Shoulder conditions
Proximal humerus fractures
A break at the top of the upper arm bone, near the shoulder, common after a fall, and very often treatable without surgery.
Fracture near the shoulder
Common after a fall
Most heal in a sling
What is a proximal humerus fracture?
A proximal humerus fracture is a break of the upper arm bone just below the ball of the shoulder. It is one of the most common fractures in older adults, usually after a fall onto an outstretched arm.
Many of these fractures are stable, with the pieces still well aligned, and heal well in a sling. Others are displaced or shattered into several fragments and may need surgery to restore alignment and function.
Overview
At a glance
Reassurance
The majority of proximal humerus fractures heal without surgery. When an operation is needed, Dr. Cohn chooses the approach that gives you the most reliable, lasting function.
Symptoms & signs
Signs of a fracture
These injuries are painful and usually obvious after a fall.
Immediate, severe pain around the shoulder and upper arm
Significant swelling and deep bruising that can spread down the arm
Inability to lift or rotate the arm
A grinding sensation if the arm is moved
Tenderness directly over the top of the arm bone
Causes & risk factors
What causes them
Most result from a fall, with bone quality playing a major role.
Falls
A fall onto an outstretched hand or directly onto the shoulder is the usual cause.
Osteoporosis
Thinned bone breaks more easily, which is why these fractures rise with age.
High-energy trauma
Car accidents and sports collisions cause more severe, displaced fractures in younger patients.
Age
Risk increases steadily with age and reduced bone density.
Treatment options
How these fractures are treated
Treatment depends on how many pieces there are and how far they have moved.
- A sling to support the arm while the bone unites
- Early gentle motion to prevent stiffness
- Pain control and regular X-rays to confirm healing
- Physical therapy as the fracture consolidates
- Plates and screws to realign and hold displaced pieces
- Reverse shoulder replacement for shattered fractures in older patients
- Restores alignment and a stable, functional shoulder
- Chosen based on fracture pattern, age, and bone quality
Related procedure
Surgical care may involve fracture fixation or, for complex breaks, a reverse shoulder replacement.
Recovery
What recovery looks like
Whether treated in a sling or with surgery, recovery follows a steady path
Protect
The arm rests in a sling while early healing begins.
Gentle motion
Therapy introduces gentle range-of-motion as the bone stabilizes.
Active motion
You progress to active use as the fracture unites.
Strength
Strengthening restores function for daily activities.
FAQ
Common questions
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Most proximal humerus fractures heal well in a sling. Surgery is reserved for fractures that are badly displaced or broken into several pieces.
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Usually around three weeks, with gentle motion starting early to prevent stiffness, Dr. Cohn guides the timing based on your X-rays.
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In older patients with a severely shattered ball, a reverse replacement often restores more reliable, lasting function than trying to rebuild the fragments.
Related procedures