Proximal Humerus Fracture ORIF Physical Therapy Protocol

Rehabilitation after open reduction internal fixation of a proximal humerus fracture must protect bone healing while gradually restoring motion and shoulder function.

Fracture pattern, fixation stability, bone quality, tuberosity involvement, and follow-up X-rays strongly influence the pace of rehabilitation.

Phase 1: Fracture Protection — 0 to 6 Weeks

• Sling protection as instructed
• Hand, wrist, and elbow motion
• Pendulum exercises
• Passive shoulder motion when permitted
• No lifting
• No pushing or pulling
• Avoid sudden shoulder movement

The primary goal is fracture protection while preventing unnecessary stiffness.

Phase 2: Motion Recovery — 6 to 12 Weeks

• Progress assisted range of motion
• Begin active motion when healing allows
• Continue X-ray monitoring
• Begin gentle scapular strengthening
• Avoid heavy resistance until fracture healing is sufficient

Progression depends on radiographic healing and the stability of the fixation.

Phase 3: Strength Recovery — 3 to 6 Months

• Progressive strengthening
• Rotator cuff and deltoid strengthening
• Functional reaching progression
• Gradual lifting progression
• Return to daily activity

The goal after proximal humerus fracture fixation is bone healing in good alignment with restoration of useful shoulder motion and function.