Shoulder Fracture

What is it?

This constitutes any break in a bone that makes up the shoulder joint, such as the proximal humerus (top of the arm), clavicle (collarbone), or scapula (shoulder blade).

Clavicle fracture

The clavicle is also known as the collarbone. It acts as a strut between the sternum (breastbone) and the scapula. The clavicle is a pivot which the shoulder blade moves around, keeping the shoulder out to the side of the body. A fracture to the clavicle can occur following a fall or blow to the shoulder.

Humeral fracture

Fractures of the humerus commonly occur after direct trauma following a fall. They are more common in osteoporotic bone which increases with age. Severe pain, swelling and an inability to move the arm are the typical signs of a broken shoulder.

Why does it occur?

A direct blow sustained after a fall, during contact sports, or as a result of a road traffic accident, is sufficient to cause fracture in these bones. Less traumatic impacts may cause injury in older patients, due to the weaker and more fragile nature of the bones.

Scapula fractures are much less common, due to the protection garnered from the chest wall and surrounding muscles. As a result, this fracture will almost always only occur as a result of high energy trauma, and is often accompanied with injuries to the chest.

Sometimes certain people may suffer instability when only a small force is applied to the shoulder. This is otherwise known as ‘atraumatic dislocation’, and occurs when the surrounding structures are lax as a result of overuse or due to congenital conditions. The joint will often relocate without need to attend hospital and such injuries are common in those who are double-jointed.

Finally, a number of patients suffer with inappropriate muscle recruitment. Otherwise known as ‘muscle patterning’, this is when the muscles surrounding a joint are not working as they should in conjunction with each other.

What are the symptoms?

Severe pain, swelling and difficulty in moving the arm are the most common symptoms. A deformity may be evident (depending on which bone is affected), with surrounding bruising and a grinding sensation when attempts are made to move the arm.

How is it diagnosed?

In addition to taking a history and a physical examination, your surgeon will take radiographs of the shoulder to determine the correct diagnosis. Occasionally, a CT scan or MRI will be needed in order to obtain a more detailed view of the fracture pattern, and so plan appropriate treatment.

How is it treated?

Clavicle

Because the clavicle has complex movement and is surrounded by muscle, it cannot be immobilised in a plaster cast. The normal treatment for a broken clavicle is simply to keep the arm in a sling. 90% of all fractures heal well with this treatment. Surgery may become necessary when:

There are multiple fragments of bone with gaps between them.
There is shortening of the clavicle when the fractured ends overlap by more than 2cm.
The broken bone has, or is at risk of penetrating through the skin.
There is a non-union (hasn’t healed) after 3-6 months.
Fractures are at the distal end of the bone (near to the shoulder), which can interfere with the acromioclavicular joint (ACJ) of the shoulder.

Humerus

Many proximal humeral fractures do not require surgical fixation, as the broken pieces of bone are in a good position and are unlikely to move. Even in cases where the fracture fragments have moved, it is not always necessary to fix them back into place because the shoulder can compensate very well. A support sling followed by early physiotherapy will result in good pain free movement. It takes two weeks for the pain to settle and sleeping can be difficult initially. After this time, the pain improves and by 6-8 weeks the bone will have mended. It is important to take regular pain relief and follow the rehabilitation program set out by your physiotherapist.