A proximal humerus fracture is a break at the top of the upper arm bone, just below the ball of the shoulder joint. It is one of the most common fractures in older adults, usually from a fall onto an outstretched arm, and in younger people it typically follows a high-energy injury such as a sports collision or car accident. Most of these fractures heal well without surgery.1,2
- Shoulder pain, swelling and bruising that can spread down the arm after a fall
- Most fractures are minimally displaced and heal in a sling
- For displaced fractures in older adults, trials show surgery is usually no better than non-surgical care
- Surgery is considered for some young or active patients, fracture-dislocations and certain fracture patterns
- Early, gentle motion and physical therapy are key to recovery
Symptoms
- Severe shoulder pain after a fall or injury
- Swelling, and bruising that may spread down the arm and chest over a few days
- Inability to lift or move the arm
- Numbness or tingling in the arm or hand, which needs prompt evaluation
Diagnosis
X-rays from several angles show the fracture and how many main pieces it is in (the “parts”: head, shaft and the two tuberosities where the rotator cuff attaches). A CT scan helps plan treatment for complex fractures. Dr. Dold also checks the nerves and blood supply of the arm, and whether the shoulder is dislocated as well.
Non-surgical treatment
Minimally displaced fractures, which are the majority, are treated in a sling for comfort, followed by gentle pendulum and range-of-motion exercises starting within the first weeks, then progressive physical therapy.2 In the large ProFHER trial of adults with displaced fractures involving the surgical neck, surgery did not give better results than non-surgical care at two years.1 A Cochrane review reached the same conclusion for most displaced fractures, and noted that surgery may increase the need for further operations.2
When is surgery considered?
The evidence above applies mainly to older adults with common fracture patterns. Surgery is considered more often for:2
- Younger, active patients and high-energy injuries
- Fracture-dislocations and fractures through the joint surface
- A displaced greater tuberosity fragment, which can block shoulder motion and weaken the rotator cuff
- Open fractures or fractures with nerve or blood vessel injury
Options include fixation with a plate and screws or other implants, repair of tuberosity fragments, and, in some older adults with complex fractures, shoulder replacement. Dr. Dold will explain which approach fits your fracture, your bone quality and your goals.
Recovery
Bone healing takes about 6 to 8 weeks, but regaining motion and strength takes longer, often several months, with continued improvement up to a year. Stiffness is common, which is why early, guided motion matters. Because these fractures are often a sign of low bone density in older adults, a bone health check is recommended.
Frequently asked questions
Do I need surgery for a broken shoulder?
Most proximal humerus fractures heal without surgery. For many displaced fractures in older adults, trials found surgery was no better than a sling and physical therapy. Surgery is considered for certain fracture types, fracture-dislocations and younger, active patients.
How long will I be in a sling?
Usually a few weeks, mostly for comfort. Gentle exercises often start within the first weeks, guided by your X-rays.
Will I get full motion back?
Many people regain good, functional motion, though some stiffness is common, especially in older adults. Following the therapy program makes a big difference.
Why is my bruise spreading down my arm?
Bleeding from the fracture tracks down the arm and sometimes the chest with gravity. This is common and fades over 1 to 2 weeks, but call if the arm becomes very swollen, numb or cold.
Should my bones be checked?
If you broke your shoulder in a simple fall and are over 50, a bone density check is usually recommended, as this can be a sign of osteoporosis.
Research cited on this page
- Handoll H, Brealey S, Rangan A, et al. The ProFHER (PROximal Fracture of the Humerus: Evaluation by Randomisation) trial: a pragmatic multicentre randomised controlled trial evaluating the clinical effectiveness and cost-effectiveness of surgical compared with non-surgical treatment for proximal fracture of the humerus in adults. Health Technol Assess. 2015;19(24):1-280. PubMed
For most adults with displaced proximal humerus fractures involving the surgical neck, current surgical practice did not give a better outcome than non-surgical treatment. - Handoll HH, Elliott J, Thillemann TM, Aluko P, Brorson S. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2022;6(6):CD000434. PubMed
High- to moderate-certainty evidence that surgery does not improve outcomes at 1 and 2 years for displaced fractures, and may increase further surgery; evidence is lacking for people under 60, high-energy injuries and less common fracture types.
Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. Last reviewed October 2026. This page is general information, not medical advice. Your own diagnosis and treatment plan depend on your exam and imaging.
