Proximal Humerus Fracture

Following your rehabilitation program can help prevent the joint stiffness that is a common complication with this type of upper arm fracture

A proximal humerus fracture is a partial or complete break in the upper arm bone (humerus) near or in the shoulder.

Anatomy and Symptoms
The proximal area of the humerus is the portion near the arm's attachment to the body. Bony landmarks in this part of your arm include the greater tuberosity, lesser tuberosity, surgical neck and anatomical neck. Most proximal humerus fractures occur in the surgical neck region where the ball-shaped head of the bone and the shaft come together. This injury is usually followed by bruising, swelling, pain and, in some cases, deformity.

Causes
A strong blow or fall is the most common cause of a proximal humerus fracture. Disease may also be indirectly responsible for the injury by weakening the bone and causing it to break easily. This is the case with certain types of tumors and osteoporosis.

Treatment
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.

As for further medical care, your doctor will gather information about your symptoms and the nature of the injury. X-rays will be used to diagnose the fracture. Non-operative treatment usually consists of setting the bone and limiting arm movement with a sling or shoulder immobilizer for 2 to 6 weeks. Nonsteroidal anti-inflammatory medications (NSAIDS) are useful for controlling pain and swelling. If further intervention is required, you will be referred to an orthopaedic surgeon who may set the bone surgically using hardware such as plates, pins or nails. Again, the arm will be immobilized for several weeks to protect the site.

Recovery
Recovery depends on your age and general health before the injury as well as how well you follow the doctor's instructions. Proximal humerus fractures typically require 6 to 8 weeks for the bone to heal, plus a period of rehabilitation of about 3 to 6 months. The goal of rehabilitation is to restore arm function and help you return to regular activities as soon as possible. Your doctor may also recommend an individualized program of physical and/or occupational therapy.

Complications
Loss of range of motion in the joint is a major problem with a proximal humerus fracture. It is critical to follow your rehabilitation program exactly to avoid joint stiffness. Other possible complications with this injury include:

• infection
• malunion (angulated but healed bone)
• nonunion (fracture that does not heal)
• bone shortening or deformity
• nerve injury and
• impaired blood circulation.