Proximal Humerus Fracture Fixation (Plate or Nail)

Phase	Rehabilitation	Precautions
Day 0	Sling 4 weeks; hand/elbow/wrist ROM; pendulums; scapular retractions.	Sling 4–6 weeks (off for exercises). No active elevation or ER past neutral initially.
0–2 weeks	Passive flexion/abd in supine to 60–90°; ER/IR to 20–30° (pain-free); continue scapula/prehab exercises.	Avoid weight on arm; no sudden movements.
2–4 weeks	Increase passive ROM to 120°; begin active-assisted flexion/abd (table slides); maintain sling when not doing exercises.	No lifting; no behind-back until soft-tissues heal.
4–6 weeks	Wean sling by 6 weeks; initiate active ROM to full flexion/abd and ER/IR (as comfort); begin isometrics.	Avoid strain at fracture site.
6–12 weeks	Strengthening cuff and deltoid gradually; wean sling completely; full active use of arm.	Functional activities as tolerated.
12+ weeks	Return to all activities (once union confirmed).

Phase

Rehabilitation

Precautions

Day 0

Sling 4 weeks; hand/elbow/wrist ROM; pendulums; scapular retractions.

Sling 4–6 weeks (off for exercises). No active elevation or ER past neutral initially.

0–2 weeks

Passive flexion/abd in supine to 60–90°; ER/IR to 20–30° (pain-free); continue scapula/prehab exercises.

Avoid weight on arm; no sudden movements.

2–4 weeks

Increase passive ROM to 120°; begin active-assisted flexion/abd (table slides); maintain sling when not doing exercises.

No lifting; no behind-back until soft-tissues heal.

4–6 weeks

Wean sling by 6 weeks; initiate active ROM to full flexion/abd and ER/IR (as comfort); begin isometrics.

Avoid strain at fracture site.

6–12 weeks

Strengthening cuff and deltoid gradually; wean sling completely; full active use of arm.

Functional activities as tolerated.

12+ weeks

Return to all activities (once union confirmed).

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