Rehabilitation following a shoulder injury is usually guided by a physiotherapist. The spectrum of injuries is varied- for example, treating a dislocation in a young person is very different to treating a complex fracture in an elderly osteoporotic person. Fractures of the upper arm (proximal humerus) are common in elderly patients and usually only after a high energy trauma in a younger person.
The initial treatment involves a two week period of rest in a sling or shoulder immobiliser without any movement. Each day, the elbow, wrist and hand should still be removed from the sling and exercised so that these joints do not also stiffen. Simple stretching exercises should suffice.
If the fracture requires fixing, then the surgeon has several treatment options including plates and screws, a intramedullary nail or a hemiarthroplasty (half a joint replacement). Range of motion exercises are started as soon as the surgeon indicates that the fracture is stable, to prevent shoulder stiffness. If pain recurs, don’t forget RICE: Rest, Ice, Compression and Elevation. Expect pain during this early period so take adequate analgesia.
Once the fracture is showing signs that it is uniting, more advanced exercise can be started, including stretching with the aid of the other arm, a stick, an elastic band and a pulley- best done under the guidance of a physiotherapist.