A broken shoulder is a serious injury involving a fracture in one or more bones of the shoulder girdle. This injury causes severe pain and loss of function in the affected limb. Understanding the specific nature of the fracture is the first step toward effective treatment and recovery.
Anatomy and Types of Shoulder Fractures
The term “broken shoulder” refers to a fracture in one of three bones: the proximal humerus, the scapula, or the clavicle. The humerus is the long bone of the upper arm, and a fracture near its top—the ball of the ball-and-socket joint—is known as a proximal humerus fracture. These are common injuries, especially in older adults with osteoporosis.
The clavicle, or collarbone, is a long, thin bone connecting the sternum to the shoulder blade, and it is one of the most frequently fractured bones in the body. Scapula fractures, involving the shoulder blade, are the least common because the bone is shielded by a thick layer of muscle and requires a high-energy impact to break. Fractures are medically classified based on whether the bone fragments have shifted, known as displaced or non-displaced fractures.
A non-displaced fracture means the broken pieces remain in satisfactory alignment, which makes treatment simpler. Conversely, a displaced fracture occurs when the bone fragments have separated significantly or rotated, often defined as a separation greater than one centimeter or an angulation of more than 45 degrees. The distinction between a closed fracture, where the skin remains intact, and an open fracture, where the bone pierces the skin, is also important for determining the urgency and type of medical care.
Recognizing the Signs and Common Causes
The most immediate sign of a broken shoulder is intense pain that worsens with any attempt to move the arm. Swelling and bruising around the shoulder area typically develop quickly after the injury. A person may also experience a grinding sensation, medically termed crepitus, when the shoulder is moved.
A visibly abnormal contour or deformity of the shoulder indicates a displaced fracture. Common causes include a direct, forceful blow to the shoulder, such as from a contact sport collision or a motor vehicle accident. Falls, particularly falling onto an outstretched hand or directly onto the shoulder, are another frequent mechanism of injury, especially for proximal humerus and clavicle fractures.
Diagnosis and Treatment Pathways
A medical professional begins the diagnostic process with a physical examination and an assessment of the patient’s symptoms and injury mechanism. Initial imaging typically involves standard X-rays, which confirm the presence of a fracture and provide a clear picture of the bone structure. If the fracture is complex, or if more detailed information about the bone fragments and joint surface is needed, a Computed Tomography (CT) scan may be necessary.
For non-displaced or minimally displaced fractures, treatment often follows a non-surgical pathway. This management involves immobilizing the arm in a sling or brace for several weeks to allow the bone to heal naturally. Pain control is managed with oral medications, and regular follow-up X-rays monitor the healing progress.
Surgical intervention is reserved for fractures that are severely displaced, unstable, or involve multiple fragments. The procedure often involves internal fixation, where the surgeon uses specialized hardware like plates, screws, or pins to realign and hold the broken pieces together. In cases of severe damage to the humeral head, particularly in older patients, a partial or total shoulder replacement may be performed to restore function.
Recovery Timeline and Physical Therapy
The duration of recovery varies significantly depending on the fracture’s severity and the chosen treatment method. Following treatment, a period of initial immobilization, usually lasting four to six weeks, is required to stabilize the fracture site. This phase allows the bone to begin the healing process.
Physical therapy is a necessary component of rehabilitation, beginning shortly after the initial immobilization period ends. Therapy starts with gentle, passive range-of-motion exercises, such as pendulum swings, to reduce stiffness without stressing the fracture. As healing progresses, the program advances to active motion exercises, followed by specific strengthening exercises. Full recovery and return to maximal strength can take several months, often between three to nine months.