Surgery for a broken upper arm near the shoulder (proximal humerus fracture) usually means a metal plate and screws on the outside of the bone, or a rod (intramedullary nail) down its center, to hold the pieces in line while they heal. Sometimes, when the ball of the shoulder is badly broken, a shoulder replacement is chosen instead. The bone typically takes 6 to 12 weeks to heal, and full function often takes 6 to 12 months. The time between injury and surgery is often days, so plan quickly.
Many people with this fracture are older, live alone or care for someone else. Getting help lined up before surgery makes the biggest difference to the first weeks of recovery. Your surgeon’s protocol comes first. If their instructions differ from anything here, use theirs.
Key takeaways
- What it does: a plate and screws, or a rod down the bone, hold the broken upper arm in line while it heals.
- Healing time: the bone typically takes 6 to 12 weeks to heal. Full function often takes 6 to 12 months.
- Sling time: most people wear a sling for about 3 to 6 weeks and cannot drive for about 6 to 10 weeks.
- Help at home: arranging help with washing, dressing, meals and shopping before surgery matters most, especially if you live alone.
- Surgeon first: your surgeon’s protocol comes first on sling time, movement and lifting.
What the operation does
The upper arm bone (humerus) ends at the shoulder in a rounded head that sits in the socket. Breaks just below that head are common after a fall onto an outstretched arm or onto the side of the shoulder. Many of these breaks heal well in a sling without surgery. Surgery is usually considered when the pieces have moved far apart, when the break involves the joint surface, or when the shoulder would not work well if left as it is.
- Plate and screws: a cut down the front or side of the shoulder lets the surgeon line up the pieces and hold them with a plate shaped to the top of the bone.
- Intramedullary nail: a rod is passed down the center of the bone through a smaller cut at the top of the shoulder and locked with screws.
- Shoulder replacement: for some complex breaks, especially in older bone, the surgeon may replace the joint instead. Recovery after a replacement follows a different protocol.
What to set up at home
- Help: arrange someone to stay with you, or visit daily, for at least the first 1 to 2 weeks. Washing your hair, putting on socks and cooking are hard with one arm.
- Clothing: loose front-opening tops a size or two larger than usual, so the sleeve slides over the operated arm first. Elastic-waist pants, slip-on shoes and front-fastening bras.
- Sleeping position: most people sleep propped up for several weeks. Set up a reclining chair, or a wedge of pillows in bed, with a pillow to rest the forearm on.
- Kitchen and bathroom: move daily items to between waist and chest height. Ready-made meals, a half-filled kettle and pump bottles make one-handed life easier. A shower chair helps if balance is a concern.
- Falls: clear loose rugs and cables, and add a night light. A second fall with one arm in a sling is a real risk.
- Driving: arrange rides for about 6 to 10 weeks, including to follow-up appointments and physical therapy.
What to practice before surgery
- Getting dressed: operated arm into the sleeve first, out last. Practice with the arm hanging relaxed by your side.
- One-handed tasks: eating, brushing teeth and using your phone with the other hand.
- Getting up from a chair or bed: push up with the uninjured arm. Try it now so it is automatic later.
- Hand, wrist and elbow movement: gently, while the arm stays supported, if your surgeon allows it. This limits swelling.
The help you arrange before surgery decides how the first two weeks go.
Questions to ask your surgeon
- Will you use a plate, a nail, or a shoulder replacement, and why for my break?
- How long will I wear the sling, and can I take it off to wash and dress?
- Which movements can I start straight away, and which must wait?
- When will physical therapy start, and how often?
- When is my first X-ray, and what are you looking for?
- When can I drive, and when can I lift a kettle or a grocery bag?
- Is my bone strength a concern, and should it be checked after this fracture?
- Which of my usual medicines should I stop or continue before surgery?
The first 48 hours
Many people stay in the hospital for 1 to 3 nights. You will wake with the arm in a sling and a dressing over the shoulder. A nerve block, if used, can leave the arm numb and heavy for several hours, sometimes into the next day. Start your pain medication before it wears off, and take it on schedule at first.
Bruising often spreads down the arm toward the elbow over the first few days. Keep the fingers, wrist and elbow moving gently if allowed.
Call your surgeon or emergency number if
- Sudden breathlessness or chest pain: call your local emergency number.
- The hand turns pale, cold or blue: or the arm becomes very swollen and tight. Call your local emergency number.
- One calf swollen, hot or painful: call your surgeon’s team or a doctor the same day.
- Fever or wound changes: 38°C (100.4°F) or above, spreading redness, discharge or a bad smell from the wound.
- Numbness that stays or spreads: numbness or weakness in the arm or hand that lasts well beyond the nerve block or is spreading.
- A new fall: any fall onto the operated arm. Call your surgeon’s team the same day.
More on this area: surgery recovery guides.
Line up the help first. The bone will do its part over the next 6 to 12 weeks.
Written by Louise Yow, Neck & Shoulder Physio.