Shoulder fractures are commonly caused by trauma and are usually treated initially by an orthopedist. Fractures to the shoulder will cause pain, limitation of motion and the need for immediate medical care. Shoulder fractures are also often associated with soft tissue damage to the shoulder including rotator cuff tears and labrum tears. There are several different types of shoulder fractures.
Clavicle fractures are one of the most common types of shoulder fractures. The clavicle is the long bone positioned between the base of the front of the neck and the shoulder. It is sometimes referred to as the collar bone. A clavicle fracture usually involves a break somewhere along the shaft of the clavicle, and 80 percent occurs in the middle section. All age groups are prone to this type of injury, and it is typically sustained by landing on the top of the shoulder during a fall.
Symptoms include pain at the fracture location, especially with arm movements. Swelling at the injury site is easily visualized, but displacement and overlapping bone fragments are confirmed by x-ray imaging. Fractures of the lateral and medial portions of the clavicle are less common. Difficulty breathing and decreased blood flow to the arm may be present with medial clavicle fractures. Emergency evaluation, therefore, is recommended for such cases.
Most clavicle fractures do not require surgery and are managed by wearing an arm sling on the affected side. This holds the fractured segments of bone in place while they heal over the course of six to eight weeks. After healing, a residual bony prominence or callous may remain.
Fracture of the humerus, or the uppermost portion of the arm, are seen in all age groups, but the cause usually differs. Under the age of 50, motor vehicle accidents are the primary cause of non-sports related humerus fractures. In the elderly, however, falls from low heights or while standing can cause these injuries. Because of the force of the impact, fractures of the forearm and thigh bones may be sustained in such incidents.
Upon examination, there may be an obvious deformity of the upper arm, along with decreased sensation. X-rays confirm the diagnosis. There may be a single, simple break, or multiple bone fragments. Surgery is the best option for complex fractures such as the latter.
In these cases, the fractures are reduced and re-aligned under general anesthesia, and hardware such as pins, rods, or plates are used to secure the bone fragments. A splint may be applied after surgery for younger patients, but a sling alone gives better outcomes to those over the age of 60. As with any fracture, physical therapy is an important part of recovery.
If the bones are not displaced or are easily re-aligned with a closed reduction, surgery may not be required. Following a reduction, a sling is worn for the duration of time it takes for the humerus to heal, but physical therapy is initiated early to prevent loss of shoulder mobility.
Initially, gravity assisted exercises are encouraged, followed by light weight bearing after three weeks. Rotator cuff muscle rehabilitation begins after six to eight weeks, once the bone has fully healed.
Scapula fractures are extremely rare but may result from a high elevation fall or a high velocity vehicle accident (ie. motorcycle, car, ATV). In this type of injury, the scapula is broken into multiple fragments, and fractures may be present elsewhere. Symptoms include severe pain upon movement of the affected arm, with swelling of the upper back. It is diagnosed by x-ray or CT scan.
For cases that do not require surgery, a sling is worn until the bones heal, but physical therapy usually begins after the first week. This is important to maintain the mobility of the shoulder and to prevent long-term disability. Only one percent of scapula fractures require surgery, typically when either the glenoid fossa or acromion process is broken.