Humeral shaft fracture
Content reviewed by✓Mr Andrew Davies, PhD FRCS (Tr & Orth)· Reviewed June 2026A break in the middle of the upper arm bone (the bone between the shoulder and the elbow). Most people heal well in a special brace, without needing surgery.
📊 Breaks of the upper arm bone are not very common. They happen most often in two groups of people: younger adults after a heavy fall or accident, and older adults after a smaller fall because the bone has weakened with age (osteoporosis).
What is a humeral shaft fracture?
The upper arm bone runs from the shoulder down to the elbow. A break in the middle section of this bone is called a humeral shaft fracture. There is a nerve (the radial nerve) that wraps around the back of this bone, controlling movement in the wrist and fingers. This nerve can sometimes be bruised or stretched when the bone breaks.
Most of these fractures heal well in a special plastic brace worn around the upper arm. Gravity gently pulls the broken ends into a good position. The brace is worn 24 hours a day, often for around 8 to 12 weeks. Most people are surprised at how well this works, with bones healing without surgery in over 9 out of 10 cases.
If the X-ray shows the bone is in a poor position, if there is more than one break, if a nerve or blood vessel is damaged, or if you cannot tolerate the brace, surgery may be recommended instead. Surgery uses either a long rod inside the bone or a metal plate fixed with screws on the outside.
Common causes
- A fall directly onto the arm (the most common cause)
- Road traffic accidents and other heavy impacts
- Sports injuries, especially in contact sports or after a heavy throw
- Low-energy falls in older people whose bones have weakened (osteoporosis)
Who is at risk? Older people with weakened bones (osteoporosis) are at risk of breaking the upper arm after a small fall. Young people are usually injured in higher-energy events such as motorbike crashes or contact sports. Any break that happens after a very minor knock should be looked into, in case the bone was weakened before the fall.
Symptoms
Symptoms vary depending on the severity and duration of the condition. Common symptoms include:
- Pain, swelling, and bruising along the upper arm
- The arm may look bent or shorter than the other side
- A grinding feeling or sound when the arm is moved
- Inability to lift the arm or hold the elbow against the body
- If the radial nerve is involved, you may not be able to lift your wrist or fingers (wrist drop)
When to seek help: Go to A&E urgently after a significant arm injury, especially if there is pain, swelling, or visible deformity. Tell the doctor straight away if you cannot lift your wrist or fingers, as this is important.
How is it diagnosed?
Your surgeon will take a detailed history and examine the joint. The following investigations may be arranged to confirm the diagnosis:
- Examination of the arm, checking for tenderness, deformity, and the working of the radial nerve (asking you to lift your wrist and fingers)
- X-rays of the upper arm, taken from the front and side, including views of the shoulder and elbow
- Occasionally a CT scan, if the break is in many pieces or surgery is being planned
- Checking the pulse and feeling in the hand to make sure no blood vessels or nerves are injured
The radial nerve is checked at every visit. Around 1 in 10 of these fractures cause some weakness in the wrist and fingers, but in most cases this recovers on its own over a few weeks or months.
Treatment pathway
Treatment is tailored to the severity of the condition, your age, activity level, and overall health. Most conditions are treated in a stepwise fashion, starting with the least invasive options.
Functional brace
A custom-fitted plastic brace is wrapped around the upper arm a few days after injury, once the initial swelling has settled. It is worn day and night for around 8 to 12 weeks. The brace allows the shoulder and elbow to move while gravity holds the broken bone in line. Daily pendulum exercises (gently swinging the arm) help prevent stiffness.
Surgery to fix the bone
Surgery is recommended for fractures where the bone is in a very poor position, where multiple bones are broken, or where the brace cannot be tolerated. The surgeon either passes a metal rod down the inside of the bone, or fixes a metal plate to the outside with screws. Both approaches allow earlier return to activity but carry the usual risks of surgery.
Living in a functional brace
Most humeral shaft fractures are treated without surgery, in a moulded plastic functional brace. The brace wraps around the upper arm, and the surrounding muscles gently compress and hold the broken ends in line while gravity helps keep the alignment. It is usually fitted within 1-2 weeks of the injury, once the initial swelling has settled.
- Wear the brace day and night. The brace is worn 24 hours a day, including in bed, and removed only for washing and exercises. Consistent wear is the single most important factor in healing.
- Sleep more upright at first. For roughly the first 4 weeks, sleeping propped up or in a recliner lets gravity keep the fracture aligned. Lying flat too early can let the arm fall sideways.
- Start pendulum exercises straight away. Gentle shoulder pendulum exercises (letting the arm hang and swing in small circles) begin as soon as the brace is fitted, and are done several times a day to prevent stiffness.
- Washing and skin care. Remove the brace to wash, supporting the arm with your other hand, and refit it before lowering the arm. Check the skin underneath for rubbing or soreness, and keep it clean and dry.
- Expect to re-tighten it. The brace can be tightened or refitted as the swelling goes down. Your physiotherapist will show you how to adjust and refit it safely.
Week by week in the brace
- Days 1-14. A collar-and-cuff or temporary cast is used at first. The functional brace is fitted once the swelling settles, and pendulum exercises begin.
- Weeks 2-8. Brace worn 24 hours a day with daily pendulum exercises. Sleep more upright for about the first 4 weeks. An X-ray around 6 weeks checks healing.
- Weeks 8-12. When the X-ray shows healing, the brace is gradually discontinued and physiotherapy for the shoulder and elbow begins.
- Months 3-6. Strength returns and most activities resume. Any radial nerve recovery continues during this time.
Contact your team urgently if the arm changes position, the pain becomes severe, or you develop new weakness or numbness in the hand.
Recovery
The brace must be worn consistently, day and night, for the period your surgeon advises. Gentle daily pendulum exercises help prevent stiffness in the shoulder and elbow. Most people see steady healing on X-rays over 8 to 12 weeks. Some shoulder stiffness is common at first but usually improves with physiotherapy.
- Brace fitted: 1-2 weeks after injury
- Bone visibly healing on X-ray: 8-12 weeks
- Brace removed: Usually around 12 weeks
- Return to normal daily activities: 3-6 months
What results can I expect?
Most upper arm breaks heal well with a brace. Where the radial nerve is affected at the time of injury, recovery is usually complete over a few months. Surgery is generally reserved for the smaller number of cases where the brace cannot work.
Upper arm fracture - brace treatment and what to expect
Common activity questions for this condition. Timelines are approximate, always follow the specific guidance given by your surgeon and physiotherapist.
| Activity | Typical timeline | Notes |
|---|---|---|
| Drive | Months 3–4 | When brace is off and arm strength is adequate for safe vehicle control. |
| Sleep in bed | Weeks 4–6 | Sleep semi-upright (45°) for about the first 4 weeks while the fracture stabilises. Most patients return to a normal sleeping position after that. |
| Shower | Week 1–2 | Brace can be removed for washing. Support the arm with the other hand. Refit before putting down. |
| Return to desk work | Weeks 4–8 | One-handed desk work possible earlier. Two-handed work when arm is out of brace. |
| Manual work | Months 4–5 | When brace is off and sufficient strength has returned. |
| Sport | Months 4–6 | Non-contact sport when healed. Contact sport after confirmed union on X-ray. |
| Brace removal | Weeks 8–12 | When X-ray confirms union. Do not remove brace without surgical team permission. |
Common concerns during recovery, and whether they are expected.
Your questions, answered
Plain-English answers to the things people most often ask, drawn from real patient questions and grounded in published guidance. Tap a question to open it.
About thisWhat is a humeral shaft fracture?
It is a break in the main shaft of the upper-arm bone, usually after a fall or a direct blow.
Your choiceDo I need surgery?
Many humeral shaft fractures heal without surgery, often supported in a functional brace. Surgery, using a plate or rod, is considered for certain patterns, multiple injuries, or if the bone is not healing. Your surgeon will advise on the best option for you.
Getting backHow long does recovery take?
Bone healing commonly takes around 8 to 12 weeks or more, with strength and function returning over the following months. A brace allows the nearby joints to keep moving while the bone heals.
Wrist nerveWhy is my wrist or hand weak?
The radial nerve runs close to this bone and can be stretched by the fracture, causing temporary weakness lifting the wrist and fingers (sometimes called wrist drop) or numbness on the back of the hand. This often recovers over weeks to months; your team will monitor it and may use a splint.
Pain & medsHow do I manage pain?
Pain relief together with support from a brace or sling. Keep the hand, wrist and shoulder moving as advised to limit stiffness.
UrgentWhen should I seek urgent help?
New weakness lifting the wrist or fingers, numbness on the back of the hand, a cold or pale hand, severe swelling, or signs of wound infection after surgery all need prompt review.
WellbeingThe long recovery is getting me down.
That is understandable with a fracture that heals slowly. Tracking small gains and keeping the nearby joints moving helps; contact your team with any concerns.
- NHS: Broken arm or wrist
- British Elbow & Shoulder Society: Early exercises for shoulder problems and sling care
- British Elbow & Shoulder Society: Patient information
These links are to UK clinical guidance and patient information from recognised organisations. This page is for general information and does not replace personalised advice from your own clinical team.
Preparing for surgery?
Read our step-by-step guide - what to expect before, during, and after your procedure.
How is it diagnosed?
- ✓Examination of the arm, checking for tenderness, deformity, and the working of the radial nerve (asking you to lift your wrist and fingers)
- ✓X-rays of the upper arm, taken from the front and side, including views of the shoulder and elbow
- ✓Occasionally a CT scan, if the break is in many pieces or surgery is being planned
- ✓Checking the pulse and feeling in the hand to make sure no blood vessels or nerves are injured
Recovery milestones
- ●Brace fitted: 1-2 weeks after injury
- ●Bone visibly healing on X-ray: 8-12 weeks
- ●Brace removed: Usually around 12 weeks
- ●Return to normal daily activities: 3-6 months