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1General considerations

Nonoperative treatment should provide mechanical support until the patient is sufficiently comfortable to begin shoulder use ...

Nonoperative treatment should provide mechanical support until the patient is sufficiently comfortable to begin shoulder use, and the fracture is sufficiently consolidated that displacement is unlikely. The intrinsic stability provided by the periosteum may guide the type of immobilization.

In fractures of the greater tuberosity and/or the surgical neck, the fracture may rest in better reduction if the arm is immobilized in abduction with a cushion.

Once these goals have been achieved, rehabilitative exercises can begin to restore range of motion, followed by strength, and function.
The three phases of nonoperative treatment are thus

  1. Immobilization
  2. Passive/assisted range of motion
  3. Progressive resistance exercises

Duration of Immobilization should be as short as possible, and as long as necessary. Typically, immobilization is recommended for 2-3 weeks, followed by gentle range of motion exercises. Resistance exercises can generally begin at 6 weeks. Isometric exercises may help maintain strength during the first 6 weeks.