Fractures that occur within the structure of the shoulder joint can appear as a break or a crack in the bone on an X-ray. A shoulder fracture is generally classified based on which bone (clavicle, humerus, or scapula) is involved. A shoulder fracture can occur when sudden force, impact, or trauma has been sustained to the shoulder joint. Hard falls during sporting events or motor vehicle trauma are examples of possible causes of fractures in the shoulder.
There are 3 distinct bones within the shoulder that could sustain a fracture: The collarbone (clavicle) is the most common place where a fracture may exist; the upper arm bone (proximal humerus) can be fractured and is often related to poor bone density; a fracture of the shoulder blade (scapula) is less common, but usually occurs during a high-energy impact.
Fractures are classified as being displaced or non-displaced. In a non-displaced fracture, the broken pieces line up on each side of the break. Displaced fractures, in which the pieces on either side of the break are out of line, may require some type of manipulation to restore normal anatomy. Occasionally the rotator cuff muscles are injured or torn at the same time as the fracture, which can further complicate the treatment.
Symptoms
Shoulder fractures are usually characterized by pain with motion or palpation of the shoulder. Other symptoms include swelling or bruising of the shoulder area, a bump or bulge at the site of the break, or an inability to move the arm without pain.
Diagnostic Testing
A physical examination reveals pain over the bone, and often swelling or bruising is present. X-rays typically show the fracture. However, in more serious cases, 3-D imaging, such as CT scans or MRIs are often ordered to get a better picture of the fracture pattern.
Treatment
Non-Surgical
Many fractures can be treated without surgery, and heal in about 4 months. Many shoulder fractures can be treated with a simple sling and limited use of the shoulder until the pain and inflammation has subsided. By immobilizing the shoulder, the bone is allowed to heal, and once it has healed enough, physical therapy is typically ordered to regain motion and strength.
Surgical
The need to surgically repair a shoulder fracture depends upon your age, activity level, and the severity of your injury. Some fractures are better treated with surgery because they may carry a high risk of arthritis if left alone. There are many different types of surgery for different types of fractures including percutaneous pinning (placing pins in the bone to secure them back in place); open reduction internal fixation (ORIF—which involves opening up the fracture, realigning the bones, and putting a plate and screws in place to hold them together); and shoulder hemiarthroplasty – replacing the shoulder if the fractures are in too many pieces.
Post-Op
After any fracture surgery, proper rest and rehabilitation is critical to good success and improvement of pain and function. Dr. Anz will prescribe a very detailed physical therapy program that, if performed consistently and successfully, will help rehabilitate the injured arm. Most patients can resume normal activities within six months following surgery.
For additional information on shoulder fractures or to learn more about treatment for this shoulder condition, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute.
