Overview
A proximal humerus fracture is a break in the upper part of the arm bone (the humerus) near the shoulder joint. It can involve the humeral head, the surgical neck, or nearby tuberosities where shoulder muscles attach. This injury often causes significant pain, swelling, and limited movement because the shoulder is designed for complex motion and the fracture can disrupt normal mechanics. If nerves around the shoulder are irritated or compressed, some people may also notice numbness or weakness in part of the arm.
Symptoms
Pain is usually felt at the top of the upper arm and shoulder, and it often worsens with any attempt to lift or rotate the arm. Swelling and bruising commonly develop over the shoulder and upper arm after the injury. Many people can't comfortably raise the arm and may protect the shoulder by keeping the arm close to the body. In some cases, numbness or tingling can occur, especially in the outer shoulder area, depending on which structures were affected.
Causes
Most proximal humerus fractures happen from a fall, especially in older adults or in people with balance problems. In younger people, they more often result from higher-energy trauma such as a car crash or a direct impact to the shoulder. Osteoporosis or weakened bone makes fractures more likely even with relatively minor falls. The fracture pattern depends on where and how the force is applied to the shoulder.
Risk Factors
Age and osteoporosis are major risk factors because bone strength decreases over time. A history of falls, poor balance, vision problems, or muscle weakness increases the chance of sustaining the injury. Certain medications that affect bone density or cause dizziness (such as long-term steroid use) can also raise risk. People with prior fractures or known bone-thinning conditions are more likely to develop this type of fracture.
Prevention
To reduce risk, focus on fall prevention by improving balance, reviewing home hazards (like loose rugs), and ensuring good lighting. Strengthening exercises for the hips and upper body, along with regular vision and medication review, can lower the likelihood of future falls. If you have osteoporosis or low bone density, talk with your clinician about bone-protective strategies and whether supplements or medications are appropriate. Wearing protective gear for higher-risk activities and using proper techniques during sports or work can also help.
How the Diagnosis Is Evaluated
Clinicians usually start with a history of how the injury occurred and a focused exam of pain, swelling, and shoulder movement. They check circulation and sensation in the arm and may assess specific nerve function, such as sensation over the outer shoulder area. X-rays are the primary imaging test to confirm the fracture and describe its location. A CT scan is sometimes used to clarify complex fracture patterns, and additional imaging may be ordered if symptoms suggest associated injuries.
Nonsurgical Treatment Options
Nonsurgical care typically includes pain control with acetaminophen or anti-inflammatory medications when appropriate, and frequent ice in the early period. The shoulder is often supported with a sling or immobilizer for a short time to help comfort and protect the fracture, while plans for early gentle motion are tailored to the fracture stability and alignment. Physical therapy usually begins with safe range-of-motion exercises to prevent stiffness, followed by gradual strengthening as healing progresses. Clinicians may also adjust activity limits and sleep positioning to reduce pain during the early healing phase. Follow-up imaging is commonly used to confirm the fracture remains stable while it heals.
When to Seek Medical Attention
Seek urgent care or emergency evaluation if you have severe deformity, uncontrolled pain, or you cannot move the arm at all after an injury. Get prompt medical attention if you notice numbness, worsening weakness, a cold or pale hand, or symptoms suggesting circulation or nerve problems. Contact a clinician urgently if there is rapidly increasing swelling, bruising that seems excessive, fever, or if you suspect an open wound over the fracture. If you also had a head injury or feel faint after the fall, it's important to be evaluated right away.
Frequently Asked Questions
Healing often takes several weeks to a few months, but the exact timeline depends on fracture type and stability.
Some stiffness and weakness can persist for a while, and physical therapy is often important for restoring function.
Next Steps
If you suspect a proximal humerus fracture, arrange an in-person evaluation promptly for exam and imaging. Follow your clinician's guidance on sling use, motion limits, and physical therapy timing to support healing and reduce stiffness. If pain, numbness, or hand circulation changes occur, seek urgent care right away.