People with chronic shoulder pain naturally avoid movements involving that part of the body, fearing they will injure themselves again or experience more discomfort. However, if this behavior continues beyond the necessary healing period for a fracture, the pain can become chronic and the joint can become more impaired. Consequently, patients have a poorer prognosis for regaining shoulder function, muscle strength, and mobility. This cycle can delay recovery and worsen functional impairment, even after the bone has healed.
A study conducted at the Ribeirão Preto School of Medicine of the University of São Paulo (FMRP-USP) in Brazil determined the appropriate duration of this behavior in patients with a proximal humerus injury, which is a fracture in the upper arm near the shoulder joint.
“Since it was unclear whether this also occurs in individuals with proximal humerus fractures, we decided to investigate the topic,” says Jaqueline Martins Priuli , a physical therapist who coordinated the study, which was supported by FAPESP . Priuli is also the co-author of an article published in the journal Disability and Rehabilitation , which presents the main findings of the study.
The study evaluated 105 individuals with this type of injury. The participants completed questionnaires about shoulder pain, limitations, avoidance behaviors regarding activities involving the shoulder, fear of moving the arm, confidence in performing activities despite discomfort, symptoms of depression, and negative thoughts about pain.
The results shed light on two key points: which factors are related to avoiding movements and activities involving the shoulder after a fracture and how scores on the ADAP Shoulder Scale, which assesses avoidance behavior in activities involving the shoulder, are distributed.
“With this data, we were able to assess whether this type of behavior is prevalent. Furthermore, our study suggested that early identification of this behavior can help determine the need for early, targeted interventions to increase confidence and engagement in rehabilitation, leading to faster recovery with fewer limitations,” Priuli adds.
According to the researcher, it is natural for a person to fear pain or re-injury of the affected area after a fracture. Patients are often advised by healthcare professionals to avoid movements involving the affected area, which is normal during the healing process.
However, some patients become unsure about what they can and cannot do. They end up avoiding movements and activities for longer than necessary, which typically lasts about three months. This can lead them to avoid safe movements, such as brushing their teeth or eating on their own. This hinders the functional recovery of the shoulder after the fracture.
A previous study by the same research group found that patients who received detailed information about the recovery process reported less uncertainty and a less stressful experience. “Therefore, in addition to physical therapy, appropriate guidance from healthcare professionals regarding the activities the individual can perform at each stage of treatment is essential to boost the patient’s confidence and help them resume their activities safely and at the appropriate time,” says the physical therapist.
About São Paulo Research Foundation (FAPESP)
The São Paulo Research Foundation (FAPESP) is a public institution with the mission of supporting scientific research in all fields of knowledge by awarding scholarships, fellowships and grants to investigators linked with higher education and research institutions in the State of São Paulo, Brazil. FAPESP is aware that the very best research can only be done by working with the best researchers internationally. Therefore, it has established partnerships with funding agencies, higher education, private companies, and research organizations in other countries known for the quality of their research and has been encouraging scientists funded by its grants to further develop their international collaboration. You can learn more about FAPESP at www.fapesp.br/en and visit FAPESP news agency at www.agencia.fapesp.br/en to keep updated with the latest scientific breakthroughs FAPESP helps achieve through its many programs, awards and research centers. You may also subscribe to FAPESP news agency at http://agencia.fapesp.br/subscribe
Disability and Rehabilitation
Avoidance behavior after proximal humerus fracture: implications for rehabilitation and a clinically relevant cutoff for the Avoidance of Daily Activities Photo Scale (ADAP Shoulder Scale)
4-May-2026