Shoulder Fracture

What is the shoulder joint?

Your shoulder is a joint suspended by many muscles surrounding the upper extremity. The shoulder bones include the:

clavicle or "collarbone"
scapula or "shoulder blade"
humerus or "upper arm bone"

The only connection of the shoulder girdle to the remainder of the skeleton is the "clavicle".

An important part of the shoulder joint is the "scapula". It serves as an anchor for many muscles and contains the socket part of the shoulder or glenoid. The upper end of the humerus has a ball-like shape that articulates with the socket. The humerus also serves as an attachment point for many muscles and tendons. One of the most important parts is the "rotator cuff". Disruption of any of these shoulder parts can create difficulty with the function of the shoulder.

What are the types of shoulder fractures and how are they treated?

There are three types of shoulder fractures, and some vary by age. The majority of fractures in children occur in the clavicle. For adults, fractures within the upper part of the arm (proximal humerus) occur with increasing frequency during older age. Some fractures occur with dislocation of the shoulder joint.

Clavicle Fractures

The most common fracture of the shoulder is of the clavicle. Frequently, this is the result of a fall onto the shoulder. Fractures of this type can be quite painful and cause difficulty in moving the arm. Classically, treatment has been non-operative. Sometimes treatment can be as simple as a sling or a “figure 8” strap, worn for three to eight weeks, depending on one's pain.

After it is healed, there may be a bump over the fracture site which may decrease with time. However, sometimes a deformity may remain permanently. The range of motion can begin as soon as the pain subsides, but, returning to sports cannot occur until full shoulder strength returns. Return to any contact sports is considered only when the fracture is shown fully healed on X-ray.

Recently, surgical treatment of these fractures has been reconsidered. Surgical treatment options may include plates and screws or even a rod placed into the bone. Considering treatment with any of these options depends upon your activity level and the dominance of arm use. For example, a right-handed athlete with an injury to the right clavicle versus an older individual not engaged in “overhead” activities.

Scapula - Shoulder Blade

Fractures of this bone rarely occur. They are usually the result of high-energy trauma, such as motor vehicle accidents or a fall onto the back from a height. X-rays are often used for the diagnosis of this fracture. At times, more definition of the fracture may require a CT scan to assess the displacement of the fracture fragments. Treatment can range from a simple sling for two to four weeks, to open surgery.

Surgery is more often needed with an injury to the glenoid with the displacement of the joint surface, the acromion, or the neck of the scapula, the connection of the shoulder blade to the shoulder socket.Shoulder Joint Fractures/Proximal Humerus Fractures

Fractures of the Proximal Humerus usually occur from a fall onto the arm. In the younger population, these injuries can be simple fractures, often associated with dislocations of the shoulder joint. When that happens, the fracture is often treated by putting the shoulder back into place. If X-rays show that the fracture is in good position, sling immobilization is often the treatment chosen. If the fracture is out of position, surgery may be recommended.

Humerus - Upper Arm

Fractures of the humerus are more common in people over 65 years of age. Sometimes, there may be no significant displacement of the bone fragments. In other cases, the fracture fragments may be more severely displaced or angulated. Fractures that are non-displaced can be treated with a sling for four weeks, after which motion can be started. Physical therapy to assist in improving motion and strength may be required for recovery. For those fractures with displacement, surgery may be the best treatment option. Surgery may entail repair of the fracture with various devices, such as plates, screws, and wires. In some cases, the fracture is so severe that a shoulder replacement may be necessary.

Regardless of how well the bone was reconstructed or joint replacement was performed, these injuries often leave one with residual shoulder stiffness. The stiffness results from associated injuries to the muscles and tendons as well as the ligaments.

With any injury of the shoulder, there are often many different treatment options. Whichever treatment is recommended for your injury, the recovery may be arduous or prolonged. Formal therapy, as well as home exercises, are a mainstay of recovery. An upper extremity specialist will be able to help guide you in obtaining your best result.

For more information about safe and effective treatments for shoulder fractures or any other conditions of the hands or upper extremities, schedule an appointment with Dr. Sagini by calling 239-337-2003.