Proximal humerus (upper arm bone) greater tuberosity fracture 

Information for patients who will need to have a follow up appointment

What is this information about?

This information is about proximal humerus (upper arm bone) greater tuberosity fracture. 

It tells you:   

• how to look after yourself when you go home from hospital with a proximal humerus fracture  
• what exercises you can do to help heal and strengthen your arm
• what follow-up treatment you might have   
• who to contact if you need further help and support.

What is a proximal humerus greater tuberosity fracture?

This is a break to the top of your upper arm bone. The ‘greater tuberosity’ area of the upper arm bone is where it is joined to the large tendons of your shoulder muscles. A tendon is like a tough ‘rope’ of body tissue that joins muscles and bones together. Together, the group of large muscles in your shoulder are called your ‘rotator cuff’ muscles.  

Do I have a fracture or a break?

If you have a fracture, it means you have a broken bone. ‘Fractured bone’ and ‘broken bone’ both mean the same.  

How long is it likely to take for my injury heal?   

It usually takes 6 to 12 weeks for a proximal humerus greater tuberosity fracture to heal. Shoulder injuries do not always heal so well that your shoulder feels as it did before your injury. It is usual to have stiffness that can last for a long time after a shoulder injury.   

Will smoking or vaping slow down my healing?

Yes. Smoking slows healing so if you smoke or vape try to stop or cut down. This is most important in the first 2 weeks after your injury. If you would like help to stop smoking talk to your GP or visit  Quit smoking – NHS (www.nhs.uk)   for further information.   

What should I do if I am in pain after my humerus greater tuberosity fracture?

If you are in pain, take your usual pain killers or pain killers given to you in A&E. Follow the dose instructions on the packet. If you are struggling with pain do speak to your GP or pharmacist.   

Why was I fitted with a shoulder sling?

You will have a special arm sling fitted to your arm after you have had a humerus greater tuberosity fracture. The sling shoulder poly sling allows your shoulder to rest and keeps it in the best position to help it to heal. Make sure that you do not place pillows below your elbow to prop up the arm

Was the sling that I was fitted with in A&E the best type for my fracture?

The best type of sling for you to wear after your proximal humerus greater tuberosity fracture is a ‘shoulder poly sling’ (shown below). Wearing this type of sling should mean that you are as comfortable as you can be and that your injury heals as well as possible. Do contact the Virtual Fracture Clinic if you were, or think you may have been, fitted with a different type of sling. We will arrange a new appointment to fit you a ‘shoulder poly sling.

Why was I fitted with a shoulder poly sling?

A shoulder poly sling allows your shoulder to rest and keeps it in the best position to help it to heal. Make sure that you do not place pillows below your elbow to prop up the arm

When should I be wearing my arm sling?

Use your sling for 4 weeks. You can take it off to wash, dress and do your exercises. You must wear your sling at night for the first 3 weeks.   

What should I do if I am struggling with my sling?

Do contact the Virtual Fracture Clinic. We can give you advice or arrange for your sling to be adjusted or changed if needed.   

When should I start exercising?

It is important to start gentle exercises straight away to prevent shoulder stiffness. Do the exercises which are shown later in this information.   

Will I have further (follow up) appointments?

Yes. You will need to have a follow up appointment 1 week after your injury. The specialist will examine your shoulder and may do another X-ray to check the position of your fracture. The specialist will also explain you the next stage of your rehabilitation. You will be sent an appointment time and date by post.  

What should I do from week one to week three after my injury?

• Remember to use your arm sling for the first 4 weeks, including for 3 weeks in bed at night. Take it off to wash, dress and do your exercises. You may find it more comfortable to sleep propped up on pillows.  
• Do not lift your elbow above shoulder height for the first 3 weeks. You should not do any heavy lifting for the first 6 weeks. 
• Rest your arm for the first 24 to 72 hours (1 to 3 days). However, it is important to keep moving around.  
• Move your fingers, wrist and elbow whilst wearing your arm sling, so they do not get stiff.  Do this gently, without causing too much pain.   
• Apply cold packs (ice pack or frozen peas wrapped in a damp towel) to the sore area for up to 15 minutes, every few hours. Cold pack applications can provide short-term pain relief.
• Take your arm out of the sling to wash, dress and do your exercises which are shown below.    

• Aim to do all the exercises 5 times a day. These exercises should not cause too much pain.  Do fewer if they are making your pain worse.  

Hand, wrist and elbow exercises  

Finger and wrist bending and straightening: open and close your hand as shown 10 times. Then move your wrist up and down 10 times.   

After around 3 to 5 days progress to holding a soft ball or ball of socks. Squeeze the ball as hard as possible without pain. Hold for 5 seconds and repeat 10 times.    

Elbow Bending to Straighten: bend and straighten your elbow as far as you can without pain. You should not feel more than a mild to moderate stretch. You can use your other arm to help if you need to. Repeat 10 times if there is no increase in pain.   

Forearm Rotations: keep your elbow at your side and bent to 90 degrees. Slowly turn your palm up (supination) and down (pronation). You should not feel more than a mild to moderate stretch. You can use your other arm to help if necessary.  Repeat 10 times if there is no increase in pain.   

Bring your shoulders back and gently squeeze your shoulder blades together. Hold for 30 seconds. Repeat 5 times.   

Shoulder pendulum (swing) exercises

Stand next to a firm surface. Support yourself with your un-injured arm and lean forwards. Let your injured arm relax and hang down to the ground.   

Gently swing your arm, making a small movement. Try to do this forward and backward, side to side and in small circles. Keep your arm relaxed as you swing it.  

You can aim to do this for 1 minute, several times in the day. However,  it is also ok to do it for less time and let the arm hang without any movement if it is too painful. Stay within your comfort level.

Aim to do this for 1 to 2 minutes in total.   

This exercise can cause some discomfort when you first start to do it. This will usually ease off after you have repeated the exercise a few times.  

You need to swing your arm gently so is does not cause you too much discomfort.  Remember keep your arm relaxed.   

What should I do from week four to week six after my injury?   

• By this time, you will have an appointment with a shoulder specialist.
• Continue using arm sling. Take your arm out of the sling to wash, dress and do your exercises which are shown below.   
• Do not lift your elbow above shoulder height for the first 5 weeks. Remember, you should not do any heavy lifting for 6 weeks. 
• Start these exercises 3 weeks after your injury. Aim to do them 5 times a day. Repeat each exercise 10 times. These exercises should not cause too much pain.  Do fewer if they are making your pain worse.

Exercises   

Supported arm elevation

Use your other hand to lift your injured arm up in front of you, as shown in these pictures. 

Supported arm rotation  
With your elbow touching the side of your body, bend your injured arm as shown below. Hold onto a stick, umbrella, or something similar. Then move your injured forearm outwards aways from your body. As you do this, keep your elbow bent and tucked into your side.   

Use your good arm to gently push the hand of your injured arm outwards. Remember to keep your elbow tucked in. If you do not have a stick, hold your injured arm at the wrist and guide it outwards with your good hand.   

What should I do from week six after my injury?

Exercises:  

Arm elevation  
Lift your arm forwards in front of you. Try to raise the arm as high as you can. This exercise can cause some discomfort. You do not need to raise your arm so high or for so long that it causes to much pain. If this is too difficult, try the same movement with a bent elbow.   

Raising your arm out to the side  
With your palm facing forwards, move your arm out to the side in a big arc. Try to raise your arm as high as you can. If this is too difficult, try the same movement with a bent elbow. You do not need to raise your arm so high or for so long that it causes too much pain. 

Arm rotation  
Start with your elbow bent by your side. Move your forearm out to the side, keeping your elbow bent and near your waist.

What other things can the Virtual Fracture Clinic help me with?

Please contact the Virtual Fracture Clinic if you:   

• are concerned about your symptoms   
• are unable to follow this rehabilitation plan or notice pain other than at your shoulder  
• struggling with your collar and cuff sling  
• are struggling to return to exercise or your usual activities   
• would like further information or support after you have read this information.

When can I start driving?

You can return to driving when:   

• you are no longer using your arm sling    
• you can turn the steering wheel as much as you need to without it is hurting   
• you can safely deal with all emergency situations without being in pain or hesitating. For example, you must be able to stop the car quickly and in full control and safely avoid obstacles   
• you are covered by your insurance company.

How can I get a certificate to say that I am fit to work?

You can get a fitness for work statement from the Virtual Fracture Clinic.