Proximal Humerus Fracture Info
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Proximal humerus fractures — Neer classification, sling management, and surgical options.
What you're feeling
You will likely feel pain in your shoulder after a break in the upper arm bone. This injury often happens because of weak bones, known as osteoporosis. The pain can be sharp at first and may stay with you for a long time. Many people find that the pain gets worse at night or when they try to sleep on the injured side. Waking up with a stiff shoulder is also common.
Simple daily tasks can become very difficult. You might struggle to reach your arm behind your back to fasten a bra. Tucking in a shirt or lifting a cup of coffee may hurt. Even moving your arm slightly can trigger a flare-up of pain. For most one-part fractures, the bone heals well without surgery. However, you may still face functional disability and feel a drop in your overall health during recovery.
Your surgeon will look at your age and gender to decide the best path. Most older adults receive non-surgical treatment because it works well for them. If you are under 65, surgery does not always offer a clear benefit over rest. While most children heal without problems, older adults face a higher risk of serious issues. You should expect that some activities will remain hard for a while, but many people recover well with the right care plan.
What's actually happening
Your shoulder is a ball-and-socket joint wrapped in a strong sleeve called the joint capsule. When you break the top part of your upper arm bone, this delicate balance is lost. Think of the bone fragments as puzzle pieces that have shifted out of place. Even a small tilt of just 15 degrees can change how the joint moves and feels. This shift puts extra pressure on the smooth cartilage that acts like a shock absorber between the bones.
The muscles around your shoulder are like ropes that pull the arm up and out. After a fracture, these ropes can pull the broken pieces into a bad position. If the lower part of the bone moves down, your shoulder will not work well. This is why your surgeon works hard to keep these pieces aligned. Without proper alignment, the joint mechanics change, leading to pain and limited movement.
In many cases, especially for older adults, the body can heal the break without surgery. Over 90% of these fractures heal successfully with rest and a sling. However, if the break is complex or the bone is too weak, surgery might be needed. In these cases, a joint replacement might be used to restore function. This involves swapping the damaged bone end for a smooth metal and plastic surface. The goal is to get your shoulder moving freely again so you can return to your daily life.
What we can do about it
Most one-part fractures heal well without surgery. You will likely start with a period of rest and gentle movement guided by a physiotherapist. Short and long periods of immobilization yield similar results, so your team will help you find a comfortable balance. The goal is to manage pain while keeping your shoulder moving to prevent stiffness. For children, the bone has tremendous potential for remodeling, making non-operative management the treatment of choice for most fractures.
Your surgeon may recommend pain medication and anti-inflammatories to help you sleep and move. While the evidence does not specify drug types or injection durations for this specific injury, your team will discuss options like cortisone or other injections if needed to reduce swelling. These treatments aim to control symptoms while your body repairs the bone. Most patients find that non-surgical management leads to successful outcomes and union rates greater than 90%.
Surgery is considered when conservative care reaches its limit or if the fracture is complex. Your surgeon may discuss a reverse total shoulder replacement if you are an older adult with a severe three- or four-part fracture. This option aims for a better long-term functional outcome when the bone cannot be easily reconstructed. The decision depends on your age, the specific fracture pattern, and your overall health goals.
When to see someone
See your GP if you have persistent pain that does not improve with rest, or if you feel weakness and instability in your shoulder. Ask for a specialist review if your arm locks or gives way, or if symptoms stop you from sleeping or working. Sudden worsening of pain is also a sign to seek help. While most one-part fractures heal well without surgery, complications can happen at the time of injury, during treatment, or later. Older adults face a higher risk of serious health events after this injury. If you are over 65, your surgeon will discuss risks carefully before any operation.
