A broken shoulder refers to a fracture in one of the bones that form the shoulder joint. These injuries most commonly affect the humerus, the long bone of the upper arm, particularly its upper end near the shoulder. Fractures can also occur in the clavicle (collarbone) or the scapula (shoulder blade). The specific treatment approach depends significantly on the fracture’s severity and location.
Understanding the Diagnosis
Diagnosing a broken shoulder begins with a physical examination. The medical team observes the shoulder for visible signs like swelling, bruising, or deformity. They also palpate the area for tenderness and assess the patient’s range of motion, noting any pain or inability to move the arm.
Imaging tests confirm the fracture and determine its characteristics. X-rays are the primary diagnostic tool, providing clear images of bone structures and revealing the fracture’s location and type. For more complex injuries, such as those involving multiple bone fragments or the joint surface, a computed tomography (CT) scan provides a detailed, three-dimensional view. Magnetic resonance imaging (MRI) assesses damage to surrounding soft tissues like ligaments or tendons.
Non-Surgical Treatments
Many broken shoulders, particularly those with stable or minimally displaced fractures, can be managed without surgery. Non-surgical treatment involves immobilizing the injured arm to allow the bone fragments to heal. This is commonly achieved using a sling, which supports the arm and keeps the shoulder still for several weeks. The duration of immobilization typically ranges from three to six weeks, depending on the fracture’s stability and location.
Pain management is also an important aspect of conservative treatment. Over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, are often recommended for mild to moderate pain. For more severe discomfort, a physician may prescribe stronger pain medication for a limited period. Alongside medication, sufficient rest is advised, meaning avoiding activities that place stress on the shoulder.
Even during the immobilization period, gentle, passive exercises may be recommended to prevent stiffness in the shoulder joint. These early movements are performed with assistance and do not involve active muscle contraction. The goal is to maintain mobility without compromising the fracture’s stability, preparing the shoulder for more active rehabilitation once healing occurs.
Surgical Treatments
Surgery is necessary for broken shoulders when the fracture is severely displaced, involves multiple fragments, or affects the joint surface in a way that non-surgical methods cannot adequately realalign the bones. Open fractures, where the bone breaks through the skin, also require surgical intervention to reduce the risk of infection and stabilize the injury. The goal of surgical intervention is to realign the fractured bone fragments and stabilize them to promote healing and restore function.
One common surgical procedure is open reduction and internal fixation (ORIF). During ORIF, the surgeon makes an incision to directly access the fractured bone fragments, which are then realigned, a process known as reduction. Once aligned, the fragments are held in place with internal fixation devices such as metal plates, screws, pins, or wires. These implants provide stability to the fracture site, allowing the bone to heal in the correct anatomical position.
In severe cases, particularly with complex fractures of the humeral head or extensive damage to the joint, shoulder joint replacement, or arthroplasty, is an option. This procedure involves replacing the damaged parts of the shoulder joint with artificial components, which can be a partial replacement (hemiarthroplasty) or a total shoulder replacement. Arthroplasty aims to alleviate pain and restore a functional range of motion when the fracture is too severe for internal fixation alone.
The Rehabilitation Process
Following either non-surgical or surgical treatment, a structured rehabilitation program is essential in regaining full shoulder function. This process begins gradually with passive range-of-motion exercises, where a physical therapist moves the patient’s arm without active muscle engagement. The initial focus is on restoring mobility and preventing stiffness in the shoulder joint.
As healing progresses, the rehabilitation program includes active range-of-motion exercises, where the patient begins to move their arm independently. This stage is followed by strengthening exercises, which target the muscles surrounding the shoulder to rebuild strength and stability. These exercises may involve resistance bands, light weights, or bodyweight movements, all tailored to the individual’s recovery progress.
Throughout the rehabilitation period, a physical therapist plays a key role in guiding the patient through each stage of recovery. They monitor progress, adjust exercises as needed, and provide education on proper body mechanics to prevent re-injury. The goal is to gradually return to daily activities, work, and recreational pursuits, ensuring the shoulder regains strength, flexibility, and function while minimizing the risk of long-term weakness or limited movement.