The proximal humerus is the top of the upper arm bone: the ball of the shoulder joint and the bony bumps (tuberosities) where the rotator cuff tendons attach. It usually breaks in a fall onto the arm or shoulder. Many of these fractures heal in a sling without surgery, but when the pieces are badly shifted, the shoulder can heal stiff, weak, or painful.
Which surgery is right for me?
Fixation is usually chosen when the bone is strong and the pieces can be put back together, often in younger or more active patients. It keeps your own shoulder joint.
Reverse shoulder replacement is usually chosen for older adults, fractures in many pieces, fragile bone, or when the ball has lost its blood supply and can't be reliably fixed. It doesn't depend on the rotator cuff healing, so recovery is more predictable in these situations.
Your age, activity level, bone quality, rotator cuff health and the fracture pattern on X-ray and CT all go into the recommendation, which we'll make together at your visit.
Surgical options
Each option has its own patient education handout and PT protocol. Open, save or print.
Option 1
Fixation (plate and screws)
Usually chosen for: Strong bone; pieces that can be put back together
Through an incision at the front of the shoulder, the broken pieces are put back in place and held with a plate and screws, often with strong sutures through the rotator cuff tendons for extra hold. Some fractures are instead held with a rod (nail) inside the bone.
Sling
Worn for 4 weeks (6 if the bone is fragile), off for therapy, hygiene, and exercises. Your therapist often begins gently moving the shoulder in the first week.
Daily life
Elbow, wrist, and hand motion right away. Desk work often within 1–2 weeks. No lifting, pushing, or leaning on the arm for 6 weeks. No driving while taking narcotic pain medication.
Usually chosen for: Older adults, many pieces, fragile bone, or a ball that can't be saved
The broken ball is replaced through an incision at the front of the shoulder. In a reverse replacement, a metal ball is fixed to the socket and a cup on a stem goes into the arm bone, so the large deltoid muscle can lift the arm. The tuberosity pieces are usually sewn back around the implant. The final plan is determined during surgery.
Sling
Weaned by 4-6 weeks (sling worn full if the bone pieces need extra protection). Gentle assisted motion starts right away.
Daily life
Generally return to desk work within first two weeks. Light tasks below shoulder height, lifting 1–2 lb. For 6 weeks: no pushing up from a chair and no reaching behind your back. No driving while taking narcotic pain medication.
