Intended for licensed physical therapists coordinating care with Dr. Vasileff. Defer to the operative note and the surgeon’s office for patient-specific direction.
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Shoulder · Fracture

Proximal Humerus Fracture (Non-Operative)

Non-operative protocol · Dr. Chris Vasileff, MD
For the treating physical therapist. This protocol is a guideline; progression is criteria-based and individualized. Defer to the operative note and the surgeon’s office for patient-specific direction.

Non-Operative Proximal Humerus Fracture

Phase I – Early Motion Phase (0 - 5 weeks)

Week 1: Early Passive Motion

  • Wear the sling at all times except to exercise
  • Hand, wrist, elbow, and cervical AROM
  • Grip and wrist strengthening
  • PROM: supine Flexion to 90* and ER (very gentle)
  • Modalities as needed for pain relief or inflammation reduction

Week 2

  • Apply hot packs 10 minutes before exercising
  • Begin pendulum (Codman) exercises with circles in and out
  • Soft tissue mobilization
  • Supine ER with a stick to 30*
    • Support elbow on a folded towel with shoulder in 15∞ ABD
    • Scapular clocks
    • Scapular retractions (no shoulder extension)

    Week 3 – 5: (begin AAROM when pain diminishes and pt is less

    apprehensive)

    • Continue all above exercises
    • Begin gentle AAROM flexion to 140* if clinical situation is stable
      • Supine Cane flexion
      • Supine AAROM with therapist assistance or with hands clasped

      Phase II – Active Motion Phase (Weeks 6 – 12)

      Week 6 – 8: AROM

      • Establish full PROM
      • Begin AROM
        • Supine flexion to patient tolerance
        • Progress to seated (or standing) flexion with a stick
        • Seated flexion with elbow bent and arm close to the body
        • Perform ER and ABD with hands behind head
        • Sidelying ER (pain-free)
        • Serratus Punches
        • Flexion: put hand on wall or top of door
        • ER: hold onto door jam and twist
        • IR: use good arm to pull affected arm into IR

        Week 8 – 10: Early Resisted ROM

        • Begin Theraband for IR, ER, flexion, ABD, and extension
        • Begin supine IR, ER with 1# (arm supported at 15∞ ABD) (pain-free)
        • Begin UBE with no resistance
        • Prone Ext and ABD (pain-free)
        • Progress to adding weight to above exercises only if pain-free
        • Biceps / Triceps strengthening with dumbbells

        Phase III – Aggressive Stretching and Strengthening Phase (beginning week 12)

        • Isotonic strengthening with weights all directions
        • Increase TheraBand or use rubber tubing
        • Increase stretches on door and add prone stretches
        • Begin functional or sport activity for strength gain

        RETURN TO ACTIVITIES

        Computer 3-4 weeks

        Driving When no longer taking narcotics

        Elliptical 1 months

        Jogging 2 months

        Golf (Chip & Putt) 2 months

        Tennis (no overhead) 3 months

        Weight training 3-4 months

        Skiing 4 months

        Swimming 4 months

        Golf (Irons & Driver) 4-5 months

        Tennis (with overhead) 4-5 months

        Contact Sports 6 months

        Overhead Throwing 6 months

        **Heavy overhead lifting (military press), pull-down behind head, wide grip bench and dips are discouraged.

Questions about a protocol? Contact Dr. Vasileff’s office at (704) 865-0077.