Humeral Shaft Fracture (Upper Arm Fracture). A serious injury of the upper arm that requires proper diagnosis, treatment, and rehabilitation

What Is a Humeral Shaft Fracture?

The humerus is the long bone of the upper arm. It has three main parts:

• The upper part, which forms the shoulder joint

• The shaft, which is the long and narrow middle section

• The lower part, which connects to the forearm bones at the elbow

A humeral shaft fracture means the bone has broken in its middle section.

How Does a Humeral Shaft Fracture Happen?

This type of fracture usually occurs due to strong force applied directly to the arm.

Common causes include:

• Contact sports injuries

• Falls from height directly onto the arm

• Road traffic accidents

• High-energy trauma

It can also happen indirectly, when force travels through the hand or elbow up to the upper arm.

Symptoms

Typical symptoms include:

• Strong, deep pain in the upper arm

• Swelling

• Redness

• Tenderness to touch

• Visible change in the shape of the arm

Moving the arm is usually very painful or impossible.

First Aid – What to Do Immediately

If a humeral shaft fracture is suspected:

1. Immobilise the arm immediatelyStabilise the arm using available objects (stick, cardboard, wooden board) and secure them with a bandage or cloth.

2. Use a slingA temporary sling (for example made from a scarf) helps support the arm.Keep the arm close to the chest.

3. Seek emergency medical careGo to the emergency department as soon as possible.

   
   

Medical Treatment

At the hospital:

• An X-ray is performed

• Doctors check for damage to important structures such as:

  • The brachial artery

  • The radial nerve

  • Signs of compartment syndrome (dangerous pressure build-up in the arm)

The X-ray shows:

• The type of fracture

• The position of bone fragments

• Whether the bone has shifted

  
  

Non-Surgical Treatment

Some humeral shaft fractures do not require surgery, especially:

• Spiral or oblique fractures

• Fractures without bone displacement

In these cases, treatment includes:

• A cast or brace

• Immobilisation for 6–8 weeks

  
  

Surgical Treatment

Surgery is required when:

• The bone is broken into multiple pieces

• The fragments are displaced

• Stability cannot be achieved with a cast

Surgical options include:

• Internal fixation using plates, screws, or rods

• External fixation (a frame outside the body that stabilises the bone)

External fixation provides excellent stability but is used only when necessary due to patient discomfort.

Physiotherapy – A Crucial Part of Recovery

The goal of physiotherapy is to restore full function of the arm.

Early Stage (During Immobilisation)

Physiotherapy begins while the arm is still in a cast or brace.

Focus areas:

• Patient education (how to move safely)

• Blood clot prevention

• Improving circulation

• Maintaining movement in nearby joints

Important exercises include:

• Wrist and hand movements

• Shoulder blade (scapula) mobility

• Gentle activation of surrounding muscles

These movements speed up recovery and reduce stiffness after the cast is removed.

During immobilisation, the physiotherapist monitors:

• Sensation

• Blood circulation

• Movement quality below the cast

Any numbness, colour change, or increasing pain must be reported immediately, as it may indicate a cast that is too tight or fixation problems.

After Cast or Brace Removal

Once immobilisation ends:

• Active exercises are introduced

• Manual therapy helps restore soft tissue flexibility

• Joint mobilisations reduce stiffness

Rehabilitation includes:

• Shoulder and elbow movement in all directions

• Gradual strengthening

• Nerve mobility exercises to restore healthy nerve function

  
  

Possible Complications

Recovery may take longer if:

• Nerves or blood vessels were damaged

• Compartment syndrome developed

• Other structures were injured

In these cases, rehabilitation requires a modified approach.

When to See a Physiotherapist

You should start physiotherapy if you:

• Have fractured your upper arm

• Feel stiffness or weakness after immobilisation

• Want to return safely to work or sport

• Want to avoid long-term arm dysfunction

Early rehabilitation significantly improves outcomes.

Reference

Hoppenfeld S., Murthy V. L. Rehabilitation of Fractures. Lippincott Williams & Wilkins, 2000.