The proximal humerus refers to the upper end of the humerus (upper arm bone) that is closest to the shoulder. This area includes the head of the humerus, which fits into the socket of the shoulder blade (the glenoid) to form the shoulder joint, as well as the greater and lesser tuberocities, which are sites of attachment for shoulder muscles. The proximal humerus is a common site for fractures, particularly in older adults, due to osteoporosis (weak bone )

Causes Of Proximal Humerus Fractures

Proximal humerus fractures typically result from a combination of trauma and bone weakness. The most common causes include:

• Falls: Especially in older adults, falling onto an outstretched hand or directly onto the shoulder can cause a proximal humerus fracture. Osteoporosis, a condition that weakens bones, makes them more susceptible to breaking from a fall.
• Direct impact: High-energy impacts from car accidents, sports injuries, or direct blows to the shoulder can fracture the proximal humerus in people of all ages.
• Osteoporosis: This condition leads to a decrease in bone density and quality, making bones more fragile and likely to fracture, even from minor falls or impacts.
• Sports and recreational activities: Activities that involve a higher risk of falling or direct impacts, such as skiing, snowboarding, and contact sports, can lead to proximal humerus fractures.
• Pathologic fractures: Occasionally, proximal humerus fractures can occur in bones weakened by disease, such as cancer. These are known as pathologic fractures and can happen with minimal or no trauma. 

Proximal Humerus Surgery Process

Understanding the cause of the fracture is essential for prevention and treatment planning. The surgical process for a proximal humerus fracture can vary depending on the severity and type of the fracture, the patient’s age, bone quality, and overall health. However, a general outline of the surgical process includes the following steps:

Preoperative Planning:

Assessment and Diagnosis: To assess the fracture’s complexity, detailed imaging studies such as X-rays, CT scans, and sometimes MRI are performed.

• Health Evaluation: The patient’s overall health is evaluated to ensure they are fit for surgery. This may include blood tests, heart monitoring, and discussions about any existing health conditions.
• Surgical Planning: The surgeon decides on the specific surgical approach and hardware (plates, screws, intramedullary nails, or a shoulder replacement) based on the fracture’s characteristics.

Anaesthesia:

• The surgery can be  performed under brachial block a kind of regional anaesthesia, some situations may require General anaesthesia base on patient condition 

Surgical Procedure:

• Incision: A surgical incision is made over the shoulder to access the fracture.
• Fracture Reduction: The broken bone pieces are realigned to their normal position.
• Fixation: Metal hardware such as pins, screws, plates, or a combination thereof is used to secure the bone fragments in place. In some cases, particularly with severe fractures or poor bone quality, part or all of the proximal humerus may be replaced with a prosthetic component in a procedure known as hemiarthroplasty or total shoulder arthroplasty.
• Closure: Once fixation is complete, the surgical site is closed with sutures or staples.

What to expect after proximal humerus surgery?

Postoperative Care

Initial Recovery: The patient’s arm is typically immobilised in a sling to keep the shoulder secure as it heals. Pain management strategies are implemented.

Rehabilitation: Physical therapy is an essential component of recovery. It begins with gentle, passive exercises and gradually progresses to active strengthening exercises to restore range of motion, strength, and function.

Follow-Up: Regular follow-up appointments are necessary to monitor healing through physical assessments and imaging.

Recovery Time

Recovery times can vary widely among individuals depending on the fracture’s severity, varying between 6-12 wks , the patient’s health status, and adherence to rehabilitation. Generally, significant healing occurs within 6 to 12 weeks, with continued improvement over 6 months 

What to expect after proximal humerus surgery? 

After proximal humerus surgery, patients can expect a period of recovery that involves several stages, including pain management, immobilisation, physical therapy, and gradually increasing activity levels. Here’s a breakdown of what to expect:

1. Immediate Postoperative Period

Pain and discomfort are common immediately after surgery. Pain management is a priority, and medications are prescribed to ease pain. The arm is typically immobilised in a sling to protect the surgical repair and keep it stable.

2. First Few Weeks:

Swelling and bruising around the shoulder are normal. Ice packs and elevation can help reduce swelling. Gentle, passive exercises may be started under the guidance of a physical therapist to prevent stiffness.

3. One to Six Weeks Post-Surgery:

Physical therapy plays a crucial role in the recovery process, focusing initially on gentle range-of-motion exercises. The frequency and intensity of physical therapy sessions will gradually increase.

4. Six Weeks to Three Months:

 Active range-of-motion exercises will be incorporated into the rehabilitation regime. Depending on the healing process and the surgeon’s advice, strength training exercises may begin.

5. Three to Six Months:

Patients typically see significant improvements in strength and range of motion. Participation in more demanding activities and exercises might be possible following clearance from the healthcare provider.

6. Beyond Six Months:

Recovery varies among individuals, but many can return to most of their pre-surgery activities with little to no limitations. Full recovery and the achievement of maximum strength and flexibility may take up to a year.

A word from Hyderabad Shoulder Clinic

Throughout the recovery process, patients must follow the instructions and recommendations of their healthcare team closely. Recovery times can vary depending on several factors, including the extent of the surgery, the patient’s overall health, and their commitment to rehabilitation. Regular follow-up appointments are essential for monitoring progress and addressing any complications promptly.

The goal of proximal humerus surgery is to restore the normal function of the shoulder, allowing the patient to return to their daily activities . For more information, please visit our website https://hyderabadshoulderclinic.com/ or contact us at +91 9959588389 or shoulderandsportsclinic@gmail.com.