Proximal Humerus Fracture Treatment
A proximal humerus fracture is a break at the top of the arm bone, at the ball of the shoulder joint. It is among the most common fractures in adults over sixty five, it usually follows a fall from standing height, and it is one of the clearest examples in orthopedics of an injury where most patients do well without surgery despite an X ray that looks alarming.
Which patients are the exception is the entire clinical question. Steven Struhl, MD has practiced in New York since 1991, is board certified in orthopedic surgery and separately in sports medicine, and operates at NYU Langone Orthopedic Hospital. He treats shoulder fractures at offices in Manhattan and White Plains.
What Is a Proximal Humerus Fracture?
The top of the humerus is described in four parts, and how many of them have separated, and how far, is what determines treatment. A fracture in which the pieces remain in reasonable position behaves very differently from one in which several parts have displaced.
- The Humeral Head: the ball that articulates against the socket of the shoulder blade.
- The Greater Tuberosity: the outer prominence where most of the rotator cuff attaches.
- The Lesser Tuberosity: the smaller inner prominence where the subscapularis tendon attaches.
- The Humeral Shaft: the arm bone below the level of the surgical neck.
Roughly eighty percent of these fractures are minimally displaced, meaning the parts have stayed close to where they belong, and those heal well without surgery.
Proximal Humerus Fracture Symptoms
- Severe Immediate Pain: pain at the shoulder that makes any movement of the arm difficult.
- Extensive Bruising: discoloration spreading down the arm and across the chest over several days.
- Swelling: significant swelling around the shoulder in the first days after injury.
- Inability To Lift: difficulty raising the arm at all, from pain and mechanical disruption.
Proximal Humerus Fracture Treatment
- Sling Immobilization: several weeks of support for the large majority of minimally displaced fractures.
- Early Motion: gentle pendulum exercises begun sooner than patients expect, to limit stiffness.
- Progressive Therapy: motion restored first, then strengthening once healing is established.
- Surgical Fixation: plates, screws, or pins for displaced fractures in patients with good bone quality.
- Shoulder Replacement: partial or reverse replacement for severely comminuted fractures.
Early motion matters more here than in most fractures. A shoulder immobilized too long after this injury stiffens badly, and stiffness is a more common cause of poor long term outcome than the fracture itself, which is why therapy begins earlier than a patient might expect.
Dr. Struhl treats stiffness as the risk to manage rather than the bone, noting that “recent advances have dramatically changed the way shoulder and knee problems are treated, with a very early return to daily tasks as well as athletic endeavors.” – Steven Struhl, MD, Board Certified Orthopedic Surgeon
Frequently Asked Questions About Proximal Humerus Fractures
- Most likely not. Roughly eighty percent of proximal humerus fractures are minimally displaced and heal well in a sling with early therapy. Surgery is considered when the parts have separated significantly, when the fracture involves the joint surface, or when the head has lost its blood supply.
- Bone union typically occurs over six to twelve weeks. Motion and strength continue improving well past that point, often for six months to a year, and the final result depends heavily on how consistently therapy was done during the recovery.
- Because stiffness is the main threat to a good outcome. A shoulder held still for too long after this fracture can become severely restricted, and regaining that motion later is harder than preventing the loss in the first place, so gentle motion generally begins within the first weeks.
- It is a replacement in which the ball and socket positions are switched so the deltoid muscle can lift the arm instead of the rotator cuff. It is used for severely fragmented fractures in older patients where the pieces cannot be reliably fixed and the cuff attachments are compromised.
- Yes. Fractures involving the anatomic neck can disrupt circulation to the humeral head and lead to osteonecrosis, where the bone dies and the surface eventually collapses. That risk is part of why displaced fractures are followed closely rather than simply released after healing.
- Many patients regain excellent function, particularly with minimally displaced fractures and consistent therapy. Some loss of end range motion is common, especially reaching fully overhead or behind the back, and it is worth knowing at the outset rather than discovering months in.
Schedule an Upper Arm Fracture Evaluation in New York City
Most proximal humerus fractures heal without surgery, and the outcome depends far more on the therapy that follows than on the X ray that started it. Dr. Struhl evaluates these fractures and manages the recovery at his Manhattan and White Plains offices. Call the New York City office at (212) 207-1990 or the Westchester office at (914) 328-4111 to schedule an appointment.
