Proximal Humerus ORIF Rehabilitation
What is a proximal humerus ORIF?
Open reduction and internal fixation (ORIF) of the proximal humerus is a surgical procedure to repair a fracture of the upper end of the humerus — the ball-shaped head of the upper arm bone that forms the glenohumeral joint with the shoulder socket. The surgery involves making an incision to directly visualise and reposition the fractured bone fragments (open reduction), then securing them with metal hardware — typically a locking plate and screws — to hold them in correct alignment while healing occurs (internal fixation).
Proximal humerus fractures are one of the most common fractures in adults over 65, ranking third in frequency behind hip and wrist fractures in the older adult population. They most commonly result from a fall onto an outstretched hand or directly onto the shoulder, and the presence of osteoporosis — which weakens bone structure — significantly increases both fracture risk and the complexity of fixation. In younger adults, proximal humerus fractures typically require higher-energy trauma and carry different bone quality considerations.
Not all proximal humerus fractures require surgery. Minimally displaced fractures — where the fragments have not significantly shifted from their normal position — are frequently managed conservatively with a sling and physiotherapy. ORIF is typically indicated for significantly displaced or comminuted (multi-fragment) fractures where the alignment cannot be maintained without surgical fixation, or where the fracture pattern risks disrupting the blood supply to the humeral head.
Why is physiotherapy essential after proximal humerus ORIF?
Physiotherapy is vital for restoring range of motion through controlled exercises that reduce stiffness and improve shoulder mobility, rebuilding strength to prevent muscle imbalances and compensatory movement patterns, and preventing complications including frozen shoulder, muscle atrophy and scar tissue formation.
The risk of frozen shoulder (adhesive capsulitis) after proximal humerus ORIF deserves specific emphasis — it is one of the most common and most debilitating complications of this procedure, and early physiotherapy intervention is the primary means of prevention. The shoulder's capsule and surrounding soft tissues stiffen rapidly in response to pain, immobilisation and surgical trauma, and once a full frozen shoulder develops, it can take twelve to thirty-six months to resolve and may require further intervention. Commencing appropriate passive range-of-motion exercises under physiotherapy guidance as early as the surgeon permits is critical.
What does rehabilitation involve?
Recovery timelines vary but generally follow these stages: zero to six weeks focuses on immobilisation with passive range-of-motion exercises; six to twelve weeks transitions to active range-of-motion and light strengthening; three to six months involves progressive strengthening and functional training.
In the first six weeks, the arm is held in a sling and the fracture site is protected while early bone healing occurs. Physiotherapy during this phase is focused primarily on preventing the frozen shoulder complication — gentle pendulum exercises, passive elevation within the surgeon's permitted range, and active movement of the hand, wrist and elbow prevent stiffness spreading beyond the fracture site. Postural education and positioning advice reduce pain and prevent the forward-rounded posture that develops rapidly with arm immobilisation.
From six to twelve weeks, as the fracture consolidates on X-ray and the surgeon clears progressive loading, active shoulder movement is introduced. Range-of-motion work in flexion, abduction and rotation is systematically progressed. Rotator cuff strengthening begins gently — initially with the arm at the side — as pain and healing allow. This phase requires close communication with the operating surgeon about the quality of the fixation and the bone, which influences how aggressively range of motion and strengthening can be pursued.
From three to six months, progressive strengthening through increasing ranges is the focus. Rotator cuff, deltoid and periscapular muscle strengthening restores the dynamic stability and movement quality needed for daily activities, overhead function and return to recreational activities. Clinical Pilates integrates well into this phase, providing controlled shoulder and scapular loading with precise progression. Real time ultrasound assists in retraining rotator cuff activation where inhibition from pain and surgery has disrupted normal musclerecruitment.
Specific considerations for older adults
For older adults — who make up the majority of proximal humerus ORIF patients — rehabilitation needs to address broader considerations beyond the shoulder itself. Falls prevention is central: the fracture typically occurred because of a fall, and without addressing the underlying balance, strength and reaction time deficits that contributed, the risk of a further fall and fracture remains elevated. Our Balance and Bones exercise classes are specifically designed for this population. Bone health management — adequate calcium and vitamin D intake, medication review, and appropriate weight-bearing exercise — is equally important and worth discussing with the patient's GP or specialist.
For patients whose fracture occurred in a motor vehicle accident or workplace incident, CTP and WorkCover funded rehabilitation is available.
Our physiotherapists Bethany Kippen and Emma Cameron both have experience in post-surgical shoulder rehabilitation and are members of the Australian Physiotherapy Association. Exercise Physiologist Ash O'Regan contributes to falls prevention and bone health programming for older adult patients.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Open reduction and internal fixation (ORIF) of the proximal humerus is a surgical procedure to repair a fracture of the upper end of the humerus — the ball-shaped head of the upper arm bone that forms the glenohumeral joint with the shoulder socket. The surgery involves making an incision to directly visualise and reposition the fractured bone fragments (open reduction), then securing them with metal hardware — typically a locking plate and screws — to hold them in correct alignment while healing occurs (internal fixation).
Proximal humerus fractures are one of the most common fractures in adults over 65, ranking third in frequency behind hip and wrist fractures in the older adult population. They most commonly result from a fall onto an outstretched hand or directly onto the shoulder, and the presence of osteoporosis — which weakens bone structure — significantly increases both fracture risk and the complexity of fixation. In younger adults, proximal humerus fractures typically require higher-energy trauma and carry different bone quality considerations.
Not all proximal humerus fractures require surgery. Minimally displaced fractures — where the fragments have not significantly shifted from their normal position — are frequently managed conservatively with a sling and physiotherapy. ORIF is typically indicated for significantly displaced or comminuted (multi-fragment) fractures where the alignment cannot be maintained without surgical fixation, or where the fracture pattern risks disrupting the blood supply to the humeral head.
Why is physiotherapy essential after proximal humerus ORIF?
Physiotherapy is vital for restoring range of motion through controlled exercises that reduce stiffness and improve shoulder mobility, rebuilding strength to prevent muscle imbalances and compensatory movement patterns, and preventing complications including frozen shoulder, muscle atrophy and scar tissue formation.
The risk of frozen shoulder (adhesive capsulitis) after proximal humerus ORIF deserves specific emphasis — it is one of the most common and most debilitating complications of this procedure, and early physiotherapy intervention is the primary means of prevention. The shoulder's capsule and surrounding soft tissues stiffen rapidly in response to pain, immobilisation and surgical trauma, and once a full frozen shoulder develops, it can take twelve to thirty-six months to resolve and may require further intervention. Commencing appropriate passive range-of-motion exercises under physiotherapy guidance as early as the surgeon permits is critical.
What does rehabilitation involve?
Recovery timelines vary but generally follow these stages: zero to six weeks focuses on immobilisation with passive range-of-motion exercises; six to twelve weeks transitions to active range-of-motion and light strengthening; three to six months involves progressive strengthening and functional training.
In the first six weeks, the arm is held in a sling and the fracture site is protected while early bone healing occurs. Physiotherapy during this phase is focused primarily on preventing the frozen shoulder complication — gentle pendulum exercises, passive elevation within the surgeon's permitted range, and active movement of the hand, wrist and elbow prevent stiffness spreading beyond the fracture site. Postural education and positioning advice reduce pain and prevent the forward-rounded posture that develops rapidly with arm immobilisation.
From six to twelve weeks, as the fracture consolidates on X-ray and the surgeon clears progressive loading, active shoulder movement is introduced. Range-of-motion work in flexion, abduction and rotation is systematically progressed. Rotator cuff strengthening begins gently — initially with the arm at the side — as pain and healing allow. This phase requires close communication with the operating surgeon about the quality of the fixation and the bone, which influences how aggressively range of motion and strengthening can be pursued.
From three to six months, progressive strengthening through increasing ranges is the focus. Rotator cuff, deltoid and periscapular muscle strengthening restores the dynamic stability and movement quality needed for daily activities, overhead function and return to recreational activities. Clinical Pilates integrates well into this phase, providing controlled shoulder and scapular loading with precise progression. Real time ultrasound assists in retraining rotator cuff activation where inhibition from pain and surgery has disrupted normal musclerecruitment.
Specific considerations for older adults
For older adults — who make up the majority of proximal humerus ORIF patients — rehabilitation needs to address broader considerations beyond the shoulder itself. Falls prevention is central: the fracture typically occurred because of a fall, and without addressing the underlying balance, strength and reaction time deficits that contributed, the risk of a further fall and fracture remains elevated. Our Balance and Bones exercise classes are specifically designed for this population. Bone health management — adequate calcium and vitamin D intake, medication review, and appropriate weight-bearing exercise — is equally important and worth discussing with the patient's GP or specialist.
For patients whose fracture occurred in a motor vehicle accident or workplace incident, CTP and WorkCover funded rehabilitation is available.
Our physiotherapists Bethany Kippen and Emma Cameron both have experience in post-surgical shoulder rehabilitation and are members of the Australian Physiotherapy Association. Exercise Physiologist Ash O'Regan contributes to falls prevention and bone health programming for older adult patients.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
