What is the recommended ROM progression after a proximal humeral fracture?

• A. AROM first, then PROM
• B. Immobilize only
• C. Isometric then Eccentric
• D. PROM first, then AROM

Answer: (D)

When healing a proximal humeral fracture, protect the fracture site while preserving joint mobility. The best approach is to start with passive range of motion (PROM) so the joint can move without the muscles pulling on the healing bone. This keeps the soft tissues flexible and helps prevent stiffness, without placing stress on the fracture fragments.

As healing progresses and pain allows, move into active-assisted ROM and then active range of motion (AROM). This gradually reintroduces muscle activity and helps restore movement and function without overloading the healing area. Strengthening exercises, such as isometric or later eccentric work, come in after ROM is established and pain-free.

Starting with PROM and then advancing to AROM protects the fracture during the early healing phase, whereas moving to active motion too soon can risk displacement, and relying on immobilization alone or jumping straight to strengthening procedures doesn’t promote mobility early on.