Shoulder Fracture / Proximal Humerus Fracture
Trauma to the shoulder is common. Injuries range from a separated shoulder resulting from a fall onto the shoulder to a high-speed car accident that fractures the shoulder blade (scapula) or collar bone (clavicle). One thing is certain: everyone injures his or her shoulder at some point in life.
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Anatomy
The shoulder is made up of three bones:
The shoulder is made up of three joints:
The shoulder also has one articulation, which is the relationship between the scapula (shoulder blade) and the chest wall. The main joint of the shoulder is the glenohumeral joint. This joint comprises a ball (the humeral head) on a golf-tee-shaped joint (the glenoid of the scapula). The bones of the shoulder are covered by several layers of soft tissues.
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Types of shoulder injuries
There are many types of shoulder injuries:
There are many types of shoulder injuries:
- Fractures are broken bones. Fractures commonly involve the clavicle (collar bone), proximal humerus (top of the upper arm bone), and scapula (shoulder blade).
- Dislocations occur when the bones on opposite sides of a joint do not line up. Dislocations can involve any of three different joints.
- A dislocation of the acromioclavicular joint (collar bone joint) is called a "separated shoulder."
- A dislocation of the sternoclavicular joint interrupts the connection between the clavicle and the breastbone (sternum).
- The glenohumeral joint (the ball and socket joint of the shoulder) can be dislocated toward the front (anteriorly) or toward the back (posteriorly).
- Soft-tissue injuries are tears of the ligaments, tendons, muscles, and joint capsule of the shoulder, such as rotator cuff tears and labral tears.
Causes
Fractures of the the proximal humerus can be caused by a direct blow to the area from a fall, collision, or motor vehicle accident.
Fractures of the the proximal humerus can be caused by a direct blow to the area from a fall, collision, or motor vehicle accident.
Symptoms of fractures
Symptoms of fractures about the shoulder are related to the specific type of fracture.
General Findings
Symptoms of fractures about the shoulder are related to the specific type of fracture.
General Findings
- Pain
- Swelling and bruising
- Inability to move the shoulder
- A grinding sensation when the shoulder is moved
- Deformity -- "It does not look right"
Proximal humerus fracture (red arrows)
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Proximal humerus fracture treated with a plate and screws
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Specific findings of proximal humerus (shoulder) fractures
- A severely swollen shoulder
- Very limited movement of the shoulder
- Severe pain
Diagnosis
Most fractures are diagnosed with X-rays of the area and by physical examination. Sometimes, additional imaging techniques, such as computed tomography (CT), are necessary.
Most fractures are diagnosed with X-rays of the area and by physical examination. Sometimes, additional imaging techniques, such as computed tomography (CT), are necessary.
Treatment options
Most fractures of the proximal humerus can be treated without surgery if the bone fragments are not shifted out of position (displaced). If the fragments are shifted out of position, surgery is usually required. Surgery usually involves fixation of the fracture fragments with plates, screws, or pins or it involves shoulder replacement. Your doctor will review all of the treatment options with you and discuss which one is right for your particular injury.
Most fractures of the proximal humerus can be treated without surgery if the bone fragments are not shifted out of position (displaced). If the fragments are shifted out of position, surgery is usually required. Surgery usually involves fixation of the fracture fragments with plates, screws, or pins or it involves shoulder replacement. Your doctor will review all of the treatment options with you and discuss which one is right for your particular injury.
Life after a shoulder injury
Life after a shoulder fracture, separation, or dislocation can be greatly affected for several weeks or even months. Most shoulder injuries whether treated surgically or nonsurgically require a period of immobilization followed by rehabilitation.
If the injury was not severe, usually there is fairly rapid improvement and return of function after the first 4 to 6 weeks. Shoulder exercises, usually as part of a supervised physical therapy program, are frequently necessary. Exercises decrease stiffness, improve range of motion, and help the patient regain muscle strength.
Life after a shoulder fracture, separation, or dislocation can be greatly affected for several weeks or even months. Most shoulder injuries whether treated surgically or nonsurgically require a period of immobilization followed by rehabilitation.
If the injury was not severe, usually there is fairly rapid improvement and return of function after the first 4 to 6 weeks. Shoulder exercises, usually as part of a supervised physical therapy program, are frequently necessary. Exercises decrease stiffness, improve range of motion, and help the patient regain muscle strength.
What Should You Discuss With Your Orthopaedic Surgeon?
Some of the information you should discuss with your orthopaedic surgeon includes the following:
Some of the information you should discuss with your orthopaedic surgeon includes the following:
- The exact type of your injury
- The severity of the injury
- The treatment plan
- The possible complications
- Whether surgery will be necessary
- When it is expected that you will be maximally improved
- What is the expected outcome will be both in the short term and in the long term
This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon.