1. This shows the anatomy of the shoulder, including the clavicle, humerus, and scapula bones.

640px-Shoulder_fracture_1_--_Smart-Servier.png

2. This shows a fracture of the proximal head of the humerus, which is a type of shoulder fracture.

3. This shows a post-op clavicle fracture treated with intramedullary clavicle fixation device.

FracturedGlenoid.png

4. This shows a fracture of the clavicle and the glenoid of the scapula.

Fracture

What is a fracture?

Fracture = Break.

Generally speaking bones break, or fracture, and too much forces placed across them.  The bone physically fails and a crack forms.  In the shoulder, this typically results from trauma, in the form of direct impact, or impact, or when the range of motion of the joint is exceeded quickly.

 

The most common fracture involving the shoulder is of the clavicle, followed by the humerus, and lastly the scapula.

Clavicle and proximal humerus fractures are often caused by a direct blow from an accident, fall, or collision. The scapula is harder to fracture than these two bones, so fractures of it are usually caused by high energy trauma.

What does a broken shoulder feel like?

The most noticeable, and earliest sign or symptom of shoulder fracture is pain.  This is typically followed by a sensation of inability to move the arm, weakness, swelling, and typically bruising is noted.  Bruising can often take days to develop, and is sometimes seen at distant locations, when the blood is brought elsewhere by gravity.  Deformity can be seen, when the broken bone pushes towards the skin.  This is a common occurrence especially with clavicle fractures.

How are shoulder fractures treated? And when will I improve?

Most fractures heal in approximately 8 weeks.  This in the shorter or longer based upon the pattern of the fracture, age, and other medical and nonmedical factors.

 

Some fractures can be treated nonoperatively, or without surgery.  When nonsurgical treatment is chosen, the fracture is immobilized and the patient is directed to rest and to avoid activities which use the shoulder.

A sling or figure 8 strap is used initially. It is important during this time to range the elbow, wrist, and hand to prevent stiffness in those joints. After the immobilization period, physical therapy and home exercises can help improve motion and strength - typically in that order.  

Surgery is needed for more serious injuries, and often involves fixation with hardware - typically metal plates and screws. Sometimes however, the injury is more severe and different types of surgeries are indicated.

Age, fracture area, and type are important factors, and some fractures require surgeries such as fusion, partial or total shoulder replacement.

Recovery after shoulder fracture surgery

After shoulder fracture surgery you may need assistance with daily functions for 5-10 days.  Typically patients may return to activities including school or work after the initial postoperative period, and after any strong medications are taken.    Generally speaking, most pain subsides after 3-4 weeks after initial injury for nonoperatively treated fractures, and sometimes earlier when they are treated operatively. Motion and strength are recovered after bony healing, and patients are typically back to their prior activities within a few months after fracture union is achieved.

It is important to note that your overall recovery will depend highly upon the type and severity of the injury, and your doctor can help you to understand these differences to help you form expectations regarding overall recovery.

References

  1. https://orthoinfo.aaos.org/en/diseases--conditions/shoulder-trauma-fractures-and-dislocations/

  2. https://my.clevelandclinic.org/health/diseases/17470-shoulder-fractures

  3. https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/orthopaedics/shoulder-pain/shoulder-fracture-diagnosis-and-treatment

  4. https://www.hopkinsmedicine.org/health/conditions-and-diseases/humerus-fracture-upper-arm-fracture

  5. https://nyulangone.org/conditions/shoulder-elbow-fractures/treatments/nonsurgical-treatment-for-shoulder-elbow-fractures

  6. https://www.hss.edu/condition-list_fractures-shoulder.asp

Attribution for Images

1. OpenStax College. “Shoulder Joint”. Wikimedia Commons, 19 May 2013, https://commons.wikimedia.org/wiki/File:914_Shoulder_Joint.jpg.

2. Laboratoires Servier. “Shoulder fracture”.  Wikimedia Commons,  29 September 2019, https://commons.wikimedia.org/wiki/File:Shoulder_fracture_1_--_Smart-Servier.png.

3. Bentplate. “Clavicle Post-op”. Wikimedia Commons,  25 August 2011, https://commons.wikimedia.org/wiki/File:Clavicle_Post-op.png.

4. James Heilman, MD. “FracturedGlenoid”. Wikimedia Commons, 19 October 2011, https://commons.wikimedia.org/wiki/File:FracturedGlenoid.png.