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Recovery time for a proximal humerus fracture

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I'm a 37 years old woman. 1 week ago I had surgery(nailing) for a proximal humerus fracture. The physio told me to do some ROM starting from the day after surgery, that I am doing at the moment. My arm is very stiff and I can't move it or lift it is very frustrating and I am scared I will never regain all full range of arm long is the recovery period after this kind of surgery?when should I start doing some proper physio?
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First Helper User Profile Gaelic

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replied January 20th, 2012
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It usually takes about 6 to 8 weeks for a proximal humerus fracture to unite. But, this is only the take for bony union, it does not take into account the time that will be needed for full recovery.

At first, with a proximal humerus fracture, the main emphasis in on regaining passive motion of the glenohumeral (shoulder) joint. Don't be too eager to start active motion in terms of forward elevation and abduction (out to the side). It is much more important to just get that passive swinging type motion, back and forth, and around in circumduction (circles). This will actually increase your motion a lot faster than the use of your muscles to lift the arm up against gravity.

You can ask your physical therapist about the Codman's exercises or also called pendulum exercises. Or you can look them up on the internet. There are a lot of short videos on how to do them on the internet.

Once you are getting the passive range of motion, and it is becoming a lot easier to move the joint, then there are other range of motion exercises that can be started to increase the arc of motion. Passive range of motion can be started now, since you have had the fracture surgically stabilized.

One of the reasons for stabilizing a fracture, is so that the patient can start therapy a lot sooner.

What you are doing now is considered "proper therapy". It is very important to get that motion going, because without motion, you can't do anything else.

Once your motion is adequate, and the fracture has healed enough to withstand the stresses of strengthening, you will start working on getting your muscle bulk and strength back.

You should also be doing exercises every day for finger, wrist, and elbow motion. You cannot forget these joints either, as they will become stiff and weak. Also, by doing exercises with these joints, it will help to return the venous blood to the body and help reduce any swelling and edema in the upper extremity.

Every patient and fracture is unique, and as such, each therapy program is tailored to that individual. Some surgeons and physical therapy departments, have protocols for post-op and post-injury rehab programs, so patients can see what they are supposed to be doing each day and what goals they should be striving for.

Ask you physical therapist if your surgeon has a post-op protocol for IM nailing of the humerus. That way you can have sort of a guide to do your daily exercises. If there is not a written protocol, ask the physical therapist to at least write down each week's exercises for you.

As with anything, you more you put into it, the more you will get out of it. You will have to work diligently in therapy to regain your function. Most patients can usually get back to doing activities of daily living and light physical activity by about 12 to 15 weeks. Some patients take less time, some longer. Again, everyone is different. And, it may be a year before you know to final outcome. It should not take you that long to get back to most of your activities, but it might take that long before you have completely and fully recovered.

If you have concerns about how you are doing ask your therapist or surgeon. Your surgeon knows what your fracture looked like and how well the fixation is holding the fracture fragments. He/she will be able to tell you how much stress you can apply to the fixation construct.

Good luck.
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replied August 15th, 2012
Thank you Gaelic,

I'm 14 an had surgery 4 weeks ago for a proximal humerus fracture. I'm very concerned about one issue though.

I have radial nerve palsy along with my fracture with 5 screws and a plate installed. Does the radial nerve palsy have an extended recovery time?
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replied August 16th, 2012
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Sorry about your injury.

Unfortunately, radial nerve palsies can take a long time to resolve, but, in other cases, they clear up in a few of weeks.

It all depends upon how significantly the nerve was injured. You state that you had the palsy with the fracture, then you had the fracture ORIFed (open reduction and internal fixation).

Usually, during the procedure, the surgeons will look at the radial nerve. Because, at the time of the injury, the nerve can be stretched (the most common injury) or it can be cut by the sharp edges of the broken bone. If it had been cut, the surgeons would sew it back together and would have told you and your parents about it. So, it is most likely a stretch.

The radial nerve is very susceptible to injury in humerus fracture, because it is so close to the bone. It occurs more commonly in distal humerus fractures (at the junction of the middle and distal thirds), where the nerve is actually in contact with the bone. It is not that common in the proximal humeral fractures, but as you can see, it does happen.

So, again, how long it takes for the nerve to recover depends upon how badly it was injured. If you have started to see some improvement already, then you may have a short recovery period. But, there is not really any way of knowing, until you start to see some recovery.

If you do not have any changes within 3 months, then electrical studies can be done at that time, to see how the nerve is doing. Some surgeons will do these at 6 weeks, but the results of the study may not show too much at that time.

The different types of injuries to the nerve are called neuropraxia, axonotmesis, and neurotmesis. In neuropraxia the nerve is slightly injured and will recover within six months. But, by definition, it is allowed up to a year to recover and still be called neuropraxia. In axonotmesis, the nerve is injured more significantly, but still has the potential to recover. But, the recovery takes more than one year. In neurotmesis, the nerve is permanently injured and will never recover. Luckily, this does not occur very often.

So, again, how long it is going to take to recover is hard to tell. You surgeon is the best person to ask, as he/she has probably actually seen the nerve and may be able to tell how significantly it was injured. You will just have to let nature take its course, and time will tell. It is hard, but, unfortunately, that is how nerve injuries go.

In the mean time, you should probably be in a radial palsy splint, which will help make the hand more functional, so that you can actually use the hand. Since it is the radial nerve, the sensory changes should be limited to the dorsal aspect (the back) of the hand. So, that should not bother you too much.

But, if you do not do range of motion exercises for the fingers and wrist every day, you can develop very stiff fingers. If that happens, then when the nerve wakes up, you will not be able to use the hand. It is just like a mechanical joint, if it rusts shut, no matter how much you pull on the cords through the pulleys, it won’t move. So, you have to keep those joints supple and mobile.

Hope that your nerve wakes up quickly. But, hang in there and do your exercises. Ask your surgeon what he/she thinks about the recovery of your nerve. Sorry that I cannot be more optimistic, but nerve injuries can be very finicky, and take a while.

Good luck.
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replied August 21st, 2012
Thank you very much.

This was so helpful!
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replied November 24th, 2012
hi NA3349 , just wondering if you recovered yet and if so, what are the first symptoms of recovery? i have radial nerve palsy for 2.5 months now and still no signs of recovery. in fact, i notice my brachioradialis muscle (the first muscle that will recover) is not responding. it is shrinking i believe due to non-use. i also have a plate and screws in my humerus. tapping behind my humerus causes electric like sensation on my thumb and index fingers so i hope that's a good sign- that my radial nerve is intact...
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replied September 23rd, 2013
I also had radial palsy after surgery where I had part of the humerus replaced with a cadaver bone. My surgeon not only had me in a splint but also a hand splint that held my fingers up at the first joint from the palm. I had physical therapy which was hard, as I couldn't move my fingers much. It had taken about 9-10 months to get movement back in my fingers and be able to bend my wrist up and down. He did have have the nerve test done to see if my nerve was coming back on it's own or not. I was so glad that it came back and I didn't need another surgery to fix it.
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