Proximal Humerus Fracture Rehab Protocol

Keys to a Successful Outcome

  • Tuberosity healing must occur before active force is applied by the attached rotator cuff tendon

  • "Slower rather than quicker" overall

  • No not stress end range motions between 0-6 weeks while performing passive movements

Phase
Brace
ROM
WB Status
Exercises
In Hospital
Worn at all times**
PROM
NWB
Passive FF while supine, gentle ER to neutral if comfortable, pendulum okay if comfortable
Weeks 0-6*
Worn at all times**
PROM
NWB
Elbow/wrist AROM, grip strength, scapula isometrics, no resistance exercises
Weeks 6-12
Used for sleeping only for weeks 6-8
AAROM>AROM as tolerated; PROM Goals: FF 120°, ER 50°, IR 50°, Active FF 100°
1lb limit
Begin active motion in plane of scapula, AAROM pulleys, sub-max pain-free isometrics in neutral, scapular strengthening, assisted horizontal Add
Weeks 12-16
None
Progress AROM/PROM; AROM goals: FF 130° (scapular plane supine), ER 55°, IR 60°
5lb limit
Initiate assisted IR behind back stretch, resisted IR/ER in scapular plane, begin supine active elevation strengthening(i.e. Therabands)
Months 4-6
None
FAROM
10lb limit
Gradually progress strengthening, return to light recreational hobbies
Months 6-12
None
FAROM
15lb limit
Avoid loading shoulder at extreme ROM, progress with strengthening activities as tolerated.

 

*If surgery was not performed, PROM should not start until 3 weeks from the date of injury.

**to be worn day and night; off for hygiene and exercises