PHYSICAL THERAPY PROTOCOL
Proximal Humerus ORIF
Physical Therapy Protocol
Rehabilitation following open reduction and internal fixation (ORIF) of a proximal humerus fracture focuses on protecting fracture healing while progressively restoring shoulder motion, strength, and functional independence.
Protect Fracture
Restore Motion
Strengthening
Fracture Union & Function
Important Note
This protocol is intended as a general guideline. Fracture pattern, bone quality, fixation stability, associated rotator cuff injury, tuberosity repair, and fracture healing may require modification. The surgeon's postoperative instructions always take precedence.
Rehabilitation Philosophy
Unlike elective shoulder surgery, rehabilitation after fracture fixation must balance restoration of motion with protection of fracture healing. Therapy progresses according to both radiographic healing and clinical recovery. Aggressive strengthening should not begin until the fracture demonstrates sufficient healing.
Phase I: Fracture Protection
Timeframe: 0–6 Weeks
Goals
- Protect fracture fixation
- Control pain and swelling
- Maintain elbow, wrist, and hand motion
- Begin gentle shoulder motion as permitted
- Prevent stiffness
Sling
- Sling for comfort and fracture protection
- Remove for hygiene and therapy
- Sleep in sling as instructed
- No lifting with the operative arm
- No supporting body weight
Exercises
- Pendulum exercises
- Passive shoulder motion as directed
- Active-assisted shoulder motion when appropriate
- Elbow, wrist, and hand motion
- Grip strengthening
- Scapular retraction exercises
Avoid
- Heavy lifting
- Forceful stretching
- Aggressive strengthening
- Supporting body weight through the arm
- Sudden shoulder movements
Phase II: Motion Recovery
Timeframe: 6–12 Weeks
Goals
- Restore passive motion
- Progress active motion
- Normalize scapular mechanics
- Improve functional use
Exercises
- Cane exercises
- Table slides
- Wall walks
- Pulleys
- Scapular stabilization
- Gentle stretching
Phase III: Strengthening
Timeframe: Begins After Fracture Healing (Typically 12+ Weeks)
Goals
- Restore strength
- Improve endurance
- Normalize shoulder mechanics
- Return to unrestricted daily activities
Exercises
- Theraband strengthening
- Progressive dumbbell strengthening
- Rotator cuff strengthening
- Deltoid strengthening
- Scapular strengthening
- Functional strengthening
Return To Activity Guidelines
Desk Work
Usually within 2–4 weeks depending on comfort.
Driving
After sling discontinuation and when safe control of the vehicle has returned.
Daily Activities
Gradually increase as fracture healing progresses.
Weight Training
Only after radiographic healing and surgeon clearance.
Golf
Usually around 4–6 months depending on fracture healing and strength.
Sports
Return once fracture union, strength, and motion have been restored.
Therapist Notes
- Protect fracture fixation during the first 6 weeks.
- Advance therapy according to radiographic healing.
- Avoid aggressive strengthening before fracture union.
- Restore motion gradually while respecting pain.
- Focus on scapular mechanics and functional shoulder use.
- Notify the office if increasing pain, hardware concerns, or loss of reduction is suspected.
Red Flags
Contact The Office For
- Increasing pain after initial improvement
- Increasing deformity
- Redness or drainage
- Loss of shoulder motion
- Sudden loss of function
Seek Urgent Care For
- Chest pain
- Shortness of breath
- Calf pain or swelling
- Severe uncontrolled pain
Related Resources
Questions About Proximal Humerus Fracture Rehabilitation?
Successful rehabilitation following fracture fixation requires patience. Protecting the healing bone while progressively restoring shoulder function provides the best opportunity for a durable recovery.
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