A proximal humerus fracture is a break in the upper portion of the humerus, the long bone of the arm, located near the shoulder joint. This common injury often results from a fall onto an outstretched hand, and its location in the highly mobile shoulder joint means recovery is complex and multi-staged. The duration of pain following this fracture is highly variable, but it follows a predictable timeline that transitions from intense, constant pain to discomfort triggered by movement and rehabilitation.
The Acute Phase of Pain (Weeks 1-6)
The initial phase following a proximal humerus fracture is characterized by severe, unrelenting pain, typically most significant for the first three weeks. This discomfort is constant and throbbing, resulting from the initial trauma, swelling, and bleeding within the injured tissues. Extensive bruising, which can travel down the arm and chest wall, is also a common side effect.
Immobilization in a sling or swathe provides support and prevents movement of the fracture fragments, which reduces movement-related pain. Finding a comfortable position for sleep is extremely challenging, and sleeping upright in a recliner or propped up with pillows is often recommended for the first two to five weeks.
Pain management during this acute phase is intensive, often involving prescription-strength analgesics, including opioids for a short duration. The goal is to quickly transition to over-the-counter pain relievers, such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs), as the initial inflammation subsides. As the bone fragments begin to stabilize, typically around the three-to-four-week mark, the constant pain rapidly decreases. Patients are then encouraged to begin gentle, gravity-assisted exercises, such as pendular or Codman exercises, to prevent joint stiffness.
Transitioning to Functional Pain (Months 2-6)
As the fracture site stabilizes, the nature of the pain fundamentally changes from constant fracture-site pain to functional discomfort. By the two-month mark, the severe, constant throbbing is largely gone, replaced by pain primarily triggered by specific movements, stretching, and the physical demands of rehabilitation. This new type of pain is often a result of joint stiffness and surrounding muscle weakness, not necessarily the fracture itself, which typically takes six to twelve weeks to heal structurally.
Physical therapy becomes a primary focus in this stage, beginning around six weeks post-injury, or once the surgeon confirms sufficient bone healing. Stiffness is a major and expected challenge, with the risk of developing a “frozen shoulder” being a concern. The exercises are designed to regain motion, with a realistic goal for many patients being to achieve 80% of their shoulder motion by three months post-injury.
Sessions with a therapist often result in a temporary spike in pain due to the stretching of contracted soft tissues and the breakdown of scar tissue. While a day of therapy may be uncomfortable, the overall range of motion and pain levels should show gradual week-to-week improvement. Consistent adherence to the exercise program is considered a strong predictor of a better functional outcome during this period.
Key Factors Influencing Long-Term Pain Duration
The overall timeline for pain resolution depends on specific mechanical and biological variables unique to each patient and injury. Fracture complexity, ranging from a simple, non-displaced break to a multi-fragmented fracture, is a major factor. More displaced fractures are associated with poorer long-term outcomes and a higher likelihood of protracted pain.
The chosen treatment method also significantly modifies the pain experience. Non-surgical management, used for the majority of minimally displaced fractures, avoids the pain associated with surgical incisions and hardware. However, surgical fixation (with plates and screws) or joint replacement introduces additional post-operative pain, even though it aims for better long-term function.
Patient-specific biological factors also play a substantial role. Older age, chronic diseases, and poor bone health, such as osteoporosis, can delay healing and lead to a longer period of pain. Lifestyle factors like smoking significantly prolong fracture healing time. Psychological factors, including kinesiophobia (fear of movement), are strong predictors of persistent limitations and pain six to nine months after the injury.
Managing Persistent Discomfort and Full Resolution
A degree of discomfort can persist well beyond the initial six months. This lingering pain is often caused by secondary issues, such as hardware irritation, post-traumatic arthritis developing in the joint, or nonunion where the fracture fails to fully fuse. Chronic stiffness that has not fully resolved through physical therapy can also be a source of discomfort, particularly during changes in weather or after periods of inactivity.
The realistic timeline for complete pain resolution and maximum functional improvement often extends to 12 to 18 months; in complex cases, some patients report intermittent symptoms for up to two years. Even with excellent recovery, some individuals may not regain a full, pre-injury range of motion and may experience mild soreness with heavy use.
Managing this residual discomfort involves non-pharmacological strategies that support continued rehabilitation. Applying heat before exercise can help loosen the stiff joint, while ice application after therapy can reduce inflammation and soreness. Consistent, gentle stretching and adherence to the prescribed home exercise program are the most effective long-term strategies for minimizing persistent pain.