A shoulder fracture is a common injury, often resulting from various accidents and impacts. While the shoulder is a complex and highly mobile joint, its bony structures are susceptible to breakage. This article explores the causes, symptoms, diagnosis, and treatment of shoulder fractures.
Understanding Shoulder Fractures
A shoulder fracture involves a break in one or more of the three bones that make up the shoulder joint: the humerus (the upper arm bone), the scapula (the shoulder blade), and the clavicle (the collarbone). These bones connect to allow extensive arm movement and function.
The humerus, specifically its upper part known as the proximal humerus, is a common site for fractures, especially near the humeral head which forms the ball of the shoulder’s ball-and-socket joint. Clavicle fractures, or broken collarbones, are also frequent, often occurring in the middle portion of the bone. The scapula, a triangular bone protected by surrounding muscles and the chest, is less commonly fractured and usually requires significant force to break.
Recognizing a Shoulder Fracture
Shoulder fractures result from direct trauma or falls. Common causes include falling onto an outstretched arm or directly onto the shoulder, direct blows, sports injuries, and motor vehicle accidents. Bone density issues, such as osteoporosis, can also increase susceptibility to these injuries, particularly for proximal humerus fractures in older adults.
A fractured shoulder presents with symptoms such as severe pain, which often worsens with any attempt to move the arm or shoulder. Swelling and bruising around the injured area are common. A visible deformity, such as a bump or abnormal shape, can be present, or a grinding sensation might be felt when trying to move the shoulder. The inability to move the arm or limited range of motion further suggests a fracture.
Diagnosis and Initial Steps
If a shoulder fracture is suspected, immediate action involves immobilizing the arm with a sling to prevent further injury and reduce pain. Applying ice to the affected area can help manage swelling and discomfort. Over-the-counter pain relievers may be used if tolerable.
Prompt medical attention is necessary for diagnosis. A healthcare provider will conduct a physical examination, assessing pain, swelling, and range of motion. Imaging tests then confirm the fracture and determine its extent.
X-rays are the primary diagnostic tool, providing clear images of bone structures. For more complex cases or to assess potential soft tissue damage, a CT scan or MRI may be used. The medical professional will also check for any associated nerve or blood vessel damage.
Treatment and Recovery
Treatment for a shoulder fracture varies depending on the specific bone involved, the fracture’s severity, and whether the bone fragments are displaced. Many shoulder fractures, particularly those that are non-displaced where the bone pieces remain in proper alignment, can be managed without surgery. Non-surgical approaches involve immobilizing the arm with a sling or brace for several weeks, often four to six weeks, to allow the bone to heal. Pain management is also a component of conservative treatment.
Surgical intervention becomes necessary for displaced fractures, open fractures where the bone breaks through the skin, or those significantly affecting the joint. A common surgical procedure is open reduction internal fixation (ORIF), where an incision is made to realign the bone fragments, which are then secured with plates, screws, or pins. In severe cases, a partial or reverse total shoulder replacement may be considered.
Recovery from a shoulder fracture involves regaining strength and mobility. Following initial immobilization, physical therapy is important. Early physical therapy begins with gentle range-of-motion exercises to prevent stiffness, progressing to strengthening exercises as healing advances. The overall recovery timeline can range from a few weeks for minor fractures to several months (three to nine months) to regain full function, with complete bone healing taking around three months. Consistent adherence to physical therapy is important to address challenges like stiffness or weakness and optimize long-term outcomes.