Physical Therapy Videos - Humerus
Basic Anatomy
The humerus is the single bone in your upper arm. The top of the humerus forms part of the shoulder joint with its connection to the scapula (shoulder blade), and the bottom of the humerus forms part of the elbow with the forearm. The middle of the humerus is called the humeral shaft and fracture of this part of the bone is called a humeral shaft fracture. The humerus has strong muscular attachments that move your shoulder and your elbow.
Mechanism and Epidemiology
Fractures of the humerus shaft make up about 5 percent of all broken bones. It typically requires more force to fracture your humeral shaft than to break your wrist or collarbone. Falls are a common cause of humerus fractures. Sometimes they happen after higher energy injuries like a motor vehicle accident. The shaft can break near the top of the bone, in the middle, or near the bottom of the bone. Depending on how and where your bone breaks, different treatments are needed.
Initial Treatment
A fractured humerus is typically very painful and you may not be able to move your arm. The diagnosis is made using a clinical examination and x-rays. This may happen in an emergency room, urgent care, or a physician’s office. Sometimes the radial nerve—one of the main nerves in the arm—can be injured when you break this bone. This happens about 15 percent of the time. It is more common with fractures that happen closer to the bottom of the bone. If this nerve is injured, you may not be able to extend your wrist, fingers, or thumb, and may have a numb patch on the back of your hand.
After your fracture is diagnosed, you will likely be placed into a splint that supports the bone until a final treatment plan is made with an orthopaedic surgeon. If your pain is controlled and you don’t have other injuries, admission to the hospital is typically not necessary. If you do have other injuries, you may be admitted to the hospital.
General Treatment
Many isolated humeral shaft fractures (assuming you do not have any other injuries) can be treated without surgery, even if you’ve injured your radial nerve. Your orthopaedic surgeon will switch you from your splint to an adjustable brace (called a Sarmiento brace) at around 1-3 weeks after your injury. This brace is typically worn full time for at least 6 weeks and possibly up to 12 weeks. Once the fracture is healing well, you will be allowed to wear the brace less often over a period of time. Generally, physical therapy is helpful to regain strength and range of motion.
There are times when your orthopaedic surgeon may choose to perform surgery on your humerus shaft fracture. For example, if your bone comes through the skin (open fracture), or if you have multiple other fractures or injuries. If surgery is chosen, this will be performed through an incision, or "cut," on either the front or the back or your arm, depending on the location of your fracture. The fracture will most likely be treated with a plate and screws on the bone, or occasionally with a rod that goes down the middle of the bone. If your fracture is treated with surgery, a brace is not required, and typically you will be able to use your arm for everyday activities immediately after surgery. This will be determined by your surgeon.
Postoperative Care
After surgery, you will most likely be allowed to move your arm freely and use your arm to assist with recovery of other injuries if you have any. Physical therapy is often prescribed to help improve your motion and strength after surgery. You may still have considerable pain in the arm, but this typically declines over several weeks. You may be seen by your surgeon or their staff several times over the next few months to make sure you are healing well.
Long Term
In general, humerus shaft fractures treated with or without surgery heal well with few long-term issues. Occasionally, a fracture will not heal, or will heal in an undesirable position. If this occurs, surgery may be necessary. You should talk with your surgeon about whether or not surgery is needed for your humerus if it fails to heal, or you are having problems with your arm.
If your fracture was associated with an injury to your radial nerve, there is a good chance that the nerve will recover completely. Most of the time the nerve is just "bruised," and it heals itself after a period of time. This process can be slow, sometimes taking up to 6-12 months. Occasionally, the nerve will not heal on its own and a nerve study can be performed to evaluate the nerve. On rare occasions, additional procedures are necessary to restore the function the nerve.
Physical Therapy Videos - Humerus
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Matthew Hogue, MD
Edited by the OTA Patient Education Committee and Steven Papp, MD (section lead)
All x-rays and pictures taken from the personal collections of Dr. Hogue and Christopher Domes, MD