Collar-and-cuff sling (most patients) or surgery (selected cases)
Content reviewed by✓Mr Andrew Davies, PhD FRCS (Tr & Orth)· Reviewed June 2026Most broken shoulders, even when displaced, are treated in a simple sling with early exercises. This page explains what to expect from recovery and what surgery involves if it is recommended.
Step 1, Starting exercises from day one
ℹ️ Whatever treatment you are having, pendulum exercises begin from day one. These are gentle swinging movements of the arm that keep the shoulder from stiffening while the bone heals. Your physiotherapist will teach you the correct technique.
If surgery is recommended, usually for severely displaced fractures or fractures with more than two major fragments in younger patients, this typically involves a locking plate fixed to the outer surface of the bone, or in some elderly patients, a shoulder replacement. Surgery is performed under general anaesthetic and takes 60–90 minutes.
Pendulum exercises from day one
Start pendulum exercises as soon as you get home. These are the most important thing you can do in the early weeks. Let the arm hang and swing gently in small circles.
Wear the sling when not exercising
The collar-and-cuff sling supports the weight of the arm and helps ease the pain. Wear it when resting, sleeping, and moving around. Remove it only for exercises and washing.
Start bone health treatment
A broken shoulder after a simple fall is a sign that the bones may be thinning (osteoporosis). Your GP or fracture liaison service will arrange assessment and treatment. This is important to prevent future fractures.
X-ray at 2 weeks is important
A follow-up X-ray at 2 weeks checks that the fracture has not moved. If it has shifted significantly, surgery may become necessary. Attend this appointment.
The day of surgery
ℹ️ You will be given a specific arrival time. Have no food from 2am on the day of surgery; you may drink clear water until 6am. Bring your medication list and any documents sent by the hospital.
Arrive at the time given
You will be admitted to the ward or day surgery unit, change into a gown, and be seen by the nursing, anaesthetic, and surgical teams before theatre.
Consent and marking
Your surgeon will confirm the procedure, mark the operative side, and you will sign a consent form before going to theatre.
Anaesthetic
You will meet the anaesthetist in the anaesthetic room. Once anaesthesia is established, the procedure will begin.
Recovery room
After surgery you will wake in the recovery room where nurses monitor your vital signs until you are stable and comfortable.
In hospital
Most patients having arthroscopic or day-case procedures go home on the day of surgery. Those having joint replacement typically stay 1–2 nights. Before discharge, the team will check your pain is controlled, give you wound care instructions, and confirm your follow-up appointment.
Pain control
You will be given oral pain relief before discharge. Take it regularly for the first 48 hours rather than waiting until pain is severe.
Wound check and dressing
A nurse will check the wound before you leave and explain how to keep it clean and dry.
Discharge letter and follow-up
You will receive a letter for your GP and details of your next outpatient appointment - usually at 2 weeks for a wound check.
You must not drive yourself home
Arrange for a family member or friend to collect you. You must not drive on the day of surgery if you have had a general anaesthetic or sedation.
Going home
⚠️ Important: Attend your 2-week X-ray. Contact your team if pain increases significantly rather than gradually improving, or if the shoulder feels different to how it did initially.
Keep the wound clean and dry
Avoid getting the wound wet until it is fully healed - usually 10–14 days. Use a waterproof cover or cling film when showering.
Take your pain relief as prescribed
Do not wait until pain is severe before taking medication. Regular simple analgesia (paracetamol, ibuprofen if appropriate) is more effective.
Attend your wound check appointment
This is usually 2 weeks after surgery. Sutures or clips will be removed if used.
When to contact the hospital
Seek urgent advice if you develop increasing redness, warmth, swelling, discharge from the wound, or a temperature above 38°C - these may indicate infection.
Recovery week by week
Sling and pendulum exercises
Arm in collar-and-cuff sling. Pendulum exercises begin. Ice for pain. Sleep propped up.
X-ray check
Follow-up X-ray to confirm the fracture position is acceptable. Physiotherapy assessment.
Increasing movement
Passive and active-assisted shoulder movements begin. Sling use reduces as comfort improves.
Active strengthening
Active elevation and strengthening exercises progress. Return to driving when safe.
Full recovery
Recovery from broken shoulders is often slow, 6–12 months is normal. Persist with your exercise programme.
Why no surgery? My shoulder looks very displaced.
Research shows that for most broken shoulders, even displaced ones, a sling and early exercises give results at least as good as surgery, with fewer risks. Surgery has genuine complications including infection, nerve injury, and implant failure. The PROFHER trial (a large UK study) found no benefit of surgery over sling treatment in most cases.
How long before I can drive?
Most patients return to driving at 2–3 months, once the fracture is healed and they have enough arm strength to control the car safely. Do not drive until you are confident you could perform an emergency stop.
Why has my shoulder changed shape?
Some displaced fractures cause a visible change in the shape of the shoulder. This usually improves as swelling settles and the fracture heals. Some change in shape may be permanent but this does not always affect function.
Recovery calendar
A week-by-week guide to recovery. Individual timelines vary, always follow your surgical team.
Consent information
Purpose and intended benefits
For locking plate fixation: the aim is to restore anatomical alignment of the humeral head and tuberosities to allow rotator cuff healing and restore shoulder function. For reverse shoulder replacement: the aim is to provide reliable pain relief and functional movement without the need for a functional rotator cuff.
What the procedure involves
Locking plate: through a cut at the front of the shoulder, the broken pieces are moved back into position and held with a specially shaped metal plate and screws fixed to the side of the bone. The bony attachments for the rotator cuff tendons are stitched securely to the plate. This takes about 90-120 minutes. Reverse shoulder replacement: the damaged ball of the shoulder is removed and replaced with an artificial joint, and the bony fragments are stitched back around it. This is used when the bone is too broken or too soft to hold a plate reliably, and also takes about 90-120 minutes.
Alternative treatments
Non-operative management
A sling for 2-4 weeks followed by physiotherapy. The standard treatment for most minimally displaced proximal humeral fractures and for elderly patients with displaced fractures, based on PROFHER trial evidence.
Locking plate fixation
For displaced fractures in active patients with good bone quality. This includes suitable patients over 65, where the bone quality and fracture pattern allow the plate and screws to hold securely.
Reverse shoulder replacement
For elderly patients with complex fractures, poor bone quality, or where reliable fixation is not possible.
Hemiarthroplasty
Replacement of the humeral head only. Less commonly used than reverse replacement for fracture indications.
Risks of the procedure
Disruption of the blood supply to the humeral head during the fracture or surgery. The humeral head collapses, causing pain and loss of function. May require revision to shoulder replacement.
Locking screws may penetrate through the humeral head into the joint, damaging the cartilage and rotator cuff. Sometimes requires removal of screws or revision surgery.
Failure of the fracture to heal or healing in a poor position. May require revision surgery.
Wound or periprosthetic infection.
Numbness over the outer shoulder and deltoid weakness. Usually a temporary neurapraxia.
Long-term complication of shoulder replacement requiring revision surgery.
Expected and managed with regular analgesia.
The arm is in a sling for 4-6 weeks. Restriction is expected during this period.
Expected after proximal humeral fracture regardless of treatment. Physiotherapy is essential.
Normal and expected after significant shoulder trauma and surgery.
If you choose not to have surgery
For most elderly patients with displaced proximal humeral fractures, the PROFHER trial demonstrates equivalent functional outcomes between surgery and non-operative management. Surgery carries additional procedural risks and should only be recommended when the expected benefit justifies these risks. For younger patients with specific displaced fracture patterns, fixation may offer a better chance of restoring normal shoulder function.
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 proximal humerus fracture?
It is a break at the top of the upper-arm bone, near the shoulder. It is common in older adults after a fall and is often linked to thinning of the bone (osteoporosis).
Your choiceDo I need surgery?
The majority are managed without surgery, in a sling, with early guided movement. Surgery, either fixation or sometimes a shoulder replacement, is considered for badly displaced or unstable breaks, particularly in more active patients. Good evidence shows many of these fractures do as well without an operation.
Getting backWhat is recovery like?
Expect a sling for a few weeks, then progressive movement and strengthening. It commonly takes several months to regain comfortable movement, and some aching or stiffness can persist.
StiffnessWhy is my shoulder so stiff?
The shoulder stiffens easily after this injury. Physiotherapy and patience are the main treatment, and most people improve steadily over time.
Pain & sleepHow do I manage pain and sleep?
Pain relief, a sling, and sleeping propped up help early on. Gentle pendulum swings and hand and elbow movements, as advised, help prevent stiffness.
Bone healthShould my bones be checked?
Yes. A fracture from a low fall in an older adult is a good reason to review your bone health and falls risk with your GP, which can reduce the chance of future fractures.
UrgentWhen should I seek urgent help?
Hand numbness or weakness, a cold or pale hand, severe uncontrolled pain, or signs of wound infection after surgery.
WellbeingThe slow shoulder recovery is frustrating.
That is very common with this injury. A realistic timeline and steady physiotherapy support recovery; reach out to your team if progress worries you.
- NHS: Broken arm or wrist
- NHS: Shoulder pain
- British Elbow & Shoulder Society: early exercises 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.