will have different pains, both at rest and with activity. As you continue to heal, you will slowly get your strength back. Most people with shoulder fractures, both those treated with surgery and those without surgery, do work with a physical therapist. You should postpone contact sports and impact activities until 4-6 months after the fracture. It may be a year or more before the swelling is down to a minimum, and the “ache” is gone. Even so, expect pain with weather changes for 1-3 years after the fracture. The shoulder may always look a little bigger, and have less motion than the “normal” shoulder.