Fractures in the shoulder commonly involve the clavicle (collar bone), proximal humerus (top of the upper arm bone), and scapula (shoulder blade).
Clavicle (collarbone) fractures
The collarbone (clavicle) is located between the ribcage (sternum) and the shoulder blade (scapula), and it connects the arm to the body. The clavicle is a long bone and most breaks occur in the middle of it. Occasionally, the bone will break where it attaches at the ribcage or shoulder blade.
Clavicle fractures are often caused by a direct blow to the shoulder. This can happen during a fall onto the shoulder or a car collision. A fall onto an outstretched arm can also cause a clavicle fracture. In babies, these fractures can occur during the passage through the birth canal.
Symptoms
- Clavicle fractures can be very painful and may make it hard to move your arm.
- Sagging shoulder (down and forward)
- Inability to lift the arm because of pain
- A grinding sensation if an attempt is made to raise the arm
- A deformity or "bump" over the break
- Bruising, swelling, and/or tenderness over the collarbone
There is usually an obvious deformity, or "bump," at the fracture site. Gentle pressure over the break will bring about pain. Although a fragment of bone rarely breaks through the skin, it may push the skin into a "tent" formation.
Treatment
In order to pinpoint the location and severity of the break, your doctor will order an x-ray. X-rays of the entire shoulder will often be done to check for additional injuries.
If the broken ends of the bones have not shifted out of place and line up correctly, you may not need surgery. Broken collarbones can heal without surgery.
Recovery
Whether your treatment involves surgery or not, it can take several months for your collarbone fracture to heal. It may take longer in diabetics or people who smoke or chew tobacco.
Most people return to regular activities within 3 months of their injury. Your doctor will tell you when your injury is stable enough to do so. Returning to regular activities or lifting with your arm before your doctor advises may cause your fracture fragments to move or your hardware to break. This may require you to start your treatment from the beginning. Once your fracture has completely healed, you can safely return to sports activities.
Humerus (upper arm bone) fractures
Fractures of the proximal humerus can be caused by a direct blow to the area from a fall, collision, or motor vehicle accident.
Symptoms
- A severely swollen shoulder
- Very limited movement of the shoulder
- Severe pain
Treatment
Most fractures of the proximal humerus can be treated without surgery if the bone fragments are not shifted out of position (displaced). If the fragments are shifted out of position, surgery is usually required. Surgery usually involves fixation of the fracture fragments with plates, screws, or pins or it involves shoulder replacement.
Recovery
Recovery from an upper arm fracture can take several weeks or even months. Most fractures whether treated surgically or nonsurgically require a period of immobilization followed by rehabilitation. If the fracture was not severe and didn’t require surgery, improvement and return of function is typically seen after the first 4 to 6 weeks.
Scapula (shoulder blade) fractures
Because the scapula is protected by the chest and surrounding muscles, it is not easily fractured. Therefore, fractures of the scapula are usually caused by high-energy trauma, such as a high speed motor vehicle accident. Scapula fractures are often associated with injuries to the chest.
Symptoms
- Pain
- Swelling
- Severe bruising about the shoulder blade
Treatment
Most fractures of the scapula can be treated without surgery. Treatment involves immobilization with a sling or shoulder immobilizer, icing, and pain medications. About 10% to 20% of scapula fractures need surgery. Fractures that need surgery usually have fracture fragments involving the shoulder joint or there is an additional fracture of the clavicle. Surgery involves fixation of the fracture fragments with plates and screws.
Recovery
It can take several weeks or even months to recover from a scapular fracture in the shoulder. Most fractures whether treated surgically or nonsurgically require a period of immobilization followed by rehabilitation. If the injury was not severe, there is fairly rapid improvement and return of function after the first 4 to 6 weeks. Shoulder exercises, usually as part of a supervised physical therapy program, are usually necessary. Exercises decrease stiffness, improve range of motion, and help the patient regain muscle strength.