Fig 1. Shoulder anatomy
Fig 2. Left mid-shaft clavicle fracture that was treated nonoperatively
Fig 3. Left displaced midshaft clavicle fracture that was treated with open reduction internal fixation surgery.
Fig 4. Proximal Humerus fracture.
Fig 5. Proximal fracture along the surgical neck of the humerus, treated with nonoperative management.
What is a fracture?
Fracture = Break.
Fractures occur when there are abnormal forces placed on the bone causing a disruption in the cortical bone. Certain conditions such as osteoporosis, thyroid disease, diabetes or renal disease may increase the risk of fractures. More commonly fractures occur from direct impact, joint dislocation or high velocity direct trauma.
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 to the shoulder 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.
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.
Most fractures heal in approximately 8 weeks. The timeline of fracture healing may vary based upon the pattern of the fracture, age, and other medical and nonmedical factors.
Some fractures can be treated nonoperatively as seen in Fig 2. 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 maintain mobility in the elbow, wrist and hand to prevent progressive stiffness and weakness in these joints.
After the immobilization period, physical therapy and home exercises can help improve motion and strength of the shoulder.
Surgery is needed for more serious injuries, and often involves fixation with hardware as seen in Fig 3. - typically metal plates and screws. Sometimes however, the injury is more severe and different types of surgeries are indicated.
Age, fracture location, 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 activities for 5-10 days. Typically patients may return to activities including school or work after the initial postoperative period, and after tapering of prescription pain medications. Generally speaking, most pain subsides after 3-4 weeks from initial injury for nonoperatively treated fractures, and sometimes earlier when they are treated operatively. It is important to understand that pain may resolve prior to complete bone healing and patients should follow activity modifications per the providers instruction.
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 surgical fixation. Your provider will work with you to manage expectations and get you back to your desired activities.
Attribution for Images
Fig 2-3 and 5. Personal collection of images from Dr. Urband's practice.