Humerus Fracture (Thrower's Fracture)

with Rehab

A humerus fracture is a break (fracture) of the bone of the upper arm (humerus). Humerus fractures may be complete or incomplete. This document does not discuss humerus fractures that involve the elbow or shoulder joints.

SYMPTOMS

  • Severe pain in the arm, at the time of injury.

  • Tenderness and swelling over the fracture site.

  • Bruising (contusion) of the arm within 48 hours of injury.

  • Later, swelling and bruising in the elbow and hand.

  • Visible deformity, if the bone fragments are out of alignment (displaced).

  • Numbness, coldness, or paralysis below the fracture, from pressure on or stretching of blood vessels or nerves (uncommon).

CAUSES

  • Direct hit (trauma) to the upper arm.

  • Indirect trauma (i.e. falling on an outstretched hand or violent muscle contraction).

  • Possibly, throwing hard enough to produce twisting force.

RISK INCREASES WITH:

  • Contact sports (i.e. football, rugby).

  • Sports requiring violent arm muscle contraction (i.e. wrestling).

  • Sports requiring arm twisting (i.e. throwing sports).

  • Children younger than 12 years of age, adults older than 60.

  • History of bone or joint disease (i.e. osteoporosis, bone tumor).

  • Previous restraint of the arm.

  • Poor arm and shoulder strength and flexibility.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Wear properly fitted and padded protective equipment, when appropriate.

PROGNOSIS

If treated properly, humerus fractures often heal within 6 to 8 weeks in adults and 4 to 6 weeks in children.

RELATED COMPLICATIONS

  • Fracture fails to heal (nonunion).

  • Fracture heals in a poor position (malunion).

  • Chronic pain, stiffness, loss of motion, or swelling of the shoulder or elbow.

  • Excessive bleeding in the arm, causing pressure and injury to nerves and blood vessels (uncommon).

  • Calcium deposits in the soft tissues (heterotopic ossification).

  • Injury to the nerves of the hand or wrist due to stretching from the fracture, causing numbness, weakness, or paralysis.

  • Shortening of the arm.

TREATMENT

Treatment first involves the use of ice and medicine, to reduce pain and inflammation. If the bone fragments are out of alignment (displaced), immediate realigning of the bone (reduction) by a medically trained person is required. Fractures that cannot be realigned by hand, or are open (bones poke through the skin) may require surgery to hold the fracture in place with screws, pins, and plates. Once the bones are properly aligned, restraint of the upper arm, elbow, and shoulder is required for at least 6 weeks, to allow for healing. After restraint, it is important to perform strengthening and stretching exercises to help regain strength and a full range of motion. These exercises may be completed at home or with a therapist.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given if your caregiver thinks they are needed. Use only as directed and only as much as you need.

COLD THERAPY

Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Pain, tenderness, or swelling gets worse, despite treatment.

  • You experience pain, numbness, or coldness in the hand.

  • Blue, gray, or dark color appears in the fingernails.

  • Any of the following occur after surgery: fever, increased pain, swelling, redness, drainage of fluids, or bleeding in the affected area.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Humerus Fracture (Thrower's Fracture)

These exercises may help you restore your elbow motion, once your physician has discontinued your restraint period. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ROM - Pendulum

  • Bend at the waist so that your right / left arm falls away from your body. Support yourself with your opposite hand on a solid surface, such as a table or a countertop.

  • Your right / left arm should be perpendicular to the ground. If it is not perpendicular, you need to lean over farther. Relax the muscles in your right / left arm and shoulder as much as possible.

  • Gently sway your hips and trunk so they move your right / left arm, without use of your right / left shoulder muscles.

  • Progress your movements, so that your right / left arm moves side to side, then forward and backward, and finally, both clockwise and counterclockwise.

  • Complete __________ repetitions in each direction. Many people use this exercise to relieve discomfort in their shoulder, as well as to gain range of motion.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION – Extension

  • Hold your right / left arm at your side and straighten your elbow as far as you can using your right / left arm muscles.

  • Straighten the right / left elbow farther, by gently pushing down on your forearm until you feel a gentle stretch on the inside of your elbow. Hold this position for __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION – Flexion

  • Hold your right / left arm at your side and bend your elbow as far as you can using your right / left arm muscles.

  • Bend the right / left elbow farther, by gently pushing up on your forearm until you feel a gentle stretch on the outside of your elbow. Hold this position for __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH – Flexion, Seated

  • Sit in a firm chair, so that your right / left forearm can rest on a table or countertop. Your right / left elbow should rest below the height of your shoulder, so that your shoulder feels supported and not tense or uncomfortable.

  • Keeping your right / left shoulder relaxed, lean forward at your waist, allowing your right / left hand to slide forward. Bend forward until you feel a moderate stretch in your shoulder, but before you feel an increase in your pain.

  • Hold for __________ seconds. Slowly return to your starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH – Flexion, Standing

  • Stand with good posture. With an underhand grip on your right / left hand, and an overhand grip on the opposite hand, grasp a broomstick or cane so that your hands are a little more than shoulder width apart.

  • Keeping your right / left elbow straight and shoulder muscles relaxed, push the stick with your opposite hand to raise your right / left arm in front of your body and then overhead. Raise your arm until you feel a stretch in your right / left shoulder, but before you have increased shoulder pain.

  • Try to avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine. Hold for __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH – Abduction, Supine

  • Lie on your back. With an underhand grip on your right / left hand, and an overhand grip on the opposite hand, grasp a broomstick or cane so that your hands are a little more than shoulder width apart.

  • Keeping your right / left elbow straight and shoulder muscles relaxed, push the stick with your opposite hand to raise your right / left arm out to the side of your body and then overhead. Raise your arm until you feel a stretch in your right / left shoulder, but before you have increased shoulder pain.

  • Try to avoid shrugging your right / left shoulder as your arm rises by keeping your shoulder blade tucked down and toward your mid-back spine. Hold for __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ROM – Flexion, Active-Assisted

  • Lie on your back. You may bend your knees for comfort.

  • Grasp a broomstick or cane so your hands are about shoulder width apart. Your right / left hand should grip the end of the stick, so that your hand is positioned "thumbs-up," as if you were about to shake hands.

  • Using your healthy arm to lead, raise your right / left arm overhead until you feel a gentle stretch in your shoulder. Hold for __________ seconds.

  • Use the stick to assist in returning your right / left arm to its starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH – Flexion, Standing

  • Stand facing a wall. Walk your right / left fingers up the wall, until you feel a moderate stretch in your shoulder. As your hand gets higher, you may need to step closer to the wall or use a door frame to walk through.

  • Try to avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine.

  • Hold for __________ seconds. Use your other hand, if needed, to ease out of the stretch and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH – External Rotation

  • Tuck a folded towel or small ball under your right / left upper arm. Grasp a broomstick or cane with an underhand grasp, a little more than shoulder width apart. Bend your elbows to 90 degrees.

  • Stand with good posture or sit in a firm chair without arms.

  • Use your healthy arm to push the stick across your body. Do not allow the towel or ball to fall. This will rotate your right / left arm away from your abdomen. Using the stick, turn or rotate your hand and forearm away from your body. Hold for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES - Humerus Fracture (Thrower's Fracture)

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does get worse, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

STRENGTH - Shoulder Abductors, Isometric

  • With good posture, stand or sit about 4-6 inches from a wall, with your right / left side facing the wall.

  • Bend your right / left elbow. Gently press your right / left elbow into the wall. Increase the pressure gradually, until you are pressing as hard as you can without shrugging your shoulder or increasing any shoulder discomfort.

  • Hold for __________ seconds.

  • Release the tension slowly. Relax your shoulder muscles completely before you begin the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Shoulder Flexion, Isometric

  • With good posture, stand or sit about 4-6 inches from a wall, with your right / left side facing the wall.

  • Keeping your right / left elbow straight, gently press the top of your fist into the wall. Increase the pressure gradually, until you are pressing as hard as you can without shrugging your shoulder or increasing any shoulder discomfort.

  • Hold for __________ seconds.

  • Release the tension slowly. Relax your shoulder muscles completely before you begin the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Internal Rotators, Isometric

  • Keep your right / left elbow at your side and bend it 90 degrees.

  • Step into a door frame so that the inside of your right / left wrist can press against the door frame, without your upper arm leaving your side.

  • Gently press your right / left wrist into the door frame, as if you were trying to draw the palm of your hand to your abdomen. Gradually increase the tension, until you are pressing as hard as you can without shrugging your shoulder or increasing any shoulder discomfort.

  • Hold for __________ seconds.

  • Release the tension slowly. Relax your shoulder muscles completely before you begin the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - External Rotators, Isometric

  • Keep your right / left elbow at your side and bend it 90 degrees.

  • Step into a door frame so that the outside of your right / left wrist can press against the door frame without your upper arm leaving your side.

  • Gently press your right / left wrist into the door frame, as if you were trying to swing the back of your hand away from your abdomen. Gradually increase the tension, until you are pressing as hard as you can without shrugging your shoulder or increasing any shoulder discomfort.

  • Hold for __________ seconds.

  • Release the tension slowly. Relax your shoulder muscles completely before you begin the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Shoulder Flexion

  • Stand or sit with good posture. Grasp a __________ weight, or an exercise band or tubing, so that your right / left hand is "thumbs-up," like you are shaking hands.

  • Slowly lift your right / left arm as far as you can, without increasing any shoulder pain. At first, many people can only raise their hand to shoulder height.

  • Avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine.

  • Hold for__________ seconds. Control your hand as you slowly return to your starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Shoulder Abduction

  • Stand or sit with good posture. Grasp a __________ weight, or an exercise band or tubing, so that your hand is "thumbs-up," like you are shaking hands.

  • Slowly lift your right / left arm out to the side, to shoulder height or as far as you can, without increasing any shoulder pain. You must have specific instruction from your caregiver in order to raise your hand above shoulder height.

  • Avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine.

  • Hold for __________ seconds. Control your hand as you slowly return to your starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - External Rotators

  • Secure a rubber exercise band or tubing to a fixed object (table, pole) so that it is at the same height as your right / left elbow when you are standing or sitting on a firm surface.

  • Stand or sit so that the secured exercise band is on your healthy side.

  • Bend your right / left elbow 90 degrees. Place a folded towel or small pillow under your right / left arm, so that your elbow is a few inches away from your side.

  • Keeping the tension on the exercise band, pull it away from your body, as if pivoting on your elbow. Be sure to keep your body steady, so that the movement is only coming from your rotating shoulder.

  • Hold for __________ seconds. Release the tension in a controlled manner as you return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Internal Rotators

  • Secure a rubber exercise band or tubing to a fixed object (table, pole) so that it is at the same height as your right / left elbow when you are standing or sitting on a firm surface.

  • Stand or sit so that the secured exercise band is on your right / left side.

  • Bend your right / left elbow 90 degrees. Place a folded towel or small pillow under your right / left arm so that your elbow is a few inches away from your side.

  • Keeping the tension on the exercise band, pull it across your body toward your abdomen. Be sure to keep your body steady, so that the movement is only coming from your rotating shoulder.

  • Hold for __________ seconds. Release the tension in a controlled manner as you return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.