9 Easy shaft of humerus fracture exercises & physiotherapy management (2023)

9 Easy shaft of humerus fracture exercises & physiotherapy management (1)

In a shaft of humerus fracture case, immediately after the removal of plaster cast the most important secondary complication is elbow joint stiffness. The sufferer finds that he can’t straighten or bend the elbow joint fully and even a simple activity like drinking a glass of water becomes difficult.

If ignored, the elbow joint stiffness can become very difficult to get rid of. That is why immediately after the plaster cast is cut removed one should start exercises and physiotherapy as early as possible.

In this article, we will cover physiotherapy management for the fractured shaft of the humerus bone.We have divided this into three phases and with each phase the exercise and physiotherapy management changes. So, let us get started.

Table Of Contents

  1. What is shaft of humerus fracture
    • Spiral fracture
    • Oblique / transverse fracture
    • Comminuted fracture
  2. Management of broken arm (upper)
    • Conservative management
    • Surgical management
  3. Physiotherapy management for fracture shaft of humerus
    • Flexion extension of the wrist
    • Wrist circumduction exercise for shaft of humerus fracture
    • Stretching of wrist flexor and extensor
    • Forearm supination, pronation exercise for broken arm
    • Ball squeezing exercise using a gel ball
    • Shoulder forward elevation
    • 6 week after the plaster is removal
    • Stretching of elbow flexor muscle
    • Progressive strengthening exercises for broken arm
  4. Final word

What is shaft of humerus fracture

When we have fractured our bone of the arm, it is actually the fracture of the humerus bone. This fracture is commonly seen in adults but in rare cases, it may also happen to children. The shaft of humerus fracture can be of three types. In one of our posts “” we have seen that our arm can get fracture at three different sites. First, on the head/ neck of the humerus; second, the shaft of the humerus and third is epicondyles of the humerus.

But to better understand the concept of fracture we first need to understand its related anatomy.

9 Easy shaft of humerus fracture exercises & physiotherapy management (2)

Our arm consists of a single long bone called the humerus bone. The upper end is known as the head, the lower end is epicondyles and the longer and middle part is known as the shaft.

It is cylindrical in shape with slightly flat on the proximal (upper) part and conical on the distal (lower) part. The bulky muscles, such as the biceps, triceps and deltoid surrounds the shaft of the humerus. It has a rich blood supply and this is why any fracture on the shaft readily heals.

The most common site of fracture is at the junction of proximal 1/3rd and distal 2/3rd. The fracture can happen due to a direct injury or assault on the arm. It can also happen due to sudden and opposite movement of the arm against the violent contraction of the muscle.

Depending on the pattern of fracture, it can be categorised into three types.

  1. Spiral fracture.
  2. Oblique fracture.
  3. Comminuted fracture.

Spiral fracture

Oblique / transverse fracture

The fracture makes a transverse pattern as shown in the figure. This fracture occurs as a result of the strong angular force exerted on the middle area of the shaft.

9 Easy shaft of humerus fracture exercises & physiotherapy management (4)

Comminuted fracture

9 Easy shaft of humerus fracture exercises & physiotherapy management (5)

When there is direct injury or assault on the arm, the bone may break into multiple pieces. The fracture becomes fragmented.

(Video) How to Rehab a Humeral Fracture

Management of broken arm (upper)

Management depends upon whether the fracture is stable or unstable. The stable fracture can be managed conservatively but the un-stable fracture needs surgical intervention.

Conservative management

The displaced fracture where fracture segments get displaced from each other is first re-aligned by the surgeon. All the process is carried out under the effect of anaesthesia.

After the fracture reduction, the immobilization of the arm is done for 6 to 8 weeks using one of the following ways.

  • U slab
  • Hanging cast.
  • Chest arm bandage.

Surgical management

If the fracture is unstable or if it is associated with multiple other bone fractures, then surgery is considered. Following are the surgical process for such fractures.

  • Intra medullary nailing.
  • Screw and plate.

After the operation, the arm immobilization is done using the sling support (or shoulder spica) for 6 weeks.

Physiotherapy management for fracture shaft of humerus

In both conservative and surgical management the immobilization is done for certain weeks. It is during the immobilisation period, most of the complication develops. The most common complication include elbow joint stiffness. However, the stiffness is not restricted to the elbow, in most cases I have found that it also affects the wrist and shoulder joint.

To reduce the complications, one should start physiotherapy as soon as the plaster cast is removed and the initial acuteness subsides. All the exercises we are going to cover is aimed at strengthening the muscle of the arm, forearm and regain the range of motion of the elbow, wrist, shoulder joint.

Flexion extension of the wrist

9 Easy shaft of humerus fracture exercises & physiotherapy management (6)

Let’s start with the elbow joint which is the most affected joint. In a normal elbow, joint four movements occur, i.e flexion, extension and pronation, supination. First, we would aim at restoring elbow flexion and extension motion.

For this sit comfortably in front of a table and place your arm of the affected side on the table. Keep the arms flat on the table to make a good base of support to perform elbow exercise. In this starting position straighten the elbow as much as it could, this is termed as an extension of the elbow.

After extending it to maximum slowly bend the elbow, i.e flex it to the maximum point. Repeat this alternate flexion-extension a minimum of 15 to 20 times in a session.

Wrist circumduction exercise for shaft of humerus fracture

9 Easy shaft of humerus fracture exercises & physiotherapy management (7)

For this exercise, our starting position would be similar to the previous exercise. In this resting position try to rotate your wrist joint. Rotate it in both clockwise and anticlockwise directions.

Rotate it clockwise 15 to 20 times and then anticlockwise 15 to 20 times, however, you can perform this exercise as many times as you could.

Stretching of wrist flexor and extensor

9 Easy shaft of humerus fracture exercises & physiotherapy management (8)

This is a stretching exercise for the wrist and our starting position would remain the same. Here we have to use our opposite hand and slightly put pressure at the end range of wrist flexion and extension. For example, to stretch the flexors, slightly extend the wrist and use the other hand to give pressure over the palm. Press and hold this position for a minimum of 30 seconds duration.

Now repeat the same process by extending the wrist to stretch the flexor group of muscles.

(Video) Fracture Shaft Of Humerus | Notes | Physiotutors

Forearm supination, pronation exercise for broken arm

9 Easy shaft of humerus fracture exercises & physiotherapy management (9)

In the list of exercises for the shaft of humerus fracture, forearm pronation and supination is another important elbow joint motion to take care of. For this exercise our starting position would be quite different, this time stabilize the forearm by keeping it flat on the table as in the figure.

Now in this position rotate your forearm clockwise and anticlockwise, clockwise rotation is called supination and anticlockwise is termed forearm pronation.

You can do this exercise freely without holding anything, but as you progress with the exercise I recommend you to hold a cane or a lightweight rod and then move the forearm in both directions. The momentum created by the cane will help make exercise more effective.

Also Read: Supracondylar Fracture of Humerus: Physiotherapy management

Ball squeezing exercise using a gel ball

Due to the long-term immobilization, it is natural that the grip strength would be affected and it becomes weak. Grip weakness is clearly visible when we try to hold a glass of water. So strengthening the grip is also very important and it is also important to carry on with other coming exercises.

For this you can use a silicone gel ball, you simply need to hold the gel ball and squeeze it as many times as you can. A very simple yet effective exercise to gain grip strength which can be done as many times as possible.

Shoulder forward elevation

9 Easy shaft of humerus fracture exercises & physiotherapy management (11)

Often shoulder joint stiffness is ignored in such conditions. Shoulder stiffness can become problematic if not taken care of.

We have to start shoulder exercises along with other exercises. I have already covered in detail the various other types of shoulder stiffness exercises which you can read by visiting this link.

So, this shoulder elevation exercise is a very simple, basic exercise. For this, simply grasp your hand and elevate it to the maximum point where you can take it to. Elevate it and then lower it down and then repeat the same process 15 to 20 times in a single session. Twice daily is recommended.

6 week after the plaster is removal

After the removal of plaster (or another sling) the most important complaint is a pain in the shoulder and elbow. The person has difficulty keeping the elbow straight includingthe shoulder joint restriction.

For elbow joint restriction, do the following exercises:

Stretching of elbow flexor muscle

9 Easy shaft of humerus fracture exercises & physiotherapy management (12)

Once again a very important stretching exercise for managing the shaft of humerus fracture. This is a stretching exercise for elbow flexors and extensors groups of muscles. Flexor muscles are present on the front of the elbow and their action brings flexon movement to the elbow joint. Extensor muscle brings extension/ straightening of the elbow joint and is present on the back of the elbow.

Let us start with stretching of elbow flexors, for this first straighten your elbow to the maximum. In this extended elbow position, put slight overpressure with the opposite hand till you feel a comfortable stretch on the front of the elbow. Hold this stretched position for a minimum of 30 sec.

Repeat the same process to stretch the elbow extensors, but this time by bending the elbow. Do it 3 to 5 times in a single session.

(Video) Humerus Fracture Physiotherapy, Humerus Fracture Exercises

Progressive strengthening exercises for broken arm

9 Easy shaft of humerus fracture exercises & physiotherapy management (13)

For this exercise, we need 1.5 to 2 kg of dumbbells. This exercise is recommended only if you have gained sufficient grip strength to hold the dumbbell firmly.

Stand straight and hold the dumbbell with the affected side hand. Hold it and allow the weight of the dumbbell to exert stretching on the elbow joint.Hold it for 1 minute to 5 minutes as per your convenient. As you become comfortable, you can increase the weight of dumbbells up to 5 kg,

Final word

Sometimes this fracture gets associates with radial nerve injury resulting inwrist drop. In some rare cases, there may be mal-union, delayed / non-union.

This is a special situation that needsa different treatment approach altogether and it is beyond the scope of this post. In my practice, I have found elbow restriction is the most common complaint after the removal of plaster. So, proper exercises are very crucial.

Keep Reading: Supracondylar Fracture of Humerus: Physiotherapy management

Author Profile

Sunit. S. Ekka

Dr Sunit Sanjay Ekka is a physiotherapist in practice for the last 15 years. He has done his BPT from one of the premium Central Government physiotherapy colleges, ie, SVNIRTAR. The patient is his best teacher and whatever he gets to learn he loves to share it on his Youtube channel and blog.

(Video) What to expect after humerus fractures.

FAQs

What exercises can I do with a fractured humerus? ›

With your thumb facing up and outwards, try to move your arm in a big arc out to the side. With your elbow by your side, rotate your forearm outwards, keeping your elbow at about 90 degrees in flexion. Repeat all of these 3 exercises 10 times each, 4-5 times a day.

When do you start physiotherapy after humerus fracture? ›

PROXIMAL HUMERUS FRACTURE - ORIF

Appointments • Begin physical therapy at 1 week post op, 2 x/week • Follow up with MD 10-14 days post op. .

How do you manage a midshaft humeral fracture? ›

Most humeral shaft fractures do not require surgery. If you don't require surgery you will be fitted with a humeral brace (a moulded plastic brace) and a sling. This helps to stabilise your broken bone and allows you to move your elbow gently to avoid that getting stiff while your fracture heals.

Which exercise would strengthen the humerus? ›

Exercises that improve humerus function and strength include isometric sub-maximal exercises, dumbbell extensions/flexion, resistance band rows, and cable pull downs.

Do you need physio after a broken humerus? ›

Following a proximal humerus fracture, physical therapy will be crucial to restore proper function of your shoulder and arm. If surgery is required, physical therapy will typically begin 1 to 4 weeks following the surgery, depending on the specific surgical intervention required.

What is the best management for a fractured arm? ›

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  • Stop any bleeding. Apply pressure to the wound with a sterile bandage, a clean cloth or a clean piece of clothing.
  • Immobilize the injured area. Don't try to realign the bone or push a bone that's sticking out back in. ...
  • Apply ice packs to limit swelling and help relieve pain. ...
  • Treat for shock.

How many days of rest is required after a fracture? ›

After bone fracture repair

Your doctor will tell you the expected recovery time for healing your fracture. According to the Cleveland Clinic, this process will typically take six to eight weeks. However, this time frame can vary based on the fracture type and location.

Is physiotherapy good for fracture? ›

Physiotherapy is an effective treatment for fractures and dislocations. Fracture are a result of excessive force applied to a bone resulting in complete or incomplete breaks. Dislocations are product of a one bone being dislodged from another from its usual position causing a separation.

How long is physical therapy for a broken humerus? ›

General Treatment

The broken bone will take 3 to 4 months to heal. During this time, you will need to perform exercises to regain range of motion, strength, and return to normal activities. Even if surgery is performed, recovery of full function often takes as long as 18 months.

What type of management should be performed for patients who encountered midshaft fracture of humerus? ›

The two approaches most commonly used for fracture exposure and plate application are the posterior approach and the anterolateral approach. Either is adequate for fractures in the midthird and distal third, but fractures in the proximal third often require the anterolateral approach.

What is the best pain relief for fractured humerus? ›

Ibuprofen (Addaprin, Advil, Caldolor, Dyspel, Motrin IB, NeoProfen, Provil) Usually DOC for treatment of mild to moderately severe pain, if no contraindications.

How do you reduce swelling from a humerus fracture? ›

Cold packs. Putting an ice pack on the injured area may help reduce swelling and pain. Pain medicines. Taking prescription or over-the-counter pain medicines may help reduce pain and swelling.

Which exercises strengthen bones? ›

Weight-bearing and resistance exercises are the best for your bones. Weight-bearing exercises force you to work against gravity. They include walking, hiking, jogging, climbing stairs, playing tennis, and dancing. Resistance exercises – such as lifting weights – can also strengthen bones.

What exercise is example of bone strengthening? ›

Include activities that make their hearts beat faster, build muscles (like climbing or doing push-ups), and strengthen bones (like running or jumping).

How do you strengthen a broken humerus bone? ›

Begin normal light activities with the arm and shoulder. Increase your movement using the Stage 3 exercises.
...
Try to relax your injured arm and let it hang down.
  1. Swing your arm slowly and gently forwards and backwards.
  2. Swing your arm slowly and gently side to side.
  3. Swing your arm slowly and gently in circles clockwise.

How long is physical therapy for a broken arm? ›

Most healing takes place in the first 6 to 12 weeks. Healing may take longer after surgery. After the immobilization period, you may begin full range-of-motion exercises. Physical therapy can last for weeks or months.

How long should you wear a sling with a broken humerus? ›

For a fractured clavicle, a sling may be worn for four to six weeks. For a fractured proximal humerus, a sling may be needed for up to two weeks. For a fractured scapula, doctors usually recommend wearing a sling until you can move the shoulder without significant pain—anywhere from two to four weeks.

How do you heal your humerus? ›

Humerus fractures are usually caused by traumas like car accidents or falls. If you break your humerus, you might need surgery to repair your bone. Some people can recover without surgery and only need a splint, cast or sling. You'll need physical therapy to regain your ability to move your arm.

What are 3 most important treatments in a fracture? ›

Treatment of bone fractures

Depending on where the fracture is and how severe, treatment may include: splints – to stop movement of the broken limb. braces – to support the bone. plaster cast – to provide support and immobilise the bone.

What are the three principles of fracture management? ›

Principles of Fracture Management - Reduce - Hold - Rehabilitate - TeachMeSurgery.

What is the general management for fractures? ›

The initial management of fractures consists of realignment of the broken limb segment (if grossly deformed) and then immobilizing the fractured extremity in a splint. The distal neurologic and vascular status must be clinically assessed and documented before and after realignment and splinting.

What are the 5 stages of fracture healing? ›

There are 5 phases to bone healing: haematoma, inflammation, proliferation, callus formation, and remodelling.

What is the best food for bone fracture? ›

Here's a list of foods that can help heal broken bones faster:
  • 1- Dairy. Milk, yogurt, and cheese are a good source of vitamin D and calcium, two key nutrients that your body requires for bone strength and growth. ...
  • 2- Soy Milk. ...
  • 3- Pumpkin Seeds. ...
  • 4- Bell Peppers. ...
  • 5- Black Beans. ...
  • 6- Meat. ...
  • 7- Sardines. ...
  • 8- Fatty Fish.
14 Sept 2022

Can a fracture heal in 20 days? ›

How Long Does a Fracture Take to Heal? Most fractures heal in 6-8 weeks, but this varies tremendously from bone to bone and in each person based on many of the factors discussed above. Hand and wrist fractures often heal in 4-6 weeks whereas a tibia fracture may take 20 weeks or more.

What improves fracture healing? ›

In particular, calcium, vitamin D and protein will be important during the bone healing process, so be sure you're focusing on food sources rich in these nutrients, including dark, leafy greens, broccoli, fish, meat, yogurt, nuts and seeds.

Is warm water good for fracture? ›

Applying heat would increase circulation to the injury site, and bring about the inflammatory properties that aim to heal the tissues. Moreover, heat can reduce muscle stiffness, and encourage movement. Is heat good for the healing of a broken bone? The answer is yes in the later stages of healing.

Is weight bearing good for bone healing? ›

Weight-bearing is essential for bone healing in patients with autoimmune disease, fractures, and following orthopedic surgery. Low-intensity weight-bearing exercise has shown to be beneficial in bone healing over non-weight bearing exercises.

How long after humerus surgery can you lift and move arm? ›

After 4-6 weeks you may stop wearing the sling and will be allowed to move the shoulder actively through a greater range. You may resume driving when you have regained control of the arm. This may take anywhere between 8-16 weeks. Strengthening exercises are started after 12 weeks or once the fracture has healed.

How do you sleep with a humerus shaft fracture? ›

Lay flat. Though it may be uncomfortable, try sleeping, as much as possible, in a seated/upright position. Lying flat may allow the bone to move and bend, even in a cast.

What is the fastest way to heal a broken humerus? ›

Nonoperative treatment is usually with a sling or shoulder immobilizer with no shoulder mobility for the first two weeks. Thereafter, the patient will be given weekly exercises to slowly increase the shoulder's range of motion.

Can you fully recover from a humerus fracture? ›

Fracture of the shaft of the humerus is a serious injury that normally occurs as the result of a significant accident. The bone has a good reputation for healing often without surgery.

Is swelling good for bone healing? ›

Bone injury elicits an inflammatory response that is beneficial to healing when acute and highly regulated; however, if this response is suppressed, dysregulated, or becomes chronic, inflammation can be detrimental to healing [56–58].

Is swelling good for healing? ›

While most people become alarmed when the body shows signs of swelling, it's important to remember that this is a natural part of the healing process. When swelling occurs, it's just the body requesting reinforcements to speed up the healing process.

Is swelling good for fracture? ›

You get a healthy swelling around the break as a blood clot starts to form. Your immune system sends in cells that act like trash collectors -- they get rid of small bone pieces and kill any germs. Also, you grow blood vessels into the area to help the healing process. This step may last a week or two.

What are 5 bone strengthening activities? ›

Examples of bone-strengthening activities suitable for young people include:
  • dance.
  • aerobics.
  • weight-training.
  • water-based activities.
  • running.
  • sports such as gymnastics, football, netball, hockey, badminton and tennis.
  • skipping with a rope.
  • martial arts.

What are 3 things you can do to strengthen your bones? ›

Activities like walking, running, jumping, and climbing are especially good for building bone. They are called weight-bearing activities because they use the force of our muscles and gravity to put pressure on our bones. The pressure makes the body build up stronger bone.

What exercises strengthen muscles? ›

A strength exercise is any activity that makes your muscles work harder than usual. This increases your muscles' strength, size, power and endurance. The activities involve using your body weight or working against a resistance. You should try to do 2 sessions or more of muscle strengthening exercises a week.

What are the 3 components of muscle and bone strengthening activity? ›

Intensity, or how much weight or force is used relative to how much a person is able to lift; Frequency, or how often a person does muscle strengthening activity; and. Repetitions, or how many times a person lifts a weight (analogous to duration for aerobic activity).

What are the basic bone strengthening exercise that you can do at home? ›

For example, weight-bearing exercises can build healthy bone. These exercises involve challenging your muscle strength against gravity and putting pressure on your bones.
...
These exercises are easy to do at home.
  • Foot stomps. ...
  • Bicep curls. ...
  • Shoulder lifts. ...
  • Hamstring curls. ...
  • Hip leg lifts. ...
  • Squats. ...
  • Ball sit. ...
  • Standing on one leg.

When should I start therapy after humerus fracture? ›

Following a proximal humerus fracture, physical therapy will be crucial to restore proper function of your shoulder and arm. If surgery is required, physical therapy will typically begin 1 to 4 weeks following the surgery, depending on the specific surgical intervention required.

How long does it take to rehab a broken humerus? ›

The broken bone will take 3 to 4 months to heal. During this time, you will need to perform exercises to regain range of motion, strength, and return to normal activities. Even if surgery is performed, recovery of full function often takes as long as 18 months.

How long does it take for a broken humerus to stop hurting? ›

Most fractures heal without any problems in six to twelve weeks. However, it may take six to twelve months for your symptoms to settle completely – these can include pain or discomfort, stiffness, decreased strength, swelling and loss of muscle bulk.

How do you regain strength after humerus fracture? ›

If the fracture to the humerus is severe, it will require a surgical procedure that repairs the bone with plates, screws or a metal rod. Once the healing process begins, you will meet with a physiotherapist who will help restore the function of your arm and strengthen the muscles.

How do you stabilize a broken humerus? ›

Humerus shaft fractures should be stabilized using a coaptation splint. Wrap splinting material snugly from axilla to nape of neck, creating a stirrup around the elbow. Fracture reduction is usually not necessary because reduction is difficult to maintain.

How do you know if a fracture isnt healing? ›

Symptoms of a fracture that is not healing normally include tenderness, swelling, and an aching pain that may be felt deep within the affected bone. Often, the bone isn't strong enough to bear weight, and you may not be able to use the affected body part until the bone heals.

Can a broken humerus heal without surgery? ›

Humerus fractures are usually caused by traumas like car accidents or falls. If you break your humerus, you might need surgery to repair your bone. Some people can recover without surgery and only need a splint, cast or sling. You'll need physical therapy to regain your ability to move your arm.

Is a broken humerus serious? ›

Most humerus fractures eventually heal without causing any long-term health problems. For the smoothest recovery process, see your doctor as soon as you notice symptoms of a fracture.

Why does my broken humerus hurt more at night? ›

During the night, there is a drop in the stress hormone cortisol which has an anti-inflammatory response. There is less inflammation, less healing, so the damage to bone due to the above conditions accelerates in the night, with pain as the side-effect.

How do you promote bone healing after a fracture? ›

In particular, calcium, vitamin D and protein will be important during the bone healing process, so be sure you're focusing on food sources rich in these nutrients, including dark, leafy greens, broccoli, fish, meat, yogurt, nuts and seeds.

What happens to the strength of bone after a fracture is fully healed? ›

Once your broken bone heals fully, it should be just as strong as the rest of your bones, so you won't be more or less likely to break it than another bone.

Whats the fastest a bone can heal? ›

Healing can range from 6 weeks or even less for certain lower arm and wrist fractures to 6 months for more challenging leg breaks. Children's bones generally heal faster than adults' bones.

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