Proximal Humerus Fx Rehab Protocol

Stable Fracture

Unstable Fracture

Stable Proximal Humerus Fracture

• This protocol is for nondisplaced proximal humerus fractures, or patients stable fractures after surgical fixation.

Goal:  Maintain range of motion (ROM) without displacing the proximal humerus fracture.

• Due to variable stability of the fracture, check for specifications and precautions ordered by the orthopedist.

Phase I  (0 – 21 days)

• Begin elbow, wrist and hand active ROM.
• A sling and swath, or Velpeau with and axillary pad should be used when not doing physical therapy.
• Begin pendulum exercises (clockwise and counterclockwise).
• After 7 days, begin supine ER with a cane.  Fifteen to 20 degrees of abduction are permitted if the patient is more comfortable.
• Establish a home exercise program so patient is performing exercises 3-5 times per day for 30 min. each session.

Phase II (3  - 6 weeks)

• Begin assisted forward elevation (FE).
• Perform pulley exercises and teach for home program.
• Perform isometric exercises for IR, ER, extension, and abduction.

Phase III (7 weeks – 2 months)

• Begin supine active FE.
• Progressively increase patient’s position from supine to erect during FE exercises.
• Use therabands of progressive strengths for IR, ER, flexion, abduction, and extension.  Goal is progressive strengthening of deltoid and rotator cuff.
• Begin flexibility and stretching exercises to progressively increase ROM in all directions.

Unstable Proximal Humerus Fracture

• This protocol is for patients with unstable proximal humerus fractures.

Goal:  Maintain ROM without displacing the proximal humerus fracture.

• Due to variable stability of the fracture, check for specifications and precautions ordered by the orthopedist.

Phase I  (0 to 21 days)

• Begin elbow, wrist and hand active ROM.
• A sling and swath, or Velpeau with an axillary pad should be used when not doing physical therapy.
• After 14 days, begin pendulum exercises (clockwise and counterclockwise).
• Establish a home exercise program so patient is performing exercises 3-5 times per day for 10 minutes each session.

Phase II (3 to 6 weeks)

• Begin supine ER with a cane.  Fifteen to 20 degrees of abduction are permitted if the patient is more comfortable.
• Begin active assisted forward elevation (FE).
• Perform pulley exercises and teach for home program.
• Perform isometric exercises for IR, ER, extension, and abduction.

Phase III (7 weeks to 2 months)

• Begin supine active FE.  Progressively increase patients position from supine to erect during FE exercises.
• Use Therabands of progressive strengths for IR, ER, anterior, middle and posterior deltoid.
• Begin flexibility and stretching exercises to progressively increase ROM in all positions (i.e. towel behind back, finger walking up the wall, etc.).