A shoulder fracture is a painful experience to put it lightly. As one of the central points in our full-range of mobility, there’s a lot of pressure on this exact area of the body. And a fracture of any size can prove debilitating.
But what are they? How does something like this occur? And what do you do when your doctor looks at your painful shoulder and tells you, “Yup – that’s a shoulder fracture”?
Join us today, as we put shoulder fractures under the microscope, and learn more about this kind of injury with Stark Feed.
The shoulder joint is a ball and socket joint. A ‘ball’ at the top of the upper arm bone (the humerus) fits neatly into a ‘socket’, called the glenoid, which is part of the shoulder blade (scapula). The labrum is a ring of fibrous cartilage surrounding the glenoid for stabilization of the shoulder joint. The biceps tendon attaches inside the shoulder joint at the superior labrum of the shoulder joint. The biceps tendon is a long cord-like structure which attaches the biceps muscle to the shoulder and helps to stabilize the joint.
The shoulder joint is the most flexible joint of the body. It allows different motions of the hands making it possible for us to do a vast array of different activities. However, its flexibility makes it more prone to injuries. A fracture is a break in the bone that commonly occurs as a result of injuries, such as a fall or a direct blow to the shoulder. The type of shoulder fracture depends on the age of the patients. Clavicle fractures are more common in children. A fracture of the upper part of the arm (proximal humerus) is more common in elderly individuals and its frequency increases with age.
A clavicle fracture also called broken collarbone is a common shoulder fracture that happens to people of all ages. The collarbone, also called the clavicle, is the bone that connects your sternum or breastbone to your shoulder. A broken collarbone normally occurs after a fall onto the shoulder or a motor vehicle accident. The most common sports associated with clavicle fractures include football, hockey, and skiing.
A broken collarbone most often causes pain, swelling and bruising over the collarbone. Pain increases with shoulder movement. Your shoulder may slump downward and forward. You may also have a bump around the area of the break. You may hear a grinding sound when you try to raise your arm.
To diagnose a broken collarbone, your doctor will take a brief history, about the injury, and perform a physical examination of your shoulder. An X-ray of the clavicle helps to identify the location of the fracture. Your doctor may also recommend a computerized tomography (CT) scan in some cases.
Most broken collarbones heal without a surgery. An arm sling may support the arm and hold the bones in their normal position. You may also receive pain medications to relieve the pain. After your pain reduces your doctor may recommend gentle shoulder and elbow exercises to minimize stiffness and weakness in your shoulder. Follow up with your doctor until your fracture heals.
Patients may require surgery in case of displaced fractures. The surgery is performed to re-align the fractured ends and stabilize them during healing. and surgery often involves the use of pins or plates and screws to maintain the proper position of the bone during healing.
Proximal Humerus Fractures
The humerus is the upper arm bone and it forms two joints —shoulder joint and elbows joint. The proximal humerus refers to the upper end of the arm bone, which forms the shoulder joint. Fractures of proximal humerus are common in elderly individuals, suffering from osteoporosis. Fractures may result from traumatic injuries such as a fall on the outstretched hand, from greater heights or motor vehicle accidents. In younger individuals, a severe trauma can cause these fractures.
Proximal humerus fractures – four categories:
- Greater tuberosity fractures: Greater tuberosity is the insertion site for attachment of rotator cuff tendons. Greater tuberosity fractures are less common, seen in cases of shoulder dislocations and in those with osteoporosis.
- Lesser tuberosity fractures: These fractures often caused by posterior shoulder dislocations or traumatic muscle contractions by electrical shock or convulsions. If left untreated, these fractures cause subscapularis muscle (stabilizer and mobilizer muscle) deficiency and require a major muscle transfer procedure.
- Surgical neck fractures: Fractures of the surgical neck are most common in patients with osteoporotic bone. These fractures also damage the axillary nerve that carries sensory impulses to the shoulder.
- Humeral head fractures: Humeral head fractures are very often in elderly individuals and chances are more in those with osteoporotic bone. These fractures occur in younger individuals by significant trauma whereas a mild traumatic injury can cause a fracture in elderly individuals with osteoporosis.
In addition to the above, another type of proximal humerus fractures is two, three, and four-part fractures, a fracture that causes multiple fragmentations of the proximal humerus.
Patients with proximal humerus fracture experience severe pain, swelling, and restricted motion of the shoulder.
Proximal humerus fracture is diagnosed by physical examination, X-ray of the affected area and/or computerized tomography (CT) scan.
Most proximal humerus fractures are minimally displaced and can be treated with conservative approaches such as the use of a sling to immobilize and early physical therapy to improve the functional outcome. Surgery may be necessary for displaced fractures. The multiple fragments are fixed with plates, screws, or pins and in severe cases, a shoulder replacement surgery is performed.
Scapular fractures are uncommon but do occur and require a large amount of force to fracture. They are usually the result of intense trauma, such as a high-speed motor vehicle accident or a fall from a height onto one’s back. They can also occur from a fall on an outstretched arm if the humeral head impacts on the glenoid cavity.
Symptoms of a scapular fracture can include the following:
- Pain: Usually severe and immediate following injury to the scapula.
- Swelling: The scapular area quickly swells following the injury.
- Bruising: Bruising occurs soon after injury.
- Impaired Mobility: Decreased range of motion of the joint occurs, often with the inability to straighten the arm.
- Numbness: Numbness, tingling, or coldness of the hand and forearm can occur from impaired blood supply or from injured nerves.
- Popping Sound: A cracking or popping sound, also referred to as crepitus, can often be heard or felt at the time of the fracture.
Scapular Fractures should be evaluated by an Orthopaedic surgeon for proper diagnosis and treatment.
Most scapular fractures are not significantly displaced due to the strong supporting soft tissue structures surrounding it. Therefore, a majority of scapular fractures benefit from conservative treatment and an early motion to reduce the risk of stiffness. They will usually heal without affecting shoulder movement. The conservative treatment options include:
- Immobilization: Slings can provide comfort and to support the shoulder to allow healing to take place. This is usually worn about 3-6 weeks depending on the type of shoulder fracture.
- Prescription Medications: Pain medications prescribed for your comfort during the healing process.
- Physical Therapy: Early progressive range of motion exercises are essential in restoring full shoulder function. Your physician will most likely refer you to a Physical Therapist for instruction on proper exercises and early motion of the shoulder to prevent complications.
Fractures of the scapula involving the neck or glenoid or with severe displacement may result in poor outcomes when treated non-operatively. Shoulder fracture repair is possible through a minimally invasive approach. Minimally invasive ORIF (open reduction internal fixation) surgery uses smaller incisions than a traditional “open” surgery. Minimally invasive incisions are limited to where surgical plates will be placed instead of a traditional incision which can be large. The benefits of minimally invasive surgery include smaller incisions, faster healing, a more rapid recovery, and less scarring.
Shoulder Fracture Repair Plates: Toby Orthopaedics
When it comes to your mobility, treating ann injury as soon as possible is important. And the best way to repair anything is with high-quality components. Toby Orthopaedics is one of Central Florida’s leading producers of orthopedic implants, specializing in flexor tendon repair, proximal humerus, and long bone fracture components.
For more on our amazing line of industry-defining products, get in touch with us or check out our other insightful blogs, today. For readers interested in mobility issues, check out our other recent article on Avoiding Flexor Tendon Laceration This Halloween.