Proximal Humerus Fractures

Fractures of the proximal humerus occur around the upper arm bone near the shoulder. They can be debilitating since they affect most of our daily activities. Younger people experience these fractures when they are involved in high-impact traumas like road accidents or sports injuries. However, they are prevalent when people are old and fall. The degree of fractures ranges from simple to complicated by the involvement of multiple fragments that should be managed and treated to allow regaining functional shoulder movements.

Recovery from illness may, therefore, require both medical treatment and rehabilitation. In some cases, surgery may be needed to realign and immobilize the broken bones. But this is only the beginning of healing. Shoulder strength and mobility imply that the patient needs to go for rehabilitation after the surgery, and physical therapists are mandatory.

We at Suarez Physical Therapy will develop a specific rehabilitation schedule because every patient has individual needs and progress. This exercise program should help improve shoulder muscle strength and flexibility and reduce shoulder pain. With the help and support of our professional Las Vegas physical therapists, you have an excellent chance to recover relatively quickly without serious complications.

Understanding Proximal Humerus Fractures

The top portion of the humerus bone, known as the proximal humerus, runs from the shoulder to the elbow. It includes the head of the humerus, which fits into the shoulder socket (glenoid), the anatomical neck just below the head, the greater and lesser tubercles where muscles attach, and the surgical neck, where the bone narrows before widening again.

When you sustain an injury, your arm and body position significantly influence how the bone fractures. Fractures can happen to anyone at any age, although those with osteoporosis are more susceptible because of their weakened bones.

The proximity of a proximal humerus fracture to important structures makes it a cause for concern. A fracture of this kind can impair the stability and functionality of the shoulder joint, restricting your shoulder’s range of motion and making daily tasks more difficult. The network of nerves known as the brachial plexus, located close to the proximal humerus, regulates sensation and movement of the hand, arm, and shoulder. These nerves are then damaged, leading to weakness, paralysis, or numbness.

Neighboring blood vessels are also at risk. The proximal humerus is near the axillary artery and vein, which supply blood to the arm. Damage to these arteries from a fracture could result in bleeding and reduced blood flow. The proximal humerus is also where the rotator cuff muscles and tendons attach, which is crucial for shoulder stability and mobility. A fracture that breaks these attachments could weaken muscles and impair shoulder function.

Signs of a Proximal Humerus Fracture

Multiple signs point to a proximal humerus fracture. Once you experience any of these, you should seek immediate medical attention:

• Severe pain — You could experience excruciating pain in the upper arm or shoulder that worsens with activity and is frequently constant at rest.

• Swelling and bruising — Patients also suffer bruising that eventually extends down the arm and swelling around the shoulder.

• Numbness or tingling — Shoulder, arm, or hand numbness, tingling, or a "pins and needles" sensation could result from local nerve injury.

• Weakness — The affected arm's muscle weakness can make it difficult to grip objects or carry out simple tasks.

• Restricted mobility — One crucial sign is difficulty moving the arm or shoulder, which makes raising or rotating the arm especially difficult.

• Deformity — The shoulder may have a noticeable displacement of the bone or an unusual bump that makes it appear malformed or misplaced.

• Tenderness — Applying pressure can be extremely uncomfortable because the area surrounding the fracture is typically painful.

Diagnosis of Proximal Humerus Fractures

Initially, your physician will review your medical history and perform a physical examination. He/she will ask about your symptoms, how the injury happened, and any previous medical issues. During the examination, he/she will check your hand, arm, and shoulder for soreness, bruising, deformity, and swelling. In addition, your physician will assess your range of motion and look for any blood vessels or nerve injuries.

Physicians rely on X-rays to diagnose proximal humerus fractures. They offer sharp pictures of the bone, which help identify the fracture's kind, location, and extent. A CT scan may be required if the fracture appears complex or the X-ray results are inconclusive. A CT scan provides precise cross-sectional images of the bone and surrounding tissues, which can help with surgical planning and evaluating complex fractures.

Your physician could require you to have an MRI done. This is possible in specific circumstances to assess soft tissue injuries, like injuries to the rotator cuff, ligaments, or nerves. X-rays and CT scans provide information about these soft tissues, but MRI offers more detailed images. Furthermore, if you sustained soft tissue injuries linked to the fracture, your physician would order an ultrasound to evaluate the state of the rotator cuff tendons and surrounding muscles.

If nerve damage is suspected, nerve conduction studies might be conducted to evaluate the function of the nerves in the shoulder, arm, and hand. These tests measure the speed and strength of electrical signals passing through the nerves, providing valuable information about nerve health.

Doctors will classify your proximal humerus fracture and recommend the appropriate course of therapy after evaluating your condition. Initially, the specialists will determine whether or not you have a nondisplaced fracture. Since the broken bones stay in their original alignment, conservative measures like physical therapy and immobilization are typically effective in treating nondisplaced fractures.

Surgery is often necessary for displaced fractures, where the broken pieces have moved out of position. The surgery realigns and stabilizes the bone. However, in some cases, non-operative measures will be sufficient.

Subsequently, the doctor will identify the specific location of the fracture on the proximal humerus. Fractures can occur at the:

• Surgical neck.

• Greater or lesser tubercles.

• Anatomical neck.

• Head of the humerus.

This information helps understand the injury's extent and determine the most effective treatment.

You should also expect your physician to assess whether you dislocated your shoulder joint. Fractures with dislocation often require more complex treatment compared to those without dislocation.

Nonoperative Treatment for Proximal Humerus Fractures

One practical option for treating proximal humerus fractures is nonoperative therapy. With this approach, doctors usually immobilize the arm using a sling. Then, a structured rehabilitation program follows. The primary objective is to promote healing and return function to the shoulder without surgery.

Nonoperative treatment is an appropriate option because of certain factors. For example, this method works well if you have minimally displaced surgical or anatomical neck fractures. In a similar vein, fractures of the greater tuberosity that have displaced less than 5 mm also react effectively. If you are at a higher risk for surgery because of underlying medical issues, nonoperative treatment is ideal.

The choice of nonoperative treatment is based on several variables, such as:

• Your age.

• Your general health.

• The nature of the fracture.

• Whether or not it affects your dominant arm.

These factors help customize the course of care to meet your unique requirements and help you heal faster.

Promptly beginning therapy helps with healing and avoids stiffness. The timing and intensity of treatment should be customized based on your condition and the fracture’s progress. This approach ensures more favorable recovery results and efficient rehabilitation.

Shoulder stiffness, also known as "frozen shoulder" or adhesive capsulitis, can make healing from a proximal humerus fracture more difficult. Immobilization after a fracture frequently causes shoulder discomfort. When you immobilize your shoulder for healing, it can reduce joint movement. The connective tissue surrounding the shoulder joint, known as the shoulder capsule, thickens and tightens due to prolonged immobilization. Your shoulder loses range of motion and flexibility due to this tightness.

Your injury will get worse if you miss or delay physical therapy. If you do not move your shoulder early, the shoulder capsule will tighten, reducing its motion even more. Your fracture’s severity, overall health, and certain medical conditions, like diabetes, can increase your risk of stiffness.

Nonoperative treatment can work, but it has risks, namely:

• Malunion  — Where the bone heals, it does not heal properly.

• Nonunion — Where it does not heal.

Regular follow-up with your healthcare provider is critical to monitoring your progress, addressing issues, and adjusting your treatment plan as needed.

How Surgery Realigns and Stabilizes a Proximal Humerus Fracture

When treating a proximal humerus fracture, surgeons try to straighten and stabilize the broken bone to promote healing and restore shoulder function. They start by carefully realigning the fractured pieces of bone to their original position, using specific techniques and instruments.

Next is to stabilize the bone pieces so they do not move during the healing process. The internal fixation techniques used by surgeons involve metal plates and screws attached to the surface of the bone. They could sometimes implant an intramedullary nail. This is a metal rod inserted into the central canal of the bone. Smaller wires or pins could hold the broken bone pieces together in some fractures.

The surgery aims to stabilize the fracture and restore normal shoulder function. By preventing complications, surgeons ensure the shoulder joint remains functional and supports a smoother recovery.

During the process, surgeons will treat the damage to the surrounding soft tissues, including the muscles, tendons, and ligaments. Proper management of these tissues will improve overall shoulder function and speed up recovery.

After surgery, you will be enrolled in a rehabilitation program. Physical therapy will focus on strengthening, stretching, and improving shoulder function.

The Role of Physical Therapist in Recovery From Proximal Humerus Fracture

Physical therapy is vital to recovery after a proximal humerus fracture. Restoring your shoulder's strength, flexibility, and function helps you return to normal activities with the most minor restrictions. The physical therapist’s priority is to increase the range of motion in your shoulder. They will recommend exercises that will gradually stretch the surrounding muscles and joints. This will minimize the stress on the healing bone while you regain movement.

As you progress, the therapist will introduce exercises to strengthen the muscles around your shoulder. Strengthening the rotator cuff and other vital muscles will help you return to normal activities and prevent further injuries by stabilizing the shoulder joint and overall function.

Another significant part of therapy is pain management. The therapist will use techniques like electrical stimulation, ultrasound, and heat or ice therapy to reduce pain. Good pain management will make your recovery smoother, and you can participate fully in the rehabilitation program.

Functional training is also important. The physical therapist will incorporate exercises that mimic daily activities like getting dressed, reaching, or lifting. This practical approach will enhance your recovery and daily living and help you do these tasks again.

Beyond the exercises, therapists will also give you posture and body mechanics tips. They will teach you how to do the exercises correctly and integrate them into your daily routine. This will prevent future injuries and long-term shoulder health. Your therapist will monitor your progress and adjust the treatment plan as needed. They will handle any difficulties or complexities, ensure your recovery is on track, and customize the program to your changing needs.

How to Prevent Proximal Humerus Fracture

You can prevent proximal humerus fracture by taking a few precautions. Start by taking care of your bone health with a balanced diet rich in calcium and vitamin D. Include bone-strengthening foods like dairy, leafy greens, and meat. Consult your doctor to take supplements to ensure you get what you need.

Take part in weight-bearing activities like strength training, running, or walking. These exercises lower your risk of fractures by increasing and preserving bone density. Exercises like yoga or tai chi can also help you become more balanced and coordinated, which can help you avoid falls and shoulder injuries. Remember to use the proper protection gear if you participate in high-risk sports or hobbies. Braces or pads for the shoulders can provide extra protection when riding, skiing, or participating in contact sports.

You should also make your living space safer to reduce the danger of falls. This is especially necessary as you age. Clear your house of any tripping hazards, like loose carpets and clutter. Install grab bars in the restroom and ensure all places have adequate illumination. This will help you reduce the risk of accidents.

Work with your healthcare physician to address any problems you may have, like osteoporosis, that impact bone health. Adhere to their advice on medication, dietary adjustments, and routine check-ups to maintain strong bones.

How Do I Sleep With a Proximal Humerus Fracture?

A broken proximal humerus might make it painful to sleep and cause the arm to be immobile. There are several techniques you can use to help you recuperate and get more sleep, namely:

• Selecting a comfortable sleeping position — It is usually preferable to sleep on your non-injured side or your back. This keeps the broken arm from being compressed and prevents you from moving in a way that could impede its healing. To support your arm and prevent it from rolling onto the damaged side, position a pillow next to you or under it to keep it elevated and reduce swelling.

• Manage your pain — Adhere to the directions on any prescription or over-the-counter pain relievers. You can also reduce pain and swelling before bed by using a warm or cold compress. Using a cloth, protect your skin from direct heat or ice.

• Maintain the proper alignment of your arm throughout the night — To stop any movement, wear your brace or sling according to the instructions. Arrange pillows or wedges to keep your arm in its natural posture and lessen the chance it will move as you sleep.

If lying flat is uncomfortable, consider finding another way to sleep. Consider sleeping with your arm on an adjustable bed or recliner for increased comfort and support. While doing all these, remember to follow your doctor's and physical therapist’s recommendations on pain management, immobilization techniques, and particular sleep guidelines.

Find a Las Vegas Physical Therapist Near Me

Effectively treating a proximal humerus fracture can significantly accelerate your healing process. Healing requires understanding your injury and adhering to the recommended treatment strategy. Following your doctor's instructions and committing to a planned rehabilitation program will help you recover, whether your treatment plan calls for non-operative measures or surgery.

One of the most impactful steps you can take is to work with an experienced physical therapist. These experts specialize in creating individualized workout plans that help your shoulders regain strength, flexibility, and functionality. They assist you in regaining your range of motion and getting back to your regular activities by guiding you through exercises designed to meet your individual needs.

Our team of experienced physical therapists at Suarez Physical Therapy can help you on your road to recovery. Contact us at 702-368-6778 to schedule a consultation with our Las Vegas team to begin your customized rehabilitation plan and progress toward a complete recovery. With our help and your perseverance, you will get closer to living an ordinary, active life again.