June 13, 2018
Shoulder pain is far too common. Unfortunately, the discomfort of a stiff, painful shoulder is often made worse by the frustration of pinpointing its exact cause. The shoulder can be injured in a variety of ways, including dislocations, labral tears, rotator cuff tears, rotator cuff tendonitis, shoulder impingement, frozen shoulder, and shoulder osteoarthritis. This article will focus on shoulder fractures and will help you determine if your pain is caused by a broken bone.
It is important to keep in mind that only an orthopaedic specialist can diagnose your pain. Schedule an appointment with a shoulder specialist for an accurate diagnosis and comprehensive treatment.
Anatomy of the Shoulder
The shoulder is made up of 3 bones, including:
- The clavicle (collarbone) which is a long, thin bone that begins at the base of the neck and continues to the shoulder.
- The humerus (upper arm bone) which runs from the shoulder to the elbow.
- The scapula (shoulder blade) which is a triangle-shaped bone that connects the clavicle and humerus.
Shoulder fractures can affect any of these bones as well as nearby muscles, ligaments, and tendons.
Types of Shoulder Fractures
A fracture is a broken bone. It can range from a small crack, also known as a hairline fracture or a stress fracture, to a complete break in the bone. Breaks can occur in any of the three shoulder bones:
- Clavicle fractures are a common type of shoulder fracture. A break in the collarbone commonly occurs when a person falls on their shoulder or with their arm stretched out. A clavicle fracture is also typically associated with a bump or protrusion.
- Humerus fractures are also a common type of shoulder fracture. A break in the humerus is classified as either proximal humeral fractures or humerus shaft fractures based on whether the break occurs close to the shoulder joint or in middle portion of the bone respectively. A break in the humerus is often the result of a high-energy event, such as a direct blow to the shoulder or a traumatic motor vehicle accident. Proximal humeral fractures, in particular, are also common among the elderly who are suffering from osteoporosis
- Scapula fractures are very rare. This is primarily due to the joint’s mobility and the thick layers of muscles surrounding the bone. A heavy, blunt force—such as a high-speed vehicular accident or a fall from a great height—is typically required to break the scapula.
Moreover, fractures are described as either displaced or non-displaced. The majority of shoulder fractures are non-displaced, meaning that the bone fragments remain near their correct anatomic position. Displaced fractures, however, require a physician to manipulate the bone back to the correct position.
Symptoms of Shoulder Fractures
All shoulder fractures involve one or more of the following symptoms:
- Severe pain that often becomes worse with arm movement
- Swelling or bruising at the fracture site
- Deformity (such as a bump or protrusion) at the fracture site
- Inability to move the arm
- Grinding sensation when moving the shoulder
Complications Caused by Shoulder Fractures
The most common complications caused by shoulder fractures are:
- Poor shoulder function or immobilization occurs when the arm is unable to move through its full range of motion.
- Shoulder stiffness develops due to the limited movement following a fracture.
- Post-traumatic arthritis is a specific form of osteoarthritis that results from injury. Arthritis will continue to cause pain, swelling, stiffness, tenderness, and joint instability long after the fracture has healed.
Complications related to bone healing and alignment may also occur. These include:
- Malunion occurs when a bone heals in the wrong position.
- Delayed union refers to a fracture that takes longer than usual to heal.
- Nonunion refers to a fracture that fails to heal.
Inadequate immobilization of the shoulder, blood supply, and nutrition all contribute to a patient’s risk for these conditions. Use of tobacco or nicotine can further inhibit bone healing and increase a patient’s risk for complications.
It’s also important to understand that all fractures damage nerves, blood vessels, and soft tissue. Rotator cuff tears occasionally occur at the same time as a fracture. And, although rare, diminished blood supply to bones can lead to a serious, life-threatening complication called avascular necrosis. Avascular necrosis, also called osteonecrosis or aseptic necrosis, causes bones to become painful, weak, and eventually collapse. These conditions can further complicate a fracture and should be treated early.
Treatments for Shoulder Fractures
Conservative treatments are used to treat shoulder fractures, regardless of their severity. These treatments include:
- Immobilization to keep bone fragments together and in the correct anatomical position. A physician will typically recommend a sling, splint, or cast for 2 to 4 weeks. An immobilization device may be recommended for longer, depending on the location and severity of the fracture.
- Physical Therapy helps restore shoulder motion and strength. Physical therapy typically starts 2 to 3 weeks after the injury occurs.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are used to relieve mild to moderately severe pain.
Many shoulder fractures heal in approximately four months with non-surgical treatment; however, some shoulder fractures require surgery in order to heal properly. Minimally-invasive shoulder fracture repair and shoulder replacement surgery are effective options for treating severe breaks and many possible complications.
Talk to a Shoulder Specialist
If you are experiencing pain in your shoulder, ask yourself these questions:
- Are you able to move your arm through its full range of motion?
- Are you able to successfully perform normal, everyday activities with your shoulder?
- Do you experience a sharp pain in your shoulder?
- Does the pain increase with movement?
- Does the pain persist through the night?
- Do you experience a grinding sensation in your shoulder?
- Do you notice an obvious deformity in your arm or shoulder?
These are signs of a serious shoulder injury.
Schedule an appointment with Dr. Robert Rolf if you are concerned that you may have a shoulder fracture. Dr. Rolf is a board-certified orthopaedic surgeon at Beacon Orthopaedics & Sports Medicine with expertise in shoulder reconstruction and replacement. Patients can meet with Dr. Rolf at Beacon’s Batesville, Lawrenceburg, or Northern Kentucky location as well as Beacon West in Harrision, Ohio. Dr. Rolf also offers Shoulder Talks at Beacon West. Visit Dr. Rolf’s page for more information on his free shoulder talk seminars or to schedule an appointment today.