Proximal Humerus Fracture Treatment
A proximal humerus fracture is a break at the top of the arm bone, at the ball of the shoulder joint. It is among the most common fractures in adults over sixty five, it usually follows a fall from standing height, and it is one of the clearer examples in orthopedics of an injury where most patients do well without surgery despite an X ray that looks alarming.
Roughly eighty percent of these fractures are minimally displaced and heal well without surgery, which makes identifying the exceptions the entire clinical question. Steven Struhl, MD is board certified in orthopedic surgery and separately in sports medicine, has practiced in New York since 1991, and operates at NYU Langone Orthopedic Hospital.
How the Fracture Is Described
The top of the humerus is described in four parts, and how many have separated, and how far, is what determines treatment.
- The Humeral Head: the ball articulating against the socket of the shoulder blade.
- The Greater Tuberosity: the outer prominence where most of the rotator cuff attaches.
- The Lesser Tuberosity: the smaller inner prominence where the subscapularis tendon attaches.
- The Humeral Shaft: the arm bone below the level of the surgical neck.
A fracture in which the parts remain close to where they belong behaves very differently from one in which several have displaced, and that is the distinction the four part description exists to capture.
Symptoms
- Severe Immediate Pain: pain at the shoulder making any movement of the arm difficult.
- Extensive Bruising: discoloration spreading down the arm and across the chest over days.
- Swelling: significant swelling around the shoulder in the first days after injury.
- Inability To Lift: difficulty raising the arm at all, from pain and mechanical disruption.
Treatment
- Sling Immobilization: several weeks of support for the majority of minimally displaced fractures.
- Early Motion: gentle pendulum exercises begun sooner than patients expect, to limit stiffness.
- Progressive Therapy: motion restored first, then strengthening once healing is established.
- Surgical Fixation: plates, screws, or pins for displaced fractures with good bone quality.
- Shoulder Replacement: partial or reverse replacement for severely comminuted fractures.
Early motion matters more here than in most fractures. A shoulder immobilized too long after this injury stiffens badly, and stiffness is a more common cause of a poor long term outcome than the fracture itself, which is why therapy begins earlier than a patient might expect.
A Specific Risk Worth Knowing
Fractures involving the anatomic neck can disrupt circulation to the humeral head and lead to osteonecrosis, where the bone dies and the surface eventually collapses. That risk is part of why displaced fractures are followed closely with imaging rather than simply released once the bone has united.
Schedule an Upper Arm Fracture Evaluation in New York City
Most proximal humerus fractures heal without surgery, and the outcome depends far more on the therapy that follows than on the X ray that started it. Dr. Struhl evaluates these fractures and manages the recovery at his Manhattan and White Plains offices. Contact the practice to schedule an appointment.
