Most breaks at the top of the upper arm bone (proximal humerus fracture) are treated without surgery, especially when the pieces have not moved much. A sling is usually worn for about 2 to 4 weeks, with gentle movement often starting within the first 1 to 3 weeks. The bone typically joins in 6 to 12 weeks. Recovering movement and strength takes longer, often 6 to 12 months, and some stiffness can remain.
This break is common in older adults after a fall onto an outstretched arm or the side of the shoulder, often because the bone has thinned (osteoporosis). This page assumes it has been X-rayed and you have a plan from the emergency department or your doctor.
Key takeaways
- Most are treated without surgery: especially when the pieces are close to their normal position.
- Bone healing: typically 6 to 12 weeks; full recovery of movement and strength often takes 6 to 12 months.
- Stiffness is the main risk: early, gentle movement as your doctor allows helps limit it.
- Common in older adults: often after a fall, and often linked to thinning bones.
- Bone health matters: this fracture is often a reason to check bone density and the risk of further falls.
Where are you right now?
- Just broken: start with the week-by-week section and “Is this normal?”.
- Weeks in and stiff: go to “If it isn’t going to plan”.
- After surgery: after a plate, a rod or a shoulder replacement, your surgeon’s protocol comes first.
- Getting back to daily life: the “When can I…” table gives typical ranges, and “Protecting your bones” covers the next step.
Week by week, then month by month
- Weeks 0 to 2: pain is often worst at night. Wear the sling, keep the elbow, wrist and hand moving, and many people start gentle pendulum swings (letting the arm hang and sway) when the doctor allows.
- Weeks 2 to 6: the sling is used less. Movement builds with the other hand helping the injured arm, often lying down at first.
- Weeks 6 to 12: once healing shows on X-ray, you start lifting the arm on its own and light strengthening begins.
- Months 3 to 6: reaching overhead and behind the back keep improving. Many people manage most daily tasks.
- Months 6 to 12: gains continue more slowly. Some people keep a small loss of overhead reach that does not stop daily life.
Protecting your bones
A break from a fall at standing height or less is often called a fragility fracture. It can be the first sign of osteoporosis, and it raises the chance of another fracture, including the hip or spine.
- Bone density: ask your doctor whether a bone density scan (DEXA) is right for you.
- Treatment: ask whether bone-strengthening medicine, calcium or vitamin D is needed. Your doctor decides this.
- Falls: ask about a falls check, including balance, eyesight, medicines that cause dizziness and hazards at home.
- Movement: regular walking and balance and strength exercise, once your doctor allows, support bone and balance.
The bone usually heals in weeks. The movement comes back over months, and gentle early motion is what protects it.
Where else this could be coming from
- Rotator cuff tear: can happen in the same fall. Weakness lifting the arm that is out of step with the healing bone.
- Nerve injury (axillary nerve): a numb patch on the outer upper arm and weakness lifting the arm sideways.
- Frozen shoulder (adhesive capsulitis): stiffness in every direction that keeps worsening after the fracture has joined.
- Dislocation with the fracture: the ball sits out of its socket on X-ray. Usually picked up at the time.
- The neck: pain that changes with neck movement, or tingling running down the arm.
Is this normal?
- “The bruising has gone all the way to my elbow and chest.” Very common. Large bruises often track down the arm and onto the chest within the first 1 to 2 weeks.
- “My hand and fingers are swollen.” Common while the arm hangs in a sling. Moving the fingers often and raising the hand on a pillow helps.
- “I cannot sleep lying down.” Many people sleep propped up or in a recliner for the first 2 to 6 weeks.
- “The exercises hurt.” A mild ache during and shortly after is common. Pain that is clearly worse the next day means the load was too much.
If it isn’t going to plan
It is week eight. Combing your hair means bending your head down to meet the brush, and the cardigan only goes on if someone helps with the first sleeve. The thought in your head is that the bone is still healing, so it is safer not to move it much.
The bone does need protection early on, but the shoulder joint lining (capsule) shrinks and stiffens when it is not moved. In older adults that stiffness sets in quickly and can be slow to reverse. Pain relief, gentle movement within the limits your doctor sets, and steady progress over weeks are what keep reach returning.
If you are 6 to 8 weeks in and the arm is not moving more each week, get assessed by a physical therapist or your doctor. Ask:
- Healing: has the bone joined enough for me to move more freely?
- Movement: which exercises should I do daily, and how should they progress?
- Pain relief: is my pain relief enough to let me do the exercises?
- Bones: should I have a bone density check?
When can I…
| Activity | Typical range |
|---|---|
| Sleep on that side | Often 2 to 3 months after a proximal humerus fracture |
| Drive | Often 6 to 10 weeks, once out of the sling and able to steer and brake safely |
| Reach overhead | Often 3 to 6 months, sometimes with a small lasting limit |
| Lift | Light items close to the body from about 6 to 8 weeks; heavier lifting often 3 to 6 months |
| Desk work | Often within 2 to 4 weeks, with the arm supported |
| Manual work or sport | Often 4 to 6 months, sometimes longer |
If you have had surgery, your surgeon’s protocol comes first.
Call your local emergency number or go to the emergency department if
- Circulation: the hand turns cold, pale or blue, or the arm swells tight and painful.
- Another fall: a new fall with severe pain, a change in shape, or a blow to the head.
- Breathing or chest: sudden breathlessness, chest pain, or a swollen, painful calf, which can signal a blood clot after an injury.
See a doctor today if
- Numbness: new numbness on the outer upper arm, or tingling or weakness in the hand.
- Uncontrolled pain: severe pain not controlled by your advised medicine.
- After surgery: redness, discharge or fever around the wound.
- Confusion: new confusion or drowsiness, especially in an older person taking strong pain medicine.
Get it checked soon if
- Not moving more: movement is not improving week to week after 6 to 8 weeks.
- Pain rising: pain is getting worse rather than easing after the first month.
- Bone health: no one has yet discussed a bone density check or a falls review.
More on this area: shoulder conditions.
A broken upper arm usually heals well, and steady, gentle movement is what brings the shoulder back with it.
Written by Louise Yow, Neck & Shoulder Physio.