Trauma to the shoulder is common, as there are multiple bones involved with the shoulder joint. Fractures can happen to the upper arm bone (humerus), shoulder blade (scapula), or collarbone (clavicle).
The shoulder is made up of three bones:
- Scapula (shoulder blade)
- Clavicle (collar bone)
- Humerus (arm bone)
These bones are joined together by soft tissues (ligaments, tendons, muscles, and joint capsule) to form a platform for the arm to work.
The shoulder is made up of three joints:
- Glenohumeral joint
- Acromioclavicular joint
- Sternoclavicular joint
Fractures of the clavicle or the proximal humerus can be caused by a direct blow to the area from a fall, collision, or motor vehicle accident. Fractures of the scapula are usually caused by high-energy trauma, such as a high speed motor vehicle accident or falls from a large height.
Symptoms of Fractures:
- Swelling over the fractured area
- An area that may have a "bump," which is actually the prominent ends of the fracture under the skin
- Shoulder range of motion is limited
- Severe pain
- Large amount of bruising
Most fractures are diagnosed with X-rays of the area and by physical examination. Sometimes, additional imaging techniques, such as a CT scan, are necessary.
Some clavicle fractures can be treated without surgery, like when the fracture fragments are not too far apart (displaced). Surgery is necessary when the bone is severely out of place. Surgery typically involves fixing of the fracture with plates and screws.
Proximal Humerus Fractures
Many fractures of the proximal humerus can be treated without surgery if the bone fragments are not too far apart (displaced). If the fragments are shifted out of position, surgery may be required to restore shoulder range of motion. Surgery usually involves fixation of the fracture fragments with plates, screws, or a replacement.
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, socket (glenoid), or there is an additional fracture of the clavicle. Surgery involves fixation of the fracture fragments with plates and screws.
If surgery is required, you will be placed into a sling to avoid any shoulder range of motion after surgery. Clavicle fracture repairs are usually a day surgery that allows you to go home the same day of surgery. Humerus fracture repairs may require an overnight stay in the hospital. In approximately 4-6 weeks, you will begin physical therapy to recover shoulder range of motion and eventually strength.