Proximal Humerus Fractures: Recovery, Pain Management, and Rehabilitation

Q: Proximal Humerus Fractures: Recovery, Pain Management, and Rehabilitation

Hello： Based on your description, you have been regularly attending follow-up appointments, and the X-rays show that the fracture site appears normal, yet you continue to experience persistent pain. <br>This is not a typical situation and may be due to delayed rehabilitation, lea

Proximal humeral comminuted fracture?

On May 26 of this year, I had a motorcycle accident that resulted in a comminuted fracture of the proximal left humerus (broken into five pieces).
On the 27th, I underwent surgery for internal fixation with a plate.
The doctor mentioned that there was also cartilage displacement and soft tissue injury, making the injury severe.
The surgery lasted nearly six hours.
After being hospitalized for 12 days, I was discharged with instructions to use a sling and to return for regular follow-ups.
After resting for a week post-discharge, I returned to work, but I found that the pain in my left arm was unbearable, making it impossible to work, and I even experienced pain at night that prevented me from sleeping.
I decided to rest at home, but the doctor only prescribed pain medication, which was not effective for me.

I returned for follow-ups on June 12, 19, and 26, and X-rays showed normal results, but the pain in my left arm persisted, with different areas experiencing varying sensations of pain.
The doctor did not provide a clear answer regarding this issue, only advising me to rest.
During my follow-up on June 26, the doctor instructed me to perform some passive shoulder exercises to prevent stiffness in the shoulder joint.
I have another follow-up scheduled for July 10, but my arm continues to ache incessantly, waking me up several times each night.
I have been unable to sleep well for an extended period (only able to sleep for a little over two hours before waking up in pain), which has been extremely distressing for me.

I would like to ask the doctor if this kind of pain is normal.
My company has given me two months of leave to recover; will there be improvement by then? Additionally, how long does it typically take for bone healing? What is the duration of rehabilitation? When can I expect to fully recover?

patrick, 50~59 year old female. Ask Date: 2009/07/06

Dr. Li Wenlin reply Orthopedics

Hello: Based on your description, you have been regularly attending follow-up appointments, and the X-rays show that the fracture site appears normal, yet you continue to experience persistent pain.
This is not a typical situation and may be due to delayed rehabilitation, leading to joint and muscle stiffness.
I personally recommend that you seek the consent of your original surgeon to begin rehabilitation (please ask your orthopedic doctor to refer you to a collaborating rehabilitation physician), as this should help alleviate your pain; relying solely on pain medication is not an ideal solution.
Proximal humeral comminuted fractures are more challenging to manage.
Generally, achieving stability within three months is considered a successful treatment outcome, while complete healing of the fracture may take six months to a year.
Rehabilitation typically requires about three to six months.
After surgery, you must wait until there is initial stability in the fracture healing before engaging in lighter activities, which usually occurs around three to six months post-operation.
Complete recovery will vary depending on the individual, the fracture pattern, and the treatment approach, so this is something to discuss with your attending physician.
In summary, if you have any questions, it is best to consult your attending physician! Wishing you a speedy recovery! Dr.
Li Wen-Lin, Chief Orthopedic Surgeon, Keelung Hospital.

Reply Date: 2009/07/06

More Info

Proximal humerus fractures, particularly those that are comminuted (broken into multiple pieces), can be quite complex and challenging to manage. Your situation, involving a five-part fracture of the proximal humerus, necessitated surgical intervention with internal fixation using plates, which is a common approach for such severe injuries. Given the nature of your injury and the subsequent treatment, it is understandable that you are experiencing significant pain and discomfort during your recovery.

Understanding the Recovery Process
1. Healing Timeline: Generally, the healing time for proximal humerus fractures can vary widely based on the severity of the fracture, the patient's age, overall health, and adherence to rehabilitation protocols. Typically, bone healing can take anywhere from 6 to 12 weeks, but full recovery, including regaining strength and range of motion, may take several months to a year.
2. Pain Management: It is not uncommon to experience persistent pain following such a significant injury. This pain can stem from several sources:
- Bone Healing: As the bone heals, it can be painful, especially if there is any movement or stress on the area.

- Soft Tissue Injury: The soft tissue surrounding the fracture, including muscles, tendons, and ligaments, may also be injured, contributing to pain.

- Nerve Sensitivity: Sometimes, nerves can become irritated during the injury or surgery, leading to pain that may feel different in various locations.

3. Rehabilitation: Rehabilitation is crucial after a proximal humerus fracture to restore function and prevent stiffness. Your doctor has recommended passive range-of-motion exercises to prevent stiffness in the shoulder joint. This is an essential step, as immobility can lead to complications such as frozen shoulder (adhesive capsulitis).
- Initial Phase: In the early stages post-surgery, focus on gentle passive movements as directed by your physical therapist or physician.
- Progressive Strengthening: As healing progresses, you will likely transition to active range-of-motion exercises and eventually to strengthening exercises. This progression is vital to regain function and strength in your arm.

4. Sleep Disturbances: Pain that disrupts sleep is a significant concern. It is essential to communicate this with your healthcare provider, as they may need to adjust your pain management plan. Options may include stronger pain medications, physical therapy modalities, or even interventions like nerve blocks if appropriate.

What to Expect Moving Forward
- Follow-Up Appointments: Regular follow-ups with your orthopedic surgeon are crucial. They will monitor your healing through X-rays and clinical assessments. If your pain persists despite normal imaging, further evaluation may be necessary to rule out complications such as non-union or malunion of the fracture.

- Expected Improvements: With consistent rehabilitation and proper pain management, many patients begin to notice improvements in pain and function within a few months. However, complete recovery can take longer, especially for complex fractures.

- Return to Activities: Depending on your progress, your doctor will provide guidance on when you can return to work and resume normal activities. It is essential to listen to your body and not rush the process, as doing so can lead to setbacks.

Conclusion
In summary, while the pain you are experiencing is not uncommon for someone recovering from a complex proximal humerus fracture, it is essential to maintain open communication with your healthcare team. They can provide tailored advice and adjustments to your treatment plan to help manage your pain and facilitate recovery. Adhering to rehabilitation protocols and being patient with the healing process will be key to regaining full function of your arm. If your pain continues to be unmanageable, do not hesitate to seek further evaluation or a second opinion.

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