Pain guide · Shoulder pain
A broken shoulder usually means a break at the top of the arm bone (the proximal humerus), most often from a fall in later life. Most heal in a sling without an operation: in the UK PROFHER trial, surgery gave no better shoulder function than a sling at 2 years or at 5.
Your team's plan comes first, and hospitals differ on how long the sling stays on and when exercises start. This guide sets out the usual stages, from hand and elbow exercises in the sling through pendulums and assisted movement to strength, with a 3D demo of each move, plus the bone health and falls checks worth asking for.
Exercise is for pain that has been checked or is clearly mild and settling.
Usually a break in the top part of the upper arm bone (the humerus), next to the shoulder joint: a proximal humerus fracture, sometimes called a fractured neck of humerus. Breaks of the collarbone and the shoulder blade are different injuries; the NHS has a separate page on a broken collarbone.
These breaks make up 5 to 6% of adult fractures. In a study of 1,027 of them, most happened in fit older people, the rate was highest in women aged 80 to 89, and about half had barely moved out of place. Most follow a fall from standing height, and NICE (the National Institute for Health and Care Excellence) counts the shoulder among the four main sites of osteoporotic fractures.
Severe pain, a very swollen shoulder, very limited movement and bruising round the top of the arm, which can spread down to the elbow and hand over the first weeks. It needs an X-ray, and sometimes a CT (computed tomography) or MRI (magnetic resonance imaging) scan.
Nerves are often affected. In 143 people tested with electrical nerve studies after a low-energy break, 67% showed nerve damage, most often to the axillary nerve (58%), and more often when the bone had moved. The nerves recovered in everyone, but more slowly, shoulder function recovered less well, and an examination alone often missed the nerve damage.
Most are treated in a collar and cuff or a sling. With a collar and cuff, the hand sits above the elbow so the weight of the arm helps keep the healing bone in line.
NICE advises treatment without surgery for uncomplicated displaced breaks from a low-energy fall in adults, and considering surgery for an open wound, skin tented by bone, a damaged blood vessel, a break with a dislocation, or a split in the ball of the joint. An operation means a plate, screws or pins, or a shoulder replacement.
The bone usually heals in 6 to 12 weeks. In one NHS trust's leaflet most of the recovery comes in the first 6 weeks, and strength can take up to a year; another says improvement continues for 12 to 18 months. Most people get back enough movement for daily activities, but some loss at the extremes often stays.
In the UK PROFHER trial, 250 adults (average age 66) with a displaced break at the neck of the humerus, including 3- and 4-part breaks, had either an operation, by surgeons experienced in it, or a sling, with the same rehabilitation for both. Over 2 years shoulder scores were almost identical (about 39 against 38 out of 48, where 5 points would matter), and complications, further operations and deaths didn't differ significantly. At 5 years there was still no difference, and surgery cost about £1,800 more per person.
A 2022 Cochrane review pooled 10 trials comparing surgery with no surgery (717 people, mostly women over 60, two-thirds with 3- or 4-part breaks). It found high-certainty evidence that surgery makes no clinically important difference to shoulder function at 1 or 2 years, and lower-certainty evidence that it leads to more repeat operations (about 38 more per 1,000 people). Evidence is lacking for people under 60, high-energy injuries and breaks with a dislocation.
In 6 mostly retrospective studies (439 people, average age 79) with 3- or 4-part breaks, a reverse shoulder replacement gave more forward lift (about 122° against 100°) and outward turn than a sling, with similar complications, but the authors call the evidence limited. The UK PROFHER-2 trial compared a reverse replacement, a half replacement and no surgery in people over 65; when its record was last updated in December 2025, no results had been published.
In 74 people with an impacted break, gentle movement started within 3 days gave better shoulder scores at 6 weeks and 3 months than 3 weeks in a sling, and less pain at 3 months, with no slipping of the bone. In 86 people with a 2-part break, physiotherapy within a week gave less pain and better function at 16 weeks than 3 weeks in a collar and cuff; by 2 years the difference was no longer significant. In 111 people (average age 70), 1 week in a sling did as well as 3 weeks, up to 2 years.
Reviews disagree on how sure we can be. A 2025 review of 6 trials (470 people) found early movement safe and better for function at 3 months, with no difference later, and rated the evidence moderate to high; a 2021 review found the gain too small to matter; and the 2022 Cochrane review rated the evidence very low certainty. The safe reading: early, gentle movement doesn't harm the break, and may make the first months easier.
In 17 healthy volunteers, the shoulder joint itself moved only about 7° to 14° during pendulums; most of the movement came from the trunk. So they are a gentle way to keep the arm moving early on, not a way to regain range. Large swings (about 51 cm across) made the rotator cuff work at more than 15% of its maximum, more than small 20 cm swings, so keep the circles small at first. These are lab studies in people without injuries.
In a Nordic trial of 72 people aged 60 and over with a 2-part break treated without surgery, 10 weeks of weekly supervised physiotherapy plus daily home exercise gave no better arm function at 3 months, or anything else at 12 months, than daily home exercise alone. A 2021 review found no evidence either way, and in PROFHER every hospital gave home exercises alongside a basic physiotherapy protocol. Ask for physiotherapy if you're struggling to regain movement.
After a fragility fracture at 50 or over, NICE asks for a fracture risk assessment, and it offers a bone density (DXA) scan after a single shoulder, wrist, hip or spine fragility fracture in the past 2 years. Its falls guideline recommends a full falls assessment for people who have fallen in the past year and were injured.
Exercise helps with the falls: in a Cochrane review of 59 trials (12,981 older people living at home), exercise cut the rate of falls by 23% (high certainty) and may reduce falls that break a bone by about a quarter (low certainty).
While the arm is in the sling and during the assisted-movement stage, NHS leaflets say: move within the limits of pain you can tolerate, don't force or stretch, and if an exercise brings a significant increase in pain, stop that exercise until you've asked your physiotherapist. Mild discomfort is fine.
From the strengthening stage, the shoulder pain rule applies: pain up to about 5 out of 10 during the exercises, back to where it started by your next session. If it isn't, use a lighter band or a smaller range next time, not nothing. In the Holmgren trial in rotator cuff pain, pain was not allowed above 5 out of 10 and had to settle before the next session; using that rule after a fracture is our suggestion.
Start at the first stage. Each move opens a full guide with a 3D demo.
As your team allows, from the first days. Wear the sling or collar and cuff as your team says, often day and night for the first 2 to 4 weeks, and take the arm out several times a day to straighten the elbow. Sleep propped up, or on the good side with pillows. Pendulums only when your team says so: lean on a table with your good hand, keep the circles small, and leave them out if your balance is poor.
3D demoTendon glides (hand tendon gliding exercises)Beginner · No equipment5 to 10 reps, 4 to 5 times a day · Make a fist and stretch the fingers wide. An NHS leaflet's dose
Harder: Ball squeeze
3D demoWrist & forearm flowBeginner · No equipment5 to 10 reps, 4 to 5 times a day · With the forearm supported. An NHS leaflet's dose
Harder: Wrist flexor stretch
3D demoElbow bend and straighten (elbow range of motion)Beginner · No equipment5 to 10 reps, 4 to 5 times a day · The other hand can help. An NHS leaflet's dose
Harder: Dumbbell biceps curl
3D demoNeck CARsBeginner · No equipmentSeparate turns, each held 5 s: 5 each way, 3 times a day · Turns rather than full circles while it's sore. An NHS leaflet's dose
3D demoPendulum exercise (Codman's pendulum)Beginner · A bench or box10 small swings or circles each way, 3 times a day, when your team allows · Lean on a table with your good hand. An NHS leaflet's dose
Move on when: Your team says the shoulder itself can start moving with help, often at 2 to 4 weeks, and the pain is settling.
As your team allows, often from about 2 to 4 weeks. Take the arm out of the sling for light tasks and these exercises, and wean off it as your team advises; one NHS trust aims to stop by about 6 weeks. Don't force or stretch.
3D demoPendulum exercise (Codman's pendulum)Beginner · A bench or box10 each way, 3 times a day · An NHS leaflet's dose
3D demoTable slide (seated forward reach)Beginner · A bench or box5 to 10 slow reps, 3 times a day · Forwards, then out to the side. NHS leaflets' doses
Easier: Pendulum exercise (Codman's pendulum) · Harder: Overhead lat stretch at a bench
3D demoStick-assisted external rotation (lying)Beginner · Other / check instructions10 reps, twice a day · Elbow tucked in at your side; one NHS trust starts this at about 4 weeks
Harder: Standing band external rotation
3D demoSeated upper-back lift (sit tall, shoulders back)Beginner · A bench or box3 to 5 reps, each held 3 to 5 s, daily · Sit tall with the shoulders gently back
Easier: Elbows back · Harder: Prone Y-T-W raises
3D demoSit to stand from a chairBeginner · A bench or boxUp to 10, standing briskly and sitting slowly · Use your legs and the good arm, not the broken one. Editorial dose
Harder: Bodyweight squat
Move on when: The arm moves more easily with help, you're out of the sling or nearly, and your team is happy for you to use the arm on its own.
As your team allows, often from about 6 weeks. Use the arm for light and then medium tasks, with no lifting above shoulder height yet. The doses at this stage are editorial.
3D demoBreath reachBeginner · No equipment5 slow breaths, lifting only as high as is comfortable
3D demoStanding band external rotationBeginner · A band + An anchor point2 sets of 10 to 15 with a light band · Elbow at your side
Harder: Side-lying external rotation
3D demoBand internal rotationBeginner · A band + An anchor point2 sets of 10 to 15 with a light band
Harder: Side-lying external rotation
3D demoBand rowBeginner · A band + An anchor point2 sets of 10 to 12 with a light band
Move on when: You can lift the arm to shoulder height on your own, daily tasks are getting easier, and the exercises pass the pain rule.
As your team allows, from about 3 months; one NHS trust's guide allows heavier and overhead lifting from 3 to 6 months. Keep up leg strength and balance work, because a broken shoulder from a fall is a reason to ask for a falls assessment. The doses are editorial.
3D demoScaption raiseBeginner · A dumbbell2 to 3 sets of 10, light, up to shoulder height
Easier: Band lateral raise · Harder: Smith machine upright row
3D demoShoulder press with a bandBeginner · A band2 to 3 sets of 8 to 12 · Once reaching overhead is comfortable
Harder: Push press
3D demoBand rowBeginner · A band + An anchor point3 sets of 10 to 15 · The move's own starting dose
3D demoTandem stance and heel-to-toe walkBeginner · A wallHold 10 to 30 s with a hand on the worktop, then without; then 10 heel-to-toe steps · Stay beside a wall or worktop
Easier: Semi-tandem stance · Harder: Single-leg stand
3D demoFarmer's carryBeginner · A dumbbell + A kettlebell3 walks of 20 to 30 m, light
Harder: Suitcase carry
Move on when: Build towards your usual activities, adding a little load every week or two. Strength can take up to a year to come back.
These come from three NHS trusts' leaflets, and they differ. Your own team's timings come first.
Many people sleep propped up at first, or on the good side with a pillow in front to rest the arm on and one behind. To wash under the arm, lean forward and let it hang slightly away from your body, sitting down if your balance is poor. Put the broken arm into a sleeve first, and take it out last.
When sitting, rest the arm on a pillow with the elbow gently straightened and the hand a little higher than the elbow, to help the swelling.
One NHS trust's guide: use the arm only for essential tasks such as washing and dressing, and avoid pushing up from a chair with it, lifting, carrying, pushing and pulling. From about 4 to 6 weeks, light housework, lifting nothing heavier than a cup of tea.
Source 1
| Habit or position | Why it matters | Instead |
|---|---|---|
| Keeping the whole arm still | The hand, wrist and elbow stiffen, and early movement was safe in trials. | Hand, wrist and elbow exercises from the start. |
| Big, fast pendulum swings early on | Large swings make the rotator cuff work harder; small ones keep the arm moving. | Small, slow circles. |
| Pendulums when your balance is poor | You lean forward on one hand, and one NHS trust says leave them out if your balance is poor. | Seated table slides, once your team allows. |
| Pushing up from a chair with the broken arm in the first weeks | One NHS trust advises against it for the first 3 weeks. | Stand up using your legs and the other arm. |
| Lifting above shoulder height before about 3 months | One NHS trust allows medium work from 6 weeks, but heavy and overhead work from 3 to 6 months. | Work at waist and chest height first. |
| Forcing a stiff shoulder | NHS leaflets say don't force or stretch. | Assisted movement within comfort; ask for physiotherapy if progress stalls. |
| Lying on the broken side | It's painful early on. | Propped up, or on the good side with pillows in front and behind. |
| Driving with a sling on | One NHS trust says you must not drive with a sling on. | Wait until you can control the car and do an emergency stop, and check with your insurer. |
A 20-minute seated workout for older adults who cannot stand for long: marching, leg and arm strength, posture, and sit-to-stands that lead back to standing.
20 minBeginner11 movesA bench or box, Something with weightA 25-minute band routine for healthy shoulders: move the shoulder and upper back through their range, then strengthen the rotator cuff and shoulder blades.
25 minBeginner12 movesA wall, A bandA 40-minute strength and balance session for over-65s, built from the Otago home programme and NHS exercises, using a chair, a counter and a step.
40 minBeginner18 movesA bench or box, Something with weightBalance practice in 10 minutes: tandem stance, single-leg stands, marches, heel walks, tree pose and floor transfers.
10 minBeginner7 movesA wall, A bench or boxStrength and balance in one session: squats, Romanian deadlifts, push-ups, rows, step-ups, back extensions, carries and single-leg balance.
45 minBeginner14 movesA wall, A dumbbellThe bone usually heals in 6 to 12 weeks. Movement can take 3 months or more to come back and strength up to a year, and many people keep improving for 12 to 18 months.
Usually not. In the UK PROFHER trial, surgery gave no better shoulder function than a sling at 2 and 5 years, and NICE advises treatment without surgery unless there is a complication such as a dislocation or a damaged blood vessel.
It depends on your hospital: one NHS leaflet says about 3 to 6 weeks, another aims to stop by 6 weeks, and a third says about 6 to 12 weeks with the first 3 to 4 day and night. Follow your team; in a trial, a week in a sling did as well as 3 weeks.
When your team says: some hospitals start them in the first days, others at 2 to 3 weeks. Lean on a table with your good hand, keep the circles small, and skip them if your balance is poor.
Make a fist and stretch your fingers, move your wrist, and bend and straighten your elbow, about 5 to 10 times, 4 to 5 times a day, plus gentle neck turns. Shoulder exercises follow when your team allows.
You should move your hand, wrist and elbow from the start. Moving the shoulder itself starts gently, often with pendulums, and starting within about a week was safe in trials, but your team will tell you when.
Many people find it easier propped up on pillows at first; otherwise lie on your good side with a pillow in front to rest the arm on and one behind you. Keep the sling on at night for as long as your team advises.
Most people get back enough movement for daily life, but some loss at the extremes is common. Keep up the exercises for several months, because improvement continues for 12 to 18 months.
In older people with a 2-part break, a home programme did as well as weekly physiotherapy. Ask for physiotherapy, or refer yourself where you can, if you're struggling to regain movement.
Not with a sling on, and only when you can control the car and do an emergency stop. One NHS hospital suggests waiting at least 4 to 6 weeks; check with your insurer too.
A bone health check, because a broken shoulder from a fall is often a fragility fracture, and a falls assessment, which NICE recommends after a fall that injured you. Balance and strength exercise cuts falls.
Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.
