Shoulder Fracture (Proximal Humerus Fracture) Treatment
A proximal humerus fracture — a break in the upper portion of the arm bone where it forms the ball of the shoulder joint — is one of the most common shoulder injuries seen in orthopedic practice, particularly among older adults after a fall and among athletes who sustain a direct blow or high-energy impact to the shoulder. Unlike a mid-shaft arm fracture, a proximal humerus fracture directly involves the shoulder joint itself, which means the break can affect the rotator cuff attachment points, disrupt the blood supply to the humeral head, damage the surrounding nerves, and compromise the shoulder’s ability to move and bear load. The severity can range from a stable, non-displaced crack that heals with immobilization to a complex, multi-part fracture that requires surgical reconstruction or joint fracture replacement. Because the treatment approach — and the long-term functional outcome — depends entirely on the fracture pattern and the condition of the surrounding soft tissues, prompt evaluation by a shoulder specialist with advanced imaging is essential.
Dr. Jonathan Glashow is a board-certified orthopedic surgeon and Clinical Associate Professor of Orthopedic Surgery at NYU Grossman School of Medicine, with specialized fellowship training in shoulder surgery that few orthopedic surgeons in the country can match. After completing his sports medicine and arthroscopic surgery fellowship at the Southern California Orthopedic Institute/UCLA, he pursued a traveling shoulder fellowship under two of the most influential shoulder surgeons in the world — Charles Rockwood, MD at the University of Texas Health Science Center in San Antonio and Richard Hawkins, MD at University Hospital in London, Ontario. This depth of shoulder-specific training, combined with over 30 years of clinical experience and more than 15,000 procedures, gives him an expert-level understanding of proximal humerus fracture patterns and the decision-making required to determine when a fracture can heal on its own and when surgical intervention is necessary to protect long-term shoulder function. Named a Castle Connolly Top Doctor every year since 2000, Dr. Glashow provides same-day imaging, immediate evaluation, and emergency surgical capability for shoulder fractures at his Upper East Side practice in New York City.
Repairing a Broken Shoulder in NYC
If the proximal humerus fracture does not shift pieces of bone out of their normal formation, the bone can usually be allowed to heal without surgery. Immobilizing shoulder and arm movement for a few weeks can allow the pieces of bone to fuse and heal. This is with monitoring of the fracture with x-rays and imaging to ensure it heals correctly. The healing process should be followed by physical therapy and exercise to restore strength and range of motion.
For more severe shoulder fractures, surgery may be required. If the humeral head has broken bones that have shifted out of place, or there is other damage to the shoulder joint, surgery can repair the bone and joint. Internal fixation can be used to repair the proximal humerus fracture. In some circumstances, the humeral head may be too damaged to repair, and partial or complete shoulder joint replacement may be required.
Shoulder fractures require the expertise of an orthopedic surgeon for the best care during recovery. Jonathan Glashow, MD, Orthopedic Surgery & Sports Medicine offers a same day diagnosis, consultation and treatment/surgery for proximal humerus fractures at our clinic on the Upper East Side of NYC. Contact us today to schedule your consultation with Dr. Glashow.
Frequently Asked Questions About Shoulder Fractures
What is a proximal humerus fracture?
The proximal humerus is the upper end of the arm bone — the portion that forms the ball of the shoulder’s ball-and-socket joint. A proximal humerus fracture is a break in this area, which can involve the humeral head (the ball itself), the greater tuberosity (where the rotator cuff attaches), the lesser tuberosity, or the surgical neck (the narrow zone just below the head). Fractures are classified by the number of parts involved — a two-part fracture means one fragment has shifted out of position, while three-part and four-part fractures involve progressively more complex displacement patterns that typically require surgical repair.
What causes proximal humerus fractures?
In older adults, the most common cause is a fall onto an outstretched hand or directly onto the shoulder — particularly in patients with osteoporosis, where reduced bone density makes the proximal humerus more vulnerable to breaking under relatively low-energy impact. In younger patients and athletes, proximal humerus fractures typically result from higher-energy trauma such as a sports collision, a cycling accident, or a motor vehicle crash. Dr. Glashow treats shoulder fractures across all age groups and energy levels at his Upper East Side practice.
How do I know if my shoulder is fractured?
A proximal humerus fracture typically produces immediate, severe pain in the shoulder and upper arm, rapid swelling and bruising that often extends down the arm and into the chest, an inability to lift or rotate the arm, and in some cases visible deformity of the shoulder. Because these symptoms can overlap with a severe rotator cuff tear or shoulder dislocation, X-rays are essential for confirming the diagnosis. Dr. Glashow offers same-day X-rays and, when needed, CT scans to fully evaluate the fracture pattern and guide treatment planning.
Do all shoulder fractures require surgery?
No. Approximately 70 to 80 percent of proximal humerus fractures are non-displaced or minimally displaced and can be treated successfully without surgery. Treatment typically involves a sling for immobilization followed by a carefully progressed physical therapy program to restore range of motion and strength as the bone heals. Surgery is recommended when the fracture fragments are significantly displaced, when the humeral head is split or its blood supply is compromised, or when the fracture extends into the joint surface in a way that would lead to post-traumatic arthritis if left unrepaired. Dr. Glashow uses X-rays and CT imaging to classify the fracture and determine the most appropriate treatment path.
What does shoulder fracture surgery involve?
The surgical approach depends on the fracture pattern and the quality of the bone. For displaced fractures where the fragments can be realigned, Dr. Glashow performs open reduction and internal fixation using a plate and screws to restore the bone’s anatomical position. For severe three-part or four-part fractures — particularly in older patients with poor bone quality or a compromised blood supply to the humeral head — a shoulder replacement (hemiarthroplasty or reverse total shoulder arthroplasty) may provide a more reliable outcome than attempting to reconstruct a badly damaged bone. Dr. Glashow discusses all available options with each patient and recommends the approach most likely to restore the best long-term function.
How long does it take to recover from a proximal humerus fracture?
Recovery timelines vary based on the severity of the fracture and whether surgery was required. Non-surgical fractures typically require two to four weeks in a sling before beginning gentle range-of-motion exercises under the guidance of a physical therapist. Surgical cases may begin controlled motion earlier, depending on the stability of the fixation. Most patients regain functional shoulder use within three to four months, though full strength and range of motion may take six months or longer. Shoulder stiffness is one of the most common complications after any proximal humerus fracture, which is why Dr. Glashow emphasizes early, structured rehabilitation coordinated closely with physical therapists to optimize each patient’s recovery.
