Humerus Fracture (Broken Upper Arm)

First aid

• support the arm in the most comfortable position with a sling or by holding it against the body
• do not try to straighten it
• apply ice wrapped in a cloth
• remove rings and watches
• take acetaminophen (paracetamol) or ibuprofen at the label dose
• go to an ER or urgent care center

Types of humerus fracture

Symptoms

• severe pain in the shoulder, upper arm or elbow
• swelling and extensive bruising that tracks down the arm, sometimes onto the chest and forearm over several days
• inability to lift or move the arm
• deformity or a shortened arm
• a grinding feeling
• numbness, tingling or weakness in the hand if a nerve is injured

Diagnosis

A doctor checks circulation, nerve function (especially the radial nerve, which allows wrist and finger extension) and the skin, then orders X-rays of the shoulder, arm and elbow, which also show whether there is an associated shoulder dislocation. A CT scan helps plan treatment of complex shoulder and elbow fractures. In children, X-rays of both elbows may be compared because growth plates make injuries harder to see.

Treatment

Proximal humerus fractures

• Non-surgical: most minimally displaced fractures, and many displaced fractures in older adults, are treated in a sling for 1 to 3 weeks followed by early gentle movement and physical therapy. Outcomes are often similar to surgery in older people
• Surgery: plate and screws, an intramedullary nail, or a shoulder replacement (often a reverse shoulder replacement in older adults) for severely displaced or shattered fractures

Humeral shaft fractures

• Functional brace: a clamshell brace allows the bone to heal while the elbow and shoulder move. Most shaft fractures heal this way in 10 to 12 weeks
• Surgery: plating or nailing for open fractures, failed bracing, fractures with blood vessel injury, or multiple injuries
• Radial nerve palsy present at the time of injury usually recovers on its own over 3 to 6 months

Distal humerus and supracondylar fractures

• Adults: usually surgery with plates and screws to restore the elbow joint, followed by early movement; sometimes elbow replacement in older adults
• Children: non-displaced fractures are treated in a cast for 3 to 4 weeks. Displaced fractures are usually set and pinned in the operating room. Children recover elbow motion well

Recovery

Physical therapy is essential, especially for shoulder and elbow fractures, to restore movement and strength. Stiffness is the most common long-term problem.

Complications

• shoulder or elbow stiffness
• radial nerve injury (wrist drop)
• artery or nerve injury in children's elbow fractures
• malunion or nonunion
• avascular necrosis of the humeral head after some proximal fractures
• arthritis after joint fractures
• frozen shoulder

Bone health

A proximal humerus fracture from a simple fall is a fragility fracture and a warning sign of osteoporosis. Ask your doctor about a bone density scan, calcium and vitamin D, fall prevention and osteoporosis medicines to prevent future hip and spine fractures.

Frequently asked questions

How long does a broken upper arm take to heal?

The bone usually heals in 6 to 12 weeks. Shaft fractures treated in a brace often take 10 to 12 weeks. Regaining full movement and strength, especially in the shoulder, can take 3 to 12 months with physical therapy.

Does a humerus fracture need surgery?

Many do not. Most proximal humerus and shaft fractures heal in a sling or functional brace. Surgery is recommended for badly displaced fractures, open fractures, many fractures around the elbow in adults, displaced elbow fractures in children, and when bracing fails.

What is wrist drop after a humerus fracture?

Wrist drop is weakness lifting the wrist and fingers caused by injury to the radial nerve, which winds around the middle of the humerus. It occurs in about 1 in 10 shaft fractures and usually recovers on its own over several months.

Can you move your arm with a broken humerus?

Movement is usually very painful at first, and doctors advise keeping the arm supported. Gentle pendulum and elbow, wrist and hand exercises often start within days to weeks, guided by your doctor or physical therapist, to prevent stiffness.