nonoperatively treated proximal humerus fractures: randomized trial of immediate versus delayed initiation of exercises

Objectives: there is debate about when to start exercises in the nonoperative treatment of a proximal humerus fracture. this randomized trial compared immediate and one -month delayed shoulder exercises in the nonoperative treatment of fractures of the proximal humerus. methods: twenty-six patients with a fracture of the proximal humerus who chose nonoperative treatment were randomized to start pendulum exercises within a few days and 24 were randomized to delayed exercises and started with active self-assisted stretching 1 month after fracture. three and six months after the injury, patients completed the disabilities of the arm shoulder and hand questionnaire to measure capability, a measure of pain intensity, and had motion measurements. results: there was no significant difference in forward flexion (primary outcome) six months after injury between patients that started motion exercises immediately compared to 1 month after injury (p = 0.85). there was no difference in any motion measurement, pain intensity, upper extremity specific disability (dash score) three or six months after injury. conclusion: delaying exercises for a month does not affect recovery from nonoperative treatment of a fracture of the proximal humerus. people can choose whether to start exercises immediately or wait until they feel comfortable.