A broken shoulder refers to a fracture in one of the three bones that make up the shoulder structure: the clavicle (collarbone), the scapula (shoulder blade), or the proximal humerus (the top of the upper arm bone). These injuries typically result from high-impact trauma, such as a fall onto an outstretched arm or a direct blow. A shoulder fracture is a serious injury requiring immediate medical attention. The severity can range from a simple crack to multiple displaced fragments, which may cause significant short-term impairment.
Visual Signs of a Broken Shoulder
One of the most apparent signs of a broken shoulder is a visible deformity, where the shoulder appears noticeably “out of place” compared to the uninjured side. A fracture in the clavicle, for instance, often results in a prominent bump or ridge under the skin, which is the ends of the fractured bone fragments. When the proximal humerus is broken, the arm may look shortened or unusually angled near the joint.
Swelling usually begins immediately at the injury site as blood and fluid accumulate. This swelling can quickly become severe, making the shoulder appear puffy or enlarged. Bruising, known medically as ecchymosis, frequently accompanies the swelling and may appear hours or even days after the initial injury.
This discoloration can be extensive, often spreading down the arm toward the elbow or across the upper chest wall. A person with a suspected fracture will adopt a protective posture, holding the injured arm tightly against their body to prevent movement. They often use their uninjured hand to support the elbow or forearm, minimizing drag on the shoulder joint.
Sensory Symptoms and Functional Limitations
A person who has broken their shoulder will experience immediate and intense pain, which is often described as a sharp, severe ache at the moment of impact. This pain is localized to the fracture site and worsens dramatically with any attempt to move the arm or shoulder. Even slight touches or pressure on the bone can elicit extreme tenderness, making examination difficult.
One specific internal sensation that indicates a fracture is crepitus, which is a grating or popping sound or feeling. This occurs when the rough edges of the broken bone fragments rub against each other during movement. Its presence is a strong indicator of a fracture, though the patient should avoid testing for this feeling.
Functional limitations are immediate and nearly complete, as the shoulder loses its ability to support and move the limb. The patient will likely be unable to lift their arm away from their body or rotate the limb due to the lack of structural support from the fractured bone. In some cases, a proximal humerus fracture may cause numbness or tingling in the arm or hand due to potential injury to the nearby nerves, such as the radial nerve.
Immediate First Aid and Next Steps
Once a broken shoulder is suspected, the immediate focus is on immobilizing the limb to prevent further injury. A temporary sling fashioned from a towel, shirt, or scarf should be used to support the arm, keeping the elbow bent and the arm resting gently against the torso. It is important not to attempt to straighten or reposition the arm, even if an obvious deformity is present.
Applying a cold compress or ice pack to the swollen area can help manage both pain and swelling by constricting local blood vessels. The ice should be wrapped in a thin towel or cloth and applied for no more than 20 minutes at a time to prevent skin damage. The arm should remain in a position of rest, and the patient should avoid any activity that might jar the shoulder.
Professional medical attention must be sought at an emergency room for a definitive diagnosis, which typically involves X-ray imaging. Immediate emergency services should be called if the bone is visible through the skin, the patient shows signs of shock, or there is significant weakness, numbness, or loss of circulation in the hand or fingers. A medical professional will determine the type of fracture and whether it requires non-surgical treatment, such as a specialized sling, or surgical intervention.