A shoulder fracture represents a break in one or more of the bones that make up this complex joint. This area is designed for maximum mobility, functioning as a ball-and-socket mechanism. Because of its flexibility, the shoulder is vulnerable to high forces. These injuries are typically the result of significant energy transfer, such as a direct blow during an accident or a forceful fall onto the shoulder or an outstretched arm. The severity of the fracture depends on which bone is affected and the energy of the impact itself.
The Bones Involved in a Shoulder Fracture
The shoulder complex involves three bones: the humerus, the clavicle, and the scapula, all of which are susceptible to fracture.
The humerus, or upper arm bone, most commonly breaks at its top end, a section known as the proximal humerus. This type of fracture is particularly frequent in older adults, often occurring from a low-energy fall due to underlying osteoporosis.
The clavicle, commonly called the collarbone, is a slender, S-shaped bone that is frequently broken across all age groups. Fractures most often occur in the middle third of the bone, known as the midshaft. A common cause is an indirect force transmitted through the arm or a fall that lands directly on the side of the shoulder.
The scapula, or shoulder blade, is the least common of the three to fracture, accounting for less than one percent of all broken bones. This flat, triangular bone is heavily protected by a thick layer of muscle and the rib cage. A scapular fracture almost always signals high-energy trauma, such as a motor vehicle collision or a fall from a considerable height.
Key Symptoms Indicating a Break
Immediate, intense pain that prevents any attempt to move the arm is one of the most reliable indicators of a fracture. Following the injury, a person will often instinctively cradle the injured limb against their chest to provide support and minimize movement. This functional loss is a key differentiator between a fracture and a less severe soft tissue injury like a sprain.
Visual signs of a break include rapid and significant swelling, along with bruising (ecchymosis) that may spread down the arm. A notable deformity, where the shoulder appears visibly misshapen or at an unnatural angle, suggests a displaced fracture. With a clavicle break, for example, a sharp bone fragment may create a visible bulge or “tenting” of the skin.
A grating, grinding, or crunching sensation, medically termed crepitus, may be felt or sometimes heard when the broken bone ends rub against each other. Furthermore, some displaced fractures can compromise nearby nerves, resulting in physical sensations such as tingling, numbness, or weakness in the arm or hand. If any of these severe signs are present, immediate medical assessment is necessary to prevent further damage.
Seeking Immediate Medical Attention
If a fracture is suspected, the immediate priority is to stabilize the injured limb to prevent the fragments from shifting. This is typically achieved by securing the arm in a sling or binding it gently to the chest. The application of ice, wrapped in a cloth to protect the skin, can help manage immediate swelling and dull the acute pain.
The injured person should be taken to an emergency department promptly, especially if there is a visible deformity or if the injury was caused by high-energy trauma. Injuries like scapula fractures often accompany other serious issues, such as chest or head trauma, requiring comprehensive evaluation. Once at the medical facility, the diagnostic process begins with a physical examination and a detailed history of the injury.
The definitive diagnosis of a fracture is established using plain film X-rays. Standard trauma imaging typically includes multiple views, such as the anterior-posterior projection and a specialized scapular-Y or axillary view, to clearly visualize the fracture lines and assess the alignment of the joint. These initial images are sufficient for diagnosing most breaks.
For more complex injuries, particularly those involving the joint surface (glenoid) or comminuted fractures, a Computed Tomography (CT) scan may be ordered. The CT scan provides detailed cross-sectional images, which are helpful for characterizing the precise orientation of the bone fragments and planning any necessary surgical intervention. This detailed imaging is particularly common for scapular fractures or highly displaced proximal humerus breaks.