HUMERUS FRACTURE

Humerus Fracture

A humerus fracture refers to a break in the bone of the upper arm (humerus), which runs from the shoulder to the elbow.
It can occur at three main levels

Proximal humerus (near the shoulder)

Shaft of humerus (mid-arm)

Distal humerus (near the elbow)

Causes

Direct trauma: Fall on the arm, blow, or accident

Indirect trauma: Fall on an outstretched hand

Pathological fracture: Due to weakened bone (e.g., osteoporosis, tumor)

Types (Based on Site)
Proximal Humerus Fracture

Common in elderly (osteoporotic bone)

May involve surgical neck or greater tuberosity

Complication: Shoulder stiffness, axillary nerve injury

Shaft (Mid-shaft) Fracture

Caused by direct trauma

Complication: Radial nerve injury → wrist drop

Distal Humerus Fracture

Common in children and young adults

Often intra-articular (involving elbow joint)

Complication: Stiffness of elbow, malunion

Clinical Features

Severe pain and swelling

Deformity and bruising

Tenderness and crepitus (grating sensation)

Inability to move arm

Shortening of arm (in displaced fracture)

Check nerve injury:

Radial nerve — wrist/finger drop

Axillary nerve — loss of sensation over deltoid

Investigations

X-ray: AP and lateral views of humerus and shoulder/elbow joint

CT scan: For complex or intra-articular fractures

Neurovascular assessment: Always necessary

Medical / Surgical Management

Non-operative:

Immobilization with U-slab, hanging cast, or functional brace (for un displaced fracture)

Sling support

Surgical:

ORIF (Open Reduction and Internal Fixation) with plate/screws or intramedullary nail

Shoulder or elbow replacement (for severe comminution in elderly)

Physiotherapy Management
Immobilization Phase

Goals: Pain relief, maintain circulation, prevent stiffness
Treatment:

Ice therapy for swelling

Active movements of fingers, wrist, and hand

Shoulder and scapular pendulum exercises (if allowed)

Isometric exercises for deltoid, biceps, triceps

Elevation of arm to reduce swelling

Post-immobilization / Post-operative Phase

Goals: Restore mobility and strength
Treatment:

Moist heat before exercises

Passive → Active-assisted → Active ROM of shoulder and elbow

Gentle joint mobilization (when fracture united)

Stretching of tight muscles

Strengthening of deltoid, biceps, triceps, and rotator cuff muscles

Functional training (reaching, dressing, grooming activities)

Functional Phase

Goals: Return to normal daily and occupational activities
Treatment:

Progressive resistive exercises with Thera bands or light weights

Proprioceptive training

Full range functional tasks (lifting, pushing, pulling)

Complications

Nerve injury (esp. radial nerve)

Malunion or nonunion

Stiffness of shoulder or elbow

Myositis ossificans (bone formation in muscle)

Complex regional pain syndrome (CRPS)

Patient Advice

Keep the arm supported in a sling

Do not lift or push objects during healing

Continue hand and finger movements

Follow up regularly for X-ray and physiotherapy

Written by : Dayana Onkarappa Senior Physiotherapist at Advanced Physiotherapy Clinic and Homecare
https://physioji.com/