What are humerus fractures?
A humerus fracture is a break in the humerus, which is the long bone of the upper arm that runs from the shoulder to the elbow. These fractures can occur in different regions of the bone, including the proximal humerus near the shoulder, the shaft in the mid-portion of the arm, or the distal humerus near the elbow. They are commonly caused by trauma such as falls, direct blows, or high-impact injuries, but in older adults, even a low-energy fall may be enough due to weakened bone from osteoporosis. The symptoms typically include sudden pain, swelling, bruising, and difficulty moving the shoulder or elbow, depending on the location of the fracture, and in some cases there may be visible deformity or abnormal arm positioning. Humerus fractures can also be associated with nerve or blood vessel injury, particularly the radial nerve in shaft fractures, which may lead to weakness or numbness in parts of the arm or hand.
Causes
A humerus fracture is most commonly caused by trauma to the upper arm, such as a fall onto an outstretched hand or directly onto the shoulder or elbow, which transmits force through the bone. High-energy injuries, including road traffic accidents, sports collisions, or industrial accidents, can also result in fractures, particularly in younger individuals. In older adults, humerus fractures often occur from low-energy falls due to underlying osteoporosis, which weakens the bone and makes it more susceptible to breaking. In some cases, the bone may be weakened by underlying conditions such as bone tumours or metastatic disease, increasing the risk of fracture even with minimal trauma.
Symptoms
Sudden severe arm pain: Sharp pain occurs immediately at the time of injury and worsens with any attempt to move the arm.
Swelling: Rapid swelling develops around the fracture site due to soft tissue injury and internal bleeding.
Bruising (ecchymosis): Discolouration of the skin appears within hours or days as blood leaks into surrounding tissues.
Visible deformity or abnormal arm shape: The arm may look bent, shortened, or out of alignment depending on the severity and location of the fracture.
Inability to move the arm normally: Movement of the shoulder or elbow becomes very difficult or impossible due to pain and instability.
Tenderness over the fracture site: Touching or pressing on the injured area causes significant pain.
Crepitus (grinding sensation): A feeling or sound of bone fragments rubbing together may be present in some cases.
Numbness or weakness (nerve involvement): If nearby nerves, such as the radial nerve, are affected, there may be tingling, numbness, or weakness in parts of the arm or hand.
Diagnosis
Your surgeon will first taking a detailed history of the injury, typically noting a clear traumatic event such as a fall, direct blow, or high-impact accident followed by immediate pain, swelling, and loss of arm function. A physical examination is then performed to assess for deformity, tenderness along the humerus, swelling, bruising, and any signs of nerve or vascular injury, particularly checking radial nerve function for weakness or sensory changes in the hand and wrist.
Imaging
To confirm the diagnosis, imaging is essential, with plain X-rays of the shoulder, humerus, and elbow as the first-line investigation to identify the location, pattern, and displacement of the fracture. If the fracture is complex, extends into a joint, or is not fully clear on X-ray, a CT scan may be used to provide more detailed three-dimensional information for surgical planning. MRI is less commonly required but may be used in selected cases to assess associated soft tissue injury or when a stress fracture or underlying bone pathology is suspected.
Treatment
Conservative (Non-operative)
Conservative management of humerus fractures is often appropriate for stable, non-displaced, or minimally displaced fractures, and aims to allow the bone to heal naturally while maintaining function and preventing complications. Initial management usually involves pain control with analgesia and immobilisation of the arm using a sling, collar-and-cuff, or functional brace to support the fracture and reduce movement. Early gentle movement of the elbow, wrist, and hand is encouraged to prevent stiffness, while shoulder motion is gradually introduced as pain allows and healing progresses. Regular follow-up X-rays are used to ensure the fracture remains in acceptable alignment during healing. Physiotherapy plays an important role in restoring range of motion and strength once the bone has begun to unite. Most humerus fractures treated conservatively heal well over several weeks to months, although recovery of full shoulder or arm function may take longer and requires structured rehabilitation.
Surgical treatment
Surgical management of humerus fractures is indicated when there is significant displacement, instability, joint involvement, open fractures, or associated nerve or vascular injury, as well as in cases where conservative treatment is unlikely to provide satisfactory alignment or function. The most common surgical option is open reduction and internal fixation (ORIF), where the fracture is realigned and stabilised using plates and screws, allowing accurate restoration of bone anatomy. In some cases, especially for certain shaft or complex fractures, intramedullary nailing may be used, where a metal rod is inserted into the central canal of the bone to provide internal support. For fractures involving the proximal humerus in older patients with poor bone quality or severe joint damage, shoulder replacement (hemiarthroplasty or reverse shoulder arthroplasty) may be considered. Post-operatively, a structured rehabilitation program is essential to regain movement, strength, and function while protecting the surgical repair during healing.
Recovery
Recovery after an open reduction and internal fixation (ORIF) of the humerus varies depending on the location and severity of the fracture, the type of fixation used, and individual healing rates. General timelines for returning to daily activities are outlined below, although your surgeon and physiotherapist will provide guidance specific to your recovery.
When can I return to daily activities?
- First 1–2 weeks: The arm is usually supported in a sling for comfort. Light activities such as eating, writing, typing, and gentle hand, wrist, and elbow movements are often encouraged as tolerated.
- 2–6 weeks: Gradual return to light daily activities is common, including dressing, personal care, and simple household tasks, provided these do not place significant strain on the arm. Driving is generally avoided until pain is controlled and arm function is adequate.
- 6–12 weeks: As the bone continues to heal, patients may progressively resume heavier household activities and increase shoulder movement and strengthening exercises under physiotherapy guidance. Many people can return to desk-based work during this period.
- Around 3 months: Most patients can return to routine daily activities with fewer restrictions, although heavy lifting, manual work, and high-impact activities may still be limited.
- 3–6 months or longer: Return to heavy labour, contact sports, or strenuous overhead activities may take several months and depends on confirmed bone healing, strength, and shoulder function.
Recovery is gradual, and following postoperative rehabilitation instructions is important to optimise healing and restore function after open reduction and internal fixation.
When can I return to leisure activities?
- 0–4 weeks: Rest and protection in a sling. Leisure activities are limited to non–arm-dependent activities such as reading, watching TV, and gentle walking.
- 6–12 weeks: Gradual return to low-impact, non-contact leisure activities that do not stress the arm (e.g., stationary cycling, light social activities).
- 3–4 months: Many patients can resume most light recreational activities, including gym-based lower-body exercise and non-strenuous hobbies, with caution.
- 4–6 months: Return to higher-demand leisure activities such as swimming, golf, light tennis, or cycling may be possible depending on strength and range of motion.
- 6+ months: Return to contact sports, heavy gym training, and high-impact or overhead sports, once full healing and strength are confirmed.
Recovery after open reduction and internal fixation should always be guided by your surgeon and physiotherapist, as return times can vary significantly between individuals.