Guidelines for Proximal Humerus Fracture (Non-Operative)
Note: This protocol is designed to serve as a guide to rehabilitation. Indications for progression should be based on patient’s complete operative procedure, functional capacity and response to treatment.
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- Schedule an Appointment
Rehabilitation Phase — Phase 1 — Weeks 1-3
Goals
- Modalities to control pain and swelling
- Protect fracture site
- Maintain ROM in surrounding joints
- Prevent deconditioning.
Appointments
- No PT for 3 weeks, unless otherwise specified by MD
General Precautions
- ROM and WB’ing limitations per MD
- Sling at all times x 3 weeks (or per MD)
- No cuff strengthening
Therapeutic Exercises
- AROM cervical, elbow, wrist, and hand
- Scapular clocks, shrugs, pinches, PNF
Cardiovascular Exercises
- Bike in sling, walking on treadmill in sling
Criteria for Progression
- X-ray evidence of healing, and clearance from MD to begin PT
Rehabilitation Phase — Phase 2 — Weeks 3-6
Goals
- Regain full ROM
- Restore GH and scapula-thoracic rhythm
- Minimize deconditioning
- Modalities to control pain and swelling
Appointments
- Begin physical therapy at 3 weeks post injury if cleared by MD
- Physical therapy 1-2 x/week
Precautions
- DC sling x 3 weeks if cleared by MD
Suggested Therapeutic Exercises
- AROM cervical, elbow, wrist and hand
- Pendelums
- Gripping exercises
- Scapular PNF
- Progress to full PROM all planes
- Supine AAROM for flexion (90 degrees), ER (40 degrees) and hyperextension.
- Submaximal RTC isometrics in neutral for IR, ER, EXT, and ABD
Cardiovascular Exercises
- Treadmill, bike
Criteria for Progression
- X-ray evidence of healing and full PROM.
Rehabilitation Phase — Phase 3 — Weeks 6-8
Goals
- Restore full AROM, and increase strength
Appointments
- Continue physical therapy 1-2 x/week
Precautions
- Allowed full PROM, AAROM and AROM without substitution
Suggested Therapeutic Exercises
- Begin with supine AROM flexion, no weights, progress to weights
- Standing wand assisted flexion
- Pulleys with eccentric lowering of involved arm
- Progress all other AROM, supine first then standing
- PNF
Cardiovascular Exercises
- Bike, treadmill, light jogging/swimming (if cleared by MD)
Criteria for Progression
- Full AROM
Rehabilitation Phase — Phase 4 — Weeks 10+
Goals
- Increase RTC strength and restore scapula-humeral rhythm.
Appointments
• Continue physical therapy 1-2 x/week
Suggested Therapeutic Exercises
- Posterior capsule stretching if indicated
- Isotonic exercises for RTC, scapular muscles
- PNF
- Theraband rows, ER, IR, shoulder extension
- Progressive strengthening program using bands, light dumbbells for RTC, deltoid and scapula
- Prone scapular strengthening (T’s, Y’s, W’s)
- Begin overhead exercises (if no impingement):
- Ball Taps
- Totally Gym pull ups
Cardiovascular Exercises
- No restriction unless directed by MD
Criteria for Progression
- DC to HEP
