What exercises are recommended for a patient after Open Reduction Internal Fixation (ORIF) surgery for a humerus shaft fracture?

Rehabilitation Exercises After Humerus Shaft Fracture ORIF

Begin immediate early active motion without restrictions on movement or force, as modern locking plate fixation allows for aggressive rehabilitation that produces equivalent or superior outcomes compared to restrictive protocols. 1

Immediate Postoperative Period (0-2 Weeks)

Isometric exercises are the foundation of early rehabilitation and can be safely initiated from the first postoperative week:

• Start isometric shoulder exercises (deltoid, rotator cuff) when they provoke no pain, focusing on muscle reactivation 2
• Perform isometric elbow flexion and extension exercises to maintain muscle tone 3
• Include straight arm raises and gentle pendulum exercises for shoulder mobility 2
• These exercises improve range of motion without compromising stability or fixation 2

No immobilization is required - the shoulder-arm-sling should only be used for comfort, not worn continuously day and night 1

Early Active Motion Phase (Weeks 2-6)

Progress from isometric to active range of motion exercises as soon as pain and swelling allow:

• Begin active-assisted range of motion exercises for shoulder flexion, abduction, and rotation 1
• Initiate elbow flexion and extension exercises through pain-free ranges 3
• Start closed kinetic chain exercises for upper extremity strengthening, such as wall push-ups and table weight-bearing 2
• Add gentle forearm supination and pronation exercises 3

Progression criteria (not time-based):

• Absence of pain with current exercise level 4
• No increase in swelling, warmth, or effusion after activity 4, 5
• Ability to perform exercises with proper form without compensation 3

Progressive Resistance Training Phase (Weeks 6-12)

Transition to concentric and eccentric strengthening exercises:

• Begin light resistance (1-2 pounds or resistance bands) for shoulder exercises including flexion, abduction, and rotation 3
• Progress to biceps curls and triceps extensions with minimal resistance 3
• Introduce eccentric exercises cautiously, starting with body weight and gradually increasing resistance 3
• Continue closed kinetic chain exercises with increasing difficulty 2

The early functional approach (no movement restrictions) produces:

• Equivalent Constant scores (89.8% of uninjured side) compared to restrictive protocols 1
• Similar DASH scores (13.8-15.9 points) regardless of rehabilitation intensity 1
• No increased complication rates despite aggressive mobilization 1

Neuromuscular and Functional Training (Weeks 8-16)

Add neuromuscular training to optimize functional outcomes and prevent compensatory patterns:

• Incorporate proprioception exercises including rhythmic stabilization and weight-bearing on unstable surfaces 3
• Focus on quality of movement rather than quantity to prevent reinjury 2, 3
• Perform functional task training specific to patient's work or sport requirements 3
• Include scapular stabilization exercises to restore normal shoulder mechanics 3

Cardiovascular Conditioning Throughout Recovery

Low-impact activities provide conditioning without upper extremity stress:

• Walking, stationary cycling, and elliptical training are ideal throughout all phases 4
• Swimming can be initiated once wounds are fully healed (typically 3-4 weeks) 4
• These activities allow progressive loading in a controlled manner with minimal reinjury risk 4

Critical Monitoring Points

Watch for complications that require immediate attention:

• Signs of infection at surgical sites: increased warmth, erythema, drainage 4
• Development of compensatory movement patterns that may lead to secondary injuries 4, 5
• Persistent pain or swelling that doesn't improve with rest 4

Common pitfall: Restricting motion unnecessarily based on outdated protocols. Modern angular stable implants with adequate patient selection allow immediate active motion without increased complication rates 1. The restrictive approach (immobilization for 4 weeks) produces no better outcomes than early active motion and may prolong rehabilitation 1.

Return to Full Activity (3-6 Months)

Functional testing at 12 weeks guides progression to unrestricted activity:

• Manual muscle testing of shoulder and elbow strength compared to contralateral side 3
• Functional assessment of activities of daily living and work-specific tasks 3
• Quality of movement assessment during overhead and reaching activities 3

Return to heavy lifting and high-demand activities requires:

• Complete resolution of pain with all movements 4
• Restoration of normal movement mechanics 4
• Achievement of adequate strength (>85% of contralateral side) 3
• Successful completion of functional tests specific to intended activities 4