Proximal Humerus Fracture Fixation

Pain Medications

In most cases local or regional nerve blocks will provide 8-12 hours of numbness.
As soon as you start to feel the numbness wearing off, begin taking oral pain medication.
Take Tylenol 500mg one tab every 8 hours.
Take Aleve (Naproxen) 220mg two tabs (440mg total) every 12 hours with food.
If you still have pain after Tylenol and Aleve/Naproxen, take one Norco tab (5mg/325mg).
If you still have pain after all of the above, take a second Norco tab.
Keep in mind Norco has Tylenol in it (325mg). If you take an extra Norco, then skip a dose of Tylenol.
DO NOT exceed 3500mg of Tylenol over 24 hours.
It is illegal to drive or operate machinery with narcotic medications.
Do not combine alcohol or other sedatives with narcotic medications.
You do not need to take pain medications once you no longer have pain.
You should stop the Norco first (usually 2-3 days), then wean off the others over the next week or two.

Other Medications

Take Zofran as needed for nausea (usually associated with anesthesia/narcotic meds).
Take an over-the-counter stool softener (Docusate/Senna/Miralax) as needed for constipation.

Activity

You may NOT bear any weight on or lift anything with your operative extremity.
Elevate your operative extremity above the heart as much as possible to decrease swelling.
It may be helpful to sleep on a recliner or with pillows supporting the arm.

Recovery Equipment

Cold Therapy

We recommend cold therapy use as much as possible in the first two weeks.
Cold therapy units may be used continuously as instructed.
Ice packs should be applied 30 minutes at a time, with 30 minutes off between applications.
Do not apply ice directly to the skin to avoid burning.

Recovery Exercises

You may perform elbow, wrist, and hand exercises as tolerated.
You will begin physical therapy around two weeks after surgery, after your first postoperative visit.

Diet: Please refer to your preoperative packet instructions.

Incision Care: Please refer to your preoperative packet instructions.

Emergencies: Please refer to your preoperative packet instructions.

Therapy Plan: Twice per week for 0-3 months, once per week for 3-6 months

ROM Progression

Initial ROM weeks 2-6:

Wean out of the sling over weeks 4-6 with the goal of being completely out of the sling at 6 weeks.

Progress passive and active ROM after 6 weeks as tolerated with the goal of full motion at 10-12 weeks.

Weight Bearing Progression

No strengthening for postoperative weeks 0-12 with progressive strengthening after week 12.

Initial Post-Operative Physical Therapy Visit (2 weeks)

Phase 1 Physical Therapy (2-6 weeks): protect the fixation, progress motion

Phase 2 Physical Therapy (6-12 weeks): progressive motion

Phase 3 Physical Therapy (12-18 weeks): progressive strengthening

Phase 4 Physical Therapy (18-24 weeks): return to pre-injury level and sport