Therapy starts with gentle range-of-motion exercises and progresses as pain improves and bones continue to heal. Physical therapy proximal humerus fractures usually begins at three weeks from injury when follow up x-rays demonstrate good maintenance of bone alignment. Cutting down or quitting smoking and tight blood sugar control if you are a diabetic is important for the healing process. If non-operative care is chosen, regular follow-up care for a physical exam and x-rays are important to ensure that the fracture stays in good position and heals appropriately. Patients often feel most comfortable sleeping in a recliner or in a bed propped up on several pillows. These devices are used for support and comfort only. Science has shown that there is no difference in use of a sling or shoulder immobilizer. Minor fractures with minimal displacement do very well with nonsurgical treatment. Many proximal humerus fractures do not require surgery and heal just fine without an operation. If the proximal humerus is broken into many pieces, surgery may be required to realign the bone fragments. This usually involves some form of physical therapy. Most proximal humerus fractures can be treated without surgery if the bone fragments have not shifted out of place. This is important when deciding if a fracture needs surgery or not and if surgery is planned, what type of surgery is needed. If the bone is broken in many pieces or into the joint a CT (computed tomography) scan is often ordered to help the doctors see the injury better. Often three or more x-rays are taken in the standing position to show the injury pattern. This helps doctors and patients make an informed decision on treatment. X-rays are used to evaluate the location, type, and severity of the broken bone. Sometimes the bone pushes against the skin causing it to “tent.” Too much pressure can result in the bone coming through the skin. Physical examination and imaging tests are used to diagnose proximal humerus fractures. Accurate and prompt diagnosis of this type of fracture is critical because important blood vessels and nerves run next to this bone and can be injured when it breaks. The doctor will also look for any open wounds over the injury. How is a Proximal Humerus Fracture Diagnosed? Shoulder arthritis occurs when the cartilage and joint surface of the ball and socket joint becomes irregular. Your rotator cuff muscles are attached to this bone. It lets you move your shoulder in circles and allows your muscles to be under the correct tension to maintain strength. The proximal humerus is the ball of the shoulder joint. It often results from a fall in an elderly patient or a motorcycle or motor vehicle accident in younger patients. This can occur in patients of all ages from a variety of traumatic causes. The bone usually fractures just below the ball of the shoulder joint. John Zebrack, MD General Orthopedic SurgeryĪ proximal humerus fracture also referred to as a broken humerus, is a break of the shoulder at the top of the upper arm bone. Jeffrey Webster, MD General Orthopedic Surgery Nichole Joslyn, MD Hand & Upper Extremity Thomas Christensen, MD Hand & Upper Extremity James Christensen, MD Hand & Upper Extremity Nikola Babovic, MD Hand & Upper Extremity
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