A broken shoulder is a general term referring to a fracture in one of the three bones that form the shoulder joint: the clavicle (collarbone), the scapula (shoulder blade), or the proximal humerus (the top of the upper arm bone). This complex joint allows for a wide range of motion, which is why any break to its bony structure can severely impair arm function and cause intense pain. Because of the shoulder’s intricate anatomy and the potential for associated injuries, a prompt and professional medical evaluation is necessary to properly diagnose the injury and determine the correct course of action.
Immediate Steps After Injury
If a fractured shoulder is suspected after a fall or direct blow, the immediate priority is to stabilize the limb and manage the initial discomfort. The injured arm should be immobilized gently using a sling or by securing it to the chest wall to prevent movement of the broken bone fragments. Minimizing motion helps to reduce pain and prevent further soft tissue or nerve damage.
Applying a cold compress or ice pack, wrapped in a towel, to the affected area can help reduce both swelling and pain. Patients may also take over-the-counter pain relievers, like acetaminophen or ibuprofen, if they have no contraindications. These steps offer temporary relief, but seeking emergency medical attention right away is necessary for definitive diagnosis and treatment.
Confirming the Fracture
The process of confirming a shoulder fracture begins with a thorough physical examination, where a physician checks for signs of deformity, swelling, bruising, and any open wounds. They will also assess nerve and blood vessel function in the arm and hand. Following this initial assessment, X-rays are the standard first-line imaging technique used to visualize the fracture, confirming its presence and location.
If the injury is complex or X-rays are unclear, advanced imaging studies may be ordered. A Computed Tomography (CT) scan provides a detailed, three-dimensional view of the bone fragments, which is helpful for surgical planning or when the fracture involves the joint surface. Magnetic Resonance Imaging (MRI) is used to evaluate surrounding soft tissues, such as the rotator cuff tendons and ligaments, which may also have been damaged. Fractures are often classified based on whether the bone pieces are non-displaced or displaced.
Treatment Pathways
Treatment for a broken shoulder is determined primarily by the type of bone fractured and the degree of displacement between the bone fragments. Most shoulder fractures, especially those of the clavicle and scapula, and non-displaced fractures of the proximal humerus, heal successfully with non-surgical management. This approach involves immobilizing the arm in a sling or specialized shoulder immobilizer for several weeks to allow the bone to mend naturally.
During non-surgical recovery, pain control is managed with medication. Patients are instructed to begin gentle, passive range-of-motion exercises shortly after the injury, often within the first two weeks, to prevent joint stiffness. The goal is to maintain the mobility of the elbow, wrist, and hand while the fracture site remains protected. Regular follow-up X-rays monitor the healing process and ensure the fracture fragments remain in an acceptable position.
Surgical management is reserved for severely displaced fractures, open fractures where the bone breaks the skin, or fractures involving multiple fragments that threaten the blood supply. The most common surgical technique is Open Reduction Internal Fixation (ORIF), where the surgeon realigns the bone fragments and secures them with metal plates, screws, or pins. For complex proximal humerus fractures, especially those with significant damage to the joint surface, a shoulder replacement procedure may be performed. This may involve replacing only the ball portion of the joint (hemiarthroplasty) or a reverse total shoulder arthroplasty.
The Path to Healing
Regardless of whether the treatment is surgical or non-surgical, the path to full recovery requires a dedicated rehabilitation program. The initial period focuses on protecting the fracture site and maintaining the mobility of adjacent joints. Once the fracture shows signs of stability, which may take between four to eight weeks, physical therapy begins in earnest.
Physical therapy is necessary for regaining the shoulder’s full range of motion and functional strength. Exercises start with gentle, assisted movements and progress gradually to active motion and strengthening exercises that target the rotator cuff and surrounding muscles. Recovery timelines vary significantly; pain and stiffness often continue for six to twelve months, though the fracture itself shows radiographic healing within six to twelve weeks. Consistent adherence to the prescribed exercises is necessary to prevent long-term complications like chronic stiffness and to restore the ability to perform daily activities.