What is a shoulder fracture?

A crack or break in the bone that occurs within the shoulder joint is called a shoulder fracture. A fracture is the medical word for a fractured bone.

A fractured shoulder might require surgery, but some only need a cast, brace, or sling to aid in the repair. The length of time it will take to heal depends on which bones are broken and what caused it.

Do not try to move your shoulder joint around to place it yourself or use it if you have had a trauma. Go to the ER if you have a fracture or any other type of shoulder injury.

What are the different types of shoulder fractures?

Most of the time, the type of fracture in your shoulder will determine how your healthcare practitioner classifies it. Your shoulder joint is made up of three bones:

• The head, or proximal portion of the humerus is the upper arm bone.
• The shoulder blade, or scapula.
• The collarbone, or clavicle.
• A fracture in any one of these bones is known as a fracture of the shoulder.

What are the two kinds of shoulder fractures?

Shoulder fractures are less common than some other types of injury, which include dislocations or separated shoulders.

Fractures of the clavicle are also common, especially in teenagers. Proximal humerus fractures are more common over 65 years of age or if there are problems with bone density. Scapula fractures are rare because muscles and other tissue in your chest and back cushion your shoulder blades well.

What are the symptoms of a fractured shoulder?

Symptoms of a fractured shoulder include:

• Shoulder pain.
• Swelling.
• Bruising or discoloration.
• Being unable to move or use your shoulder.
• A bony deformity or bump that is not usually present on your body.

What causes shoulder fractures?

Most shoulder fractures are due to traumas that cause your shoulder to be hit with a lot of force in an instant. Some common cases include:

• Sports injuries
• Falls
• Car accidents

How is a shoulder fracture diagnosed?

A healthcare professional will diagnose a fracture based on a physical exam and some imaging tests. If you go to the emergency room after a traumatic injury, such as a car accident, providers in the emergency room can diagnose the fracture.

What diagnostic tests do providers use to establish shoulder fracture?

You will likely need at least one of many different imaging tests to get a few pictures of the fracture:

• X-rays: An X-ray of the shoulder will confirm any fractures and show how much damage your bones have suffered.
• MRI: Your provider may use an MRI to understand the full extent of damage to your bones and their surrounding tissue. An MRI will also help visualize tissue such as cartilage and ligaments surrounding your bones.
• CT scan: CT scans will help your surgeon or physician get a much more detailed view of your bones and surrounding tissue than an X-ray would.

What are the risk factors for shoulder fracture?

Anyone may be at risk for a shoulder fracture, but it most commonly occurs in kids and teens experiencing trauma and adults 65 years and above who have fallen.

Patients with osteoporosis or osteopenia are much more likely to have a bone fracture, often due to falls. Osteoporosis weakens bones so that they break from even minor, unforeseen fractures. Many individuals do not realize they have osteoporosis until after it causes them to break a bone. Other than for fractures that happen, there are generally no apparent symptoms.

What are the complications of shoulder fractures?

Many people who break their shoulder will suffer permanent stiffness in the joint, even after the break has healed. You may also be more likely to develop arthritis in the affected shoulder following a fracture.

If the bone breaks your skin (open fracture), you are also at a higher risk of osteomyelitis, a bone infection.

It's unlikely, but possible, that the injury that led to the fracture may cause damage elsewhere in your shoulder, such as to your:

• Muscles.
• Ligaments.
• Tendons.
• Nerves.
• Blood vessels.

Shoulder fractures: Displaced vs. non-displaced

Your physician will categorize the fracture as either displaced or non-displaced.

A displaced fracture means that the sections of your bone are moved so much that there is a gap where the two sections meet at the fracture site.

Non-displaced fractures are broken bones, but the portions were not shifted sufficiently to be out of position.

Open vs. closed shoulder fractures

Your provider will determine whether your break is an open or closed fracture. An open fracture describes a break in the bone that reaches through to your skin. Fractures where the bone breaks through your skin are sometimes called compound fractures. Patients with an open fracture have a higher risk of developing infections and other complications. Closed fractures are severe but don't penetrate your skin.

What is the treatment for a shoulder fracture?

The treatment of your provider for a broken shoulder depends on which of the bones are broken and if you have other injuries as well.

Immobilization

If the fracture is minor and your bones weren't terribly out of alignment, you may only require a sling or brace. Once again, this depends on what caused the fracture and of what kind. You would also need follow-up X-rays to make sure that those bones are healing appropriately.

Most fractures of the clavicle and scapula require only immobilization and physical therapy to restore your shoulder movement.

Shoulder fracture surgery

Not all shoulder fractures require surgery. Surgery might be necessary if the fracture has damaged the socket in your scapula that holds your humerus in place, referred to as the glenoid.

There are several types of common shoulder fracture surgeries: Open reduction and internal fixation.

The surgeon will bend your bones to their proper position and then set them in place so that they can heal and join back together. The surgeon usually does internal fixation, where they place metal plates, screws, or pins into your bone to stabilize it as it heals.

You will be walking around with these shards lodged in your bones for the rest of your life. Some people have to return to the OR to have them taken out.

Arthroplasty

Arthroplasty is replacement surgery on a joint. Depending on how severely the fracture damaged your shoulder joint, you might have to have a shoulder replacement. Your surgeon will take out the lousy joint and replace it with an artificial one, known as a prosthesis.

Complications of shoulder fracture surgery

Complications from shoulder fracture surgery are unusual but may include:

• ACS: Fluid pressure can accumulate within your muscles. This can keep blood from reaching the tissue; an effect of this is permanent muscle and nerve damage.
• Malunion: The fracture increases the likelihood that broken-up bone will heal in an improper position.
• Nonunion: Your bones may not join or may partially reunite.

How do I avoid shoulder fractures?

General Safety

Always wear your seat belt.

Wear appropriate protective clothing and equipment for all jobs and sports.

Ensure your home and work space are clutter-free, which may lead to tripping or causing others to trip.

Always use the correct devices or appliances in the house to attain things. Remain seated at tables, chairs, or counters.

Stick to a diet and exercise regimen that will support the health of your bones.

Discuss bone density testing with your provider if you are older than 65 or if you have a first-degree relative who has had osteoporosis. Make any necessary changes to reduce your risk of falls if you have a history of poor mobility or are at high risk for considering a cane or walker.

What can I expect if I have a shoulder fracture?

Most individuals who have a shoulder fracture will require the input of a physiotherapist for many months as they recover. Your physiotherapist will help you regain your strength and range of motion - or how far you can move your shoulder.

Severe fractures may result in permanent stiffness or impaired shoulder range of motion. Your doctor or surgeon will speak with you about this.

How long does it take to recover from a broken shoulder?

This depends on a few factors:

• The specific bone that was fractured.
• What caused the fracture?
• The extent of treatments you require.
• Any other injuries you may have sustained.

Complete healing may take several weeks or even months. As with any surgery, your provider or surgeon will create a treatment timeline and review it with you.

Ask your provider when you can return to physical activities. You'll need to keep moving your shoulder around to keep it from getting stiff during healing, but you should not return to playing sports, working out, or lifting with a fractured shoulder before your provider says it's okay to do so.

Living With

When should I go to the emergency room?

Call on emergency number or seek emergency care right away if you think you have a broken shoulder or any other broken bone. You should go to the ER if you have any of the following symptoms:

• Extreme pain.
• You are unable to move your shoulder whatsoever.
• Your shoulder or arm appears abnormally or in an odd position.
• The bone is visible through your skin.
• Swollen.
• New bruising that develops in association with any of the preceding.

To seek an expert consultation for any orthopedic condition.

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