Shoulder hemiarthroplasty or ORIF for 2 & 3 part proximal humeral fractures
Considerations for Physiotherapy

In severe fractures of the proximal humerus the tuberosities and the head of the humerus are separated. The tuberosities are reattached during fixation or secured to the prosthesis. For this reason mobilisation of the shoulder is delayed for three weeks to allow bony union to occur.

Op notes should be checked to determine a safe range of rotation which is dependent on the stability of the tuberosities.

Day 1 post-op

Polysling and body belt

Elbow, radioulnar, wrist and hand maintenance exercises

Pendular exercises

At 3 weeks

Continue pendular exercises

Start passive flexion, abduction and external rotation in supine

NB Avoid external rotation beyond neutral

At 6 weeks

Continue to progress passive range of movement aiming for full range

Begin active assisted exercises progressing to active exercises as the patient is able

Encourage patient to move through all ranges and to stretch at ends of range

Return to functional activities

Driving

When patient has pain free active movements and good strength and control

Swimming

Breast stroke at 8 weeks

Freestyle will take longer and will depend on recovery of range of movement

Lifting

At 8 weeks light lifting for ADL can begin provided the patient has sufficient muscle power for this. Heavy lifting should be avoided for 6 months.

Return to work

Dependent on patient's occupation. Heavy manual workers should be guided by the surgeon.

Written by Clare Connor MCSP and Claire Kellaway MCSP

Review date: October 2003