After surgery for a broken upper arm near the shoulder (proximal humerus fracture), with a plate and screws or a rod down the bone (intramedullary nail), the bone typically takes 6 to 12 weeks to heal. Most people regain useful daily movement over 3 to 6 months. Full strength and the last of the range often take 6 to 12 months, and some stiffness can remain. Your surgeon’s protocol comes first. If their timings differ from the ranges here, use theirs.
The metalwork put in during upper arm fracture surgery holds the pieces of bone in line while they knit. Recovery is a balance between protecting that fixation and keeping the shoulder from stiffening. Stiffness is the most common problem after this injury, so early gentle movement, when your surgeon allows it, matters.
Key takeaways
- Bone healing: the upper arm bone typically takes 6 to 12 weeks to heal after plate or nail fixation. Full function takes longer.
- Long recovery: full strength and range often take 6 to 12 months.
- Stiffness: stiffness is the most common problem after this fracture, and early gentle movement is usually part of the plan.
- Surgeon first: your surgeon’s protocol comes first on sling time, movement limits and lifting.
- Outer arm numbness: a numb patch on the outer upper arm should be reported, as it can involve the nerve to the deltoid muscle.
Where are you right now?
- First 2 weeks: read days 1 to 3, weeks 1 to 2 and “Is this normal?”. Pain, sleep and swelling down the arm are the main issues.
- Weeks 2 to 6: gentle, often assisted, movement is building while the bone is still weak. Read weeks 2 to 6 and the “When can I” table.
- 6 to 12 weeks: the bone is usually healing and active movement opens up. Read weeks 6 to 12 and “If it isn’t going to plan”.
- 3 months on: read the month-by-month section. The focus is range, strength and returning to heavier tasks.
Week by week
- Days 1 to 3: the arm rests in a sling. Pain is managed with prescribed medication. Hand, wrist and elbow movement often starts straight away.
- Weeks 1 to 2: the wound is checked and stitches or clips are usually removed around day 10 to 14. Many surgeons allow gentle pendulum swings or movement assisted by the other arm or a PT, within set limits.
- Weeks 2 to 6: the sling is usually worn most of the time, typically for 3 to 6 weeks. Assisted movement continues and range builds slowly. Lifting and pushing up from a chair with this arm are usually not allowed.
- Weeks 6 to 8: an X-ray often checks healing. If the bone is uniting, the sling usually comes off and you start lifting the arm under its own power.
- Weeks 8 to 12: active movement and light strengthening build. Reaching to shoulder height becomes easier.
Month by month
- Month 3: most people can use the arm for light daily tasks below shoulder height. Overhead reach is often still limited. Strengthening for the rotator cuff and shoulder blade muscles usually steps up.
- Months 4 to 6: range and strength keep improving, often more slowly than in the first 3 months. Many people return to moderate lifting and lighter manual work in this window, with the surgeon’s agreement.
- Months 6 to 12: gains continue in smaller steps. Heavy manual work and sport often return here. Some loss of overhead reach or rotation is common after this fracture and may persist, especially in more complex breaks.
Is this normal?
- Night pain: yes. Night pain is common for the first 6 to 8 weeks. Many people sleep propped up or in a reclining chair, with a pillow under the forearm.
- Swelling and bruising down the arm: bruising often tracks down to the elbow and forearm in the first 2 weeks.
- Stiffness: yes, and it is expected. The shoulder has to be protected while the bone heals, and the joint stiffens in that time. Most of the range usually returns over months with a regular program.
- Clicking: painless clicking as range returns is common. A new clunk, grinding or catching with fresh pain should be checked.
- Numbness near the scar: a small numb strip next to the incision is common. A larger numb patch on the outer upper arm, or difficulty lifting the arm out to the side, is different and should be reported.
- Low mood: yes. Months of limited use, poor sleep and dependence on others wear on most people. Tell your doctor if it lasts more than a few weeks.
If it isn’t going to plan
You are 10 weeks in. You can comb your hair if you bend your head down to meet the brush, but the arm still will not lift past shoulder height on its own. You have done the exercises, but the last three weeks have looked the same. Waiting for the stiffness to wear off is a reasonable belief in week 4. By week 10 to 12, a plateau is worth a closer look.
The usual reason is a stiff joint capsule and weak rotator cuff after weeks of protection. It often needs a more targeted stretching and strengthening plan. Less often, pain rising after week 6, or weakness that is not improving, comes from the fixation, slow bone healing or a nerve problem. These are checked with an X-ray and an examination.
Stiffness is the expected cost of protecting the bone. It is also the part you can work on.
The route is a review with your surgeon or physical therapist. Ask: Is the bone healed on the latest X-ray? Is the metalwork in a good position? Which movements are limited by stiffness and which by weakness? What should my range be by my next review?
When can I…
| Activity | Typical range |
|---|---|
| Shower | Often from about 3 to 14 days, depending on the dressing. Keep the arm hanging or supported. |
| Sleep in bed | Often 3 to 8 weeks, propped up at first. |
| Drive | Often 6 to 10 weeks, once out of the sling and able to control the wheel safely. |
| Desk work | Often 2 to 6 weeks. |
| Lift | Light objects from about 6 to 8 weeks. Moderate loads from about 3 months. Heavy loads usually after 4 to 6 months. |
| Reach overhead | Often from about 3 to 4 months. Full overhead reach can take 6 to 12 months. |
| Manual work or sport | Usually 4 to 6 months, sometimes longer. |
Your surgeon’s protocol comes first.
Call your local emergency number or go to the emergency department if
- Sudden breathlessness or chest pain: especially with one calf swollen, hot or painful.
- The hand turns pale, cold or blue: or the arm becomes suddenly very swollen and tight with severe pain.
- Fever with a spreading red wound: together with shivering, confusion or feeling very unwell.
See a doctor today if
- Wound changes: redness spreading from the scar, increasing heat, discharge, a bad smell, or the wound opening.
- Fever: a temperature of 38°C (100.4°F) or above.
- Spreading numbness or weakness: numbness, tingling or weakness spreading into the forearm or hand, or a new numb patch on the outer upper arm.
- Uncontrolled pain: pain getting worse each day or not controlled by the medication you were given.
Get it checked soon if
- A clunk or new deformity: a clunk, grinding or a change in the shape of the upper arm, especially after a fall.
- Pain rising after week 6: rather than easing.
- Cannot lift the arm out to the side: at all, once you are allowed to try.
- A plateau: no gain in range for 3 to 4 weeks after the sling has come off.
More on this area: surgery recovery guides.
Protect the bone for the first 6 to 12 weeks. Keep working on range for months after that.
Written by Louise Yow, Neck & Shoulder Physio.