You’ve broken the upper part of your humerus – that’s the long bone in your upper arm. The top of this bone is shaped like a ball and forms part of the shoulder joint. It connects to the rest of the arm through a narrow section called the neck. The ball sits in a shallow socket in the shoulder blade, which allows for a wide range of movement. But this flexibility also means the joint can easily stiffen up if it's not moved for a while, or if scar tissue builds up after injury.

 

These types of fractures – called proximal humerus fractures – usually happen after a fall, especially in older adults with weaker bones. In younger or more active people, it often takes more force, like a sports injury, a fall from height or a car accident.

 

Once your fracture has been confirmed in the Emergency Department, you’ll go home in a collar and cuff sling. You should wear this all the time, including overnight, for the first three weeks. After that, you can start removing it during rest or when doing physio exercises – but otherwise, keep it on. You’ll be seen in fracture clinic within a week or two, where we’ll review your injury and make a longer-term plan.

We may also repeat your X-rays to check how the bone is healing and confirm that the position remains acceptable.

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Most of these fractures don’t need surgery, especially if the bone fragments haven’t moved much, or if you’re older, frailer, or have other health conditions. Even when the bone is slightly out of place, the weight of your arm can help gently realign things over time. One important tip: don’t rest your elbow on anything, like an armrest or table – this can cancel out the helpful downward pull and affect how the bone heals.

 

Surgery may be considered if the fracture is more complex – for example, if there are multiple pieces, if the break involves the joint surface, or if the bone has moved significantly. These types of injuries can increase the risk of future problems like stiffness, instability or arthritis. Surgery is more commonly offered to younger or more active patients, but we make decisions based on the exact fracture, your shoulder muscles, and your overall health.

 

Sometimes the decision for surgery is made directly in the fracture clinic. In borderline or more complex cases, we may arrange for you to see a shoulder specialist. If surgery is clearly needed, it can usually be offered within the first couple of weeks. Options include fixing the bone with a plate and screws, inserting a rod down the centre of the bone, or replacing part of the shoulder joint if the surface has been badly damaged. Each of these operations has its own risks and recovery timeline, and we’ll explain which option is most appropriate for your specific case.

 

If your injury is treated without surgery, you should keep the sling on full-time for the first three weeks. After that, you’ll start physio – at first, this involves gentle exercises that don’t use your shoulder muscles, like letting your arm swing with the help of gravity. Most fractures have healed well enough by six weeks for you to be discharged from clinic. At this point, you can start doing light activities again. This might include basic household tasks or gentle use of the arm below shoulder height, depending on your range of movement.

 

With regular physio, you’ll usually be able to get back to heavier lifting or high-impact activity around ten to twelve weeks after injury – provided everything looks good at your final clinic appointment. However, full strength and confidence in the shoulder can take several more months, especially in older patients or after more complex fractures.

 

These injuries usually cause quite a bit of pain and swelling, and the shoulder may be very hard to move at first. You might notice significant bruising down the arm and across the chest. This can look alarming but is expected – it happens because gravity pulls the blood from the injury site into the surrounding tissues. Elevating the arm is difficult, which means the swelling often takes longer to settle than in other parts of the body. Some patients also report a feeling of heaviness or throbbing, especially in the evenings – this is common and usually improves as the swelling settles.

 

There are some possible complications to be aware of. These include stiffness, frozen shoulder, healing in the wrong position, failure of the bone to heal, or loss of blood supply to the bone. These are more likely in more severe injuries, if the bone is already weak, or if the shoulder stays immobile for too long. We monitor for these problems during your follow-up appointments and will let you know if further treatment is needed.

 

Most people recover with regular outpatient care and physiotherapy. But if you notice new or worsening symptoms – like increasing pain, reduced movement, or any signs of infection – you should contact the team for reassessment. Even after discharge, you can get back in touch if something doesn’t feel right. Pain that gets worse rather than better, or a sudden loss of movement, are both reasons to seek further review.

 

During recovery, you’ll notice gradual improvements in pain and movement over the first few weeks. The shoulder usually feels sore and stiff at first, especially when coming out of the sling or starting physio. That’s normal and doesn’t mean something’s gone wrong.

 

Early physio focuses on passive exercises – where your arm moves without using your muscles. As healing progresses, you’ll gradually start using your shoulder muscles again. Your physio will guide you through each phase and adjust your exercises depending on how your shoulder responds.

 

It can take several months to fully recover. Some people – particularly older patients – may be left with mild stiffness or discomfort, but most regain good function. Sleeping is often difficult early on, so using pillows to support the arm can help. Bruising and swelling can last several weeks but usually settle without needing any treatment. Staying mobile, following the rehab plan, and being patient with the process all make a big difference in the long-term outcome.