Your shoulders are the joints where your upper-arm bones (humerus), shoulder blades (scapula), and collarbone (clavicle) meet. The humerus fits into the rounded socket of the scapula on each side of your body. Each shoulder is held in place by a group of four muscles and tendons, called a rotator cuff, which covers and protects the humerus and allows you to raise and move your arm.
A fracture of any of the bones in the shoulder can greatly impair your mobility and cause severe pain. Shoulder fractures occur as a result of trauma or injury to the shoulder from a fall, sports injury, car accident or any direct blow to the shoulder.
Here are different types of shoulder fractures:
Proximal Humerus Fractures
Most people who talk about a shoulder fracture are describing a fracture of the proximal humerus. A proximal humerus fracture is a common injury to the shoulder. Especially common in elderly individuals due to osteoporosis, proximal humerus fractures are among the most common broken bones in the shoulder. In fact, in patients older than 65, proximal humerus fractures are the third most common broken bone (after hip fractures and wrist fractures).
A proximal humerus fracture occurs when the ball, of the ball-and-socket shoulder joint, is broken. The fracture is actually at the top of the arm bone (the humerus). Most proximal humerus fractures are non-displaced (not out of position), but about 15-20 percent of these fractures are displaced, and these may require more invasive treatment.
To determine the best treatment, your doctor will start by taking an X-ray of your arm and shoulder area. They may also have you do some movements with your arm. This will help them determine the type of fracture you have and whether you have any other injuries.
In many cases, proximal and mid-shaft humerus fractures do not require surgery since the broken ends usually stay close together. This makes it easier for your humerus to heal on its own. If you have broken the humerus bone, you will need to wear a sling, brace, or splint to keep your arm from moving and stabilize your shoulder. Occasionally, surgery is required with either plates, screws, rods, or sometimes replacement of your shoulder joint with use of a prosthesis. Distal fractures and more severe proximal or mid-shaft fractures usually require surgery.
Regardless of whether or not you need surgery, your doctor will probably suggest following up with physical therapy. This will help you learn exercises and movements you can do to help strengthen your arm muscles and regain your range of motion.
The clavicle (collarbone) is one of the most fractured bones in the body. Clavicle fractures are classified into three types based on the location of the fracture: 1) near the sternum (least common), 2) near the AC joint (second most common), or 3) in the middle of the bone between the sternum and AC joint (most common).
These fractures may be very painful, but are rarely serious and are typically managed with a sling rather than requiring surgery. Broken collarbones are often caused by contact sports such as football, wrestling, ice hockey and rugby, winter sports such as skiing and snowboarding and cycling (particularly mountain biking).
Children may fracture their collarbone when playing or falling out of bed. Weakness in the collar bone from conditions such as osteoporosis or cancer can also lead to a clavicle fracture.
If you think that the clavicle is broken, it is best to seek medical treatment immediately. The first thing the physician will do is take an X-ray to determine if the clavicle is broken, where the fracture is located and how many pieces it is broken into. Clavicle fractures are basically divided into three types based upon location. Fractures near the sternum are the least common (less than 5 percent of all clavicle fractures). Fractures near the AC joint are the second most common and can come in many different patterns. The most common fractures of the clavicle are in the middle of the shaft of the bone, approximately halfway between the sternum and the AC joint.
Nonsurgical Treatment for a Clavicle Fracture
Nonsurgical treatment for a broken clavicle can include the following:
- An arm sling or wrap is typically worn after the break occurs. This helps prevent arm movement as the collarbone recovers.
- Pain medication, typically nonsteroidal anti-inflammatory drugs such as naproxen and ibuprofen, can be taken to reduce pain.
- Physical therapy exercises will be recommended once the collarbone begins to mend. The patient will begin with mild movements to ease stiffness. More intense exercises will be added after the bone recovers.
Surgical Treatment for a Clavicle Fracture
Clavicle surgery may be needed if the fractured bones if the fractured pieces of bone are not in their correct, anatomical location. (The medical term for this is a displaced fracture). In these cases, the bones need to be moved and secured in order to heal properly. Plates, screws, and pins are often used during the surgical process. Rehabilitation after surgery involves exercises that can be done at home or with a physical therapist.
Scapula (Shoulder Blade) Fractures
The shoulder blade (scapula) is a triangular-shaped bone that is protected by a complex system of surrounding muscles. Scapula fractures represent less than 1% of all broken bones and many of them can be treated without surgery.
High-energy, blunt trauma injuries, such as those experienced in a motorcycle or motor vehicle collision or falling from a significant height, can cause a scapula fracture. Other major injuries often accompany scapular fractures, such as fractures in the shoulder, collarbone and ribs, or damage to the head, lungs, or spinal cord.
Types of Scapular Fractures
- Scapular body, the large, flat, triangle-shaped area of the scapula
- Acromion, a bony projection of the scapula located at the top-most part of the shoulder, forming a joint with the end of the clavicle (the acromioclavicular joint)
- Coracoid, a curved, hook-like projection off the front of the scapula located under the clavicle, between the shoulder’s ball and socket and the first rib
- Glenoid, the shoulder socket
- Scapular neck, the portion of the bone that connects the glenoid and the scapular body
There is great variability in the treatment of scapular fractures. Surgery is often recommended for glenoid fractures because of the effects on the shoulder joint. However, there is significant variability in the treatment of scapular body fractures.
If you have sustained a scapular fracture, you will need to be evaluated by an orthopedic surgeon. Often orthopedic surgeons that specialized in either shoulder surgery or trauma surgery will help to manage complex scapular injuries. Your surgeon will review imaging studies and examining her shoulder to determine if surgical treatment is needed.
Nonsurgical treatment with a simple sling works for most fractures of the scapula. The sling holds your shoulder in place while the bone heals. Your doctor may want you to start moving your shoulder within the first week after the injury to minimize the risk of shoulder and elbow stiffness. The sling is discontinued as your pain improves. Passive stretching exercises should be continued until complete shoulder motion returns. This may take 6 months to 1 year.
Certain types of scapular fractures may need surgery:
- Fractures of the glenoid articular surface in which bone has moved out of place (displaced)
- Fractures of the neck of the scapula with a lot of angulation
- Fractures of the acromion process that cause the arm bone to hit against it (impingement syndrome)
How Can I Get Started?
The experienced and dedicated orthopedic surgeons at Ventura Orthopedics are here for you. If you are suffering from a fractured shoulder, it may be time to consult a medical professional. The experienced and dedicated orthopedic surgeons at Ventura Orthopedics are here for you. We are committed to helping you through any procedure until optimum health, strength and mobility are restored.
Call us today at 800-698-1280 to schedule an appointment.