Shoulder fracture treatment

A shoulder fracture can be a painful and disruptive injury, significantly impacting your daily life. Whether it’s a fall, a sports injury, or another form of trauma, understanding your treatment options and what the recovery process entails is crucial. This guide aims to provide you with helpful and informative insights into shoulder fracture treatment, from initial diagnosis to getting back to your normal activities.

Understanding Shoulder Fractures: What You Need to Know

The shoulder is a complex joint, made up of three main bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). A shoulder fracture refers to a break in any of these bones. The most common type is a proximal humerus fracture, which is a break in the upper part of your arm bone, near the shoulder joint. Clavicle fractures and scapula fractures are less common but can also significantly affect shoulder function.

Common Causes of Shoulder Fractures:
Shoulder fractures typically result from a direct impact or significant force. Some common causes include:

  • Falls: This is a very common cause, especially in older adults whose bones may be more brittle (osteoporosis can be a contributing factor). Falling onto an outstretched hand or directly onto the shoulder can lead to a fracture.
  • Direct Trauma: A direct blow to the shoulder, such as during a contact sport (like football or hockey) or a motor vehicle accident (car accidents), can cause any of the shoulder bones to break.
  • High-Impact Injuries: Severe trauma, such as a fall from a height, can result in complex shoulder fractures.

Types of Shoulder Fractures:
Shoulder fractures can be classified in several ways, which helps your health provider determine the best course of treatment:

  • Location: As mentioned, fractures can occur in the proximal humerus, clavicle, or scapula.
  • Open vs. Closed Fracture: A closed fracture means the bone is broken, but the skin remains intact. An open fracture (or compound fracture) occurs when the broken bone pierces the skin, creating an open wound. Open fractures have a higher risk of infection and require immediate medical attention.
  • Displaced vs. Non-displaced Fracture: A non-displaced fracture means the bone fragments are still aligned correctly. A displaced fracture means the bone pieces have moved out of their normal alignment. Displaced fractures are more likely to require shoulder fracture surgery.
  • Pattern of the Break: Fractures can be simple (a clean break) or comminuted (the bone shatters into multiple pieces).

Understanding the specifics of your bone fracture is the first step your doctor will take in planning your shoulder fracture treatment.

Recognizing the Signs: Symptoms and Diagnosis of a Shoulder Fracture

If you’ve injured your shoulder, it’s important to recognize the signs that might indicate a fracture. Prompt medical attention can lead to a better outcome.

Common symptoms of a shoulder fracture include:

  • Severe pain: This is often the most immediate and noticeable symptom. The shoulder pain may worsen with any attempt to move the arm.
  • Swelling and Bruising: The shoulder area may become swollen, tender to the touch, and develop bruising that can extend down the arm or onto the chest.
  • Limited range of motion: You may find it very difficult or impossible to lift or move your arm and shoulder.
  • Deformity: In some cases, the shoulder may look visibly out of place or deformed, especially with displaced fractures or a shoulder dislocation accompanying the fracture.
  • Grinding or Popping Sensation: You might hear or feel a grating or crackling sound (crepitus) when you try to move your shoulder.
  • Numbness or Tingling: If nerves are affected, you might experience numbness, tingling, or weakness in your arm or hand.

How a shoulder fracture diagnosis is made:
If you suspect a fractured shoulder, it’s crucial to see a doctor or go to an emergency room as soon as possible. Your doctor will perform a physical exam, carefully checking for pain, swelling, deformity, and your ability to move your arm. They will also ask about how the injury occurred.

To confirm the diagnosis of shoulder fracture and determine its severity and type, imaging tests are usually necessary:

  • X-rays: These are the most common imaging tests used to identify broken bones. X-rays can show the location and pattern of the fracture.
  • Computed Tomography (CT) Scan: If the X-ray isn’t clear enough, or if the fracture is complex (involving the joint surface or multiple fragments), a CT scan may be ordered. This provides more detailed, cross-sectional images of the bone.
  • Magnetic Resonance Imaging (MRI): An MRI is less commonly used for diagnosing fractures themselves but may be helpful if your doctor suspects associated soft tissue injuries, such as tears in the rotator cuff tendons or ligaments.

Early and accurate diagnosis is key to effective shoulder fracture treatment and minimizing potential long-term complications.

Once a shoulder fracture is diagnosed, your orthopaedic specialist will discuss the most appropriate treatment plan for your specific injury. The goal is to allow the bone to heal in the correct position, restore function, and relieve pain. Shoulder fracture treatment can be broadly divided into non-surgical and surgical methods.

Non-surgical treatment for shoulder fracture:
Many shoulder fractures, especially non-displaced or minimally displaced ones, can be treated successfully without surgery. Non-surgical treatment options include:

  • Immobilization: This is a cornerstone of non-surgical treatment.
    • Sling or Shoulder Immobilizer: You will likely be fitted with a shoulder fracture sling or a more restrictive shoulder immobilizer. This supports the arm, keeps the broken bone in a stable position to promote healing, and helps reduce pain. You’ll typically wear the sling for several weeks (e.g., 2-6 weeks, depending on the fracture type and healing progress).
  • Pain Management:
    • Medication: Over-the-counter pain relievers like ibuprofen or naproxen can help manage pain and reduce inflammation. For more severe pain, your doctor might prescribe stronger pain medication for a short period.
    • Ice Packs: Applying ice packs to the affected area for 15-20 minutes at a time, several times a day, can help reduce swelling and pain, especially in the initial days after the injury.
  • Follow-up and Monitoring: Regular follow-up appointments with your doctor are essential. They will monitor your healing with X-rays to ensure the bone fragments remain in a good position.

Shoulder fracture surgery:
In some cases, shoulder fracture surgery is necessary to achieve the best outcome. Surgery is often recommended for:

  • Displaced fractures: If the bone fragments are significantly out of alignment, surgery can reposition them correctly.
  • Open fractures: These require surgery to clean the wound and repair the bone, reducing the risk of infection.
  • Multiple breaks (comminuted fractures): When the bone is broken into several pieces, surgery may be needed to stabilize them.
  • Fractures involving the joint surface: Precise alignment is crucial for joint function, often requiring surgical intervention.
  • Fractures associated with nerve or blood vessel damage.
  • Active individuals: Younger, more active patients may opt for surgery to ensure optimal strength and function.

Several surgical procedures can be used for shoulder fracture treatment:

  • Open Reduction and Internal Fixation (ORIF): This is a common surgical technique. “Open reduction” means the surgeon makes an incision to directly access and realign the broken bone fragments. “Internal fixation” involves using specialized orthopaedic hardware – such as plates, screws, pins, or wires – to hold the bone pieces together in the correct position while they heal. This is often referred to as internal fixation your bone.
  • Shoulder Replacement (Arthroplasty): For very severe proximal humerus fractures, particularly in older patients with poor bone quality or when the fracture is shattered and cannot be reliably pieced back together, a shoulder replacement might be the best option. This involves replacing the damaged parts of the shoulder joint with artificial components. This could be a hemiarthroplasty (replacing only the ball part of the joint) or a total shoulder replacement (replacing both the ball and socket). In some cases, a reverse total shoulder replacement is performed, especially if the rotator cuff tendons are also severely damaged.
  • Percutaneous Pinning: For certain types of fractures, especially in children or some less displaced fractures, pins can be inserted through small incisions to hold the bones in place without a large open incision.

Potential shoulder fracture surgery complications and risks:
Like any surgery, shoulder fracture surgery carries potential risks, although they are generally uncommon. These can include:

  • Infection
  • Nerve or blood vessel damage
  • Stiffness of the shoulder joint
  • Nonunion (the fracture doesn’t heal) or malunion (the fracture heals in a wrong position)
  • Hardware irritation (the plates or screws may cause discomfort later)
  • Anesthesia-related complications

Your surgeon will discuss these risks with you before the procedure.

The Road to Recovery: Rehabilitation and Healing After a Shoulder Fracture

Healing from a shoulder fracture takes time and dedication to rehabilitation. The goal of shoulder fracture recovery is to regain strength, flexibility, and full range of motion in your shoulder.

Typical shoulder fracture recovery time:
The healing process varies depending on several factors:

  • The type and severity of the fracture
  • Your age and overall health
  • Whether you had surgery or non-surgical treatment
  • Your adherence to the rehabilitation program

Generally, bones take about 6-12 weeks to heal significantly, but full recovery, including regaining strength and motion, can take several months, sometimes up to a year or more for complex injuries. For example, a proximal humerus fracture recovery timeline will be carefully managed by your healthcare team.

The crucial role of physical therapy and shoulder fracture rehabilitation exercises:
Physical therapy is almost always a critical component of shoulder fracture treatment, whether you had surgery or not. A physical therapist will guide you through a structured program of shoulder fracture rehabilitation exercises designed to:

  • Reduce pain and swelling.
  • Restore range of motion: Initially, these will be gentle, passive, or active-assisted exercises to prevent stiffness. Examples include pendulum exercises, table slides, and gentle assisted lifting of the arm. Your therapist will provide specific shoulder fracture exercises 0-3 weeks post-injury or surgery, gradually progressing as healing allows.
  • Improve strength: As your shoulder heals, you’ll begin strengthening exercises for the muscles around your shoulder and arm.
  • Regain function: The ultimate goal is to help you return activities of daily living.

Your rehabilitation program will likely be phased:

  • Early Phase (e.g., 0-6 weeks): Focus on protecting the healing fracture, managing pain and swelling, and gentle range movement exercises. You might still be wearing a shoulder fracture sling. Your therapist will provide guidance on shoulder fracture exercises 3-6 weeks as well.
  • Intermediate Phase (e.g., 6-12 weeks): As the bone shows signs of healing, exercises will become more active to improve range of motion and begin light strengthening.
  • Late Phase (e.g., 12+ weeks): Focus on more advanced strengthening, endurance, and sport-or-activity-specific training. Guidance for shoulder fracture exercises after 6 weeks and beyond will be tailored to your progress.

It’s important to follow your therapist’s instructions carefully and consistently. Trying to do too much too soon can delay healing or cause further injury.

Managing pain and swelling during recovery:

  • Continue to use pain medication as prescribed or recommended by your doctor.
  • Apply ice packs as needed.
  • Elevate your arm when resting if it helps with swelling.

Return to activities:
Your doctor and physical therapist will let you know when it’s safe to resume various activities:

  • Return to driving: This usually depends on your ability to control the vehicle safely and comfortably, often several weeks after the sling is removed and you have regained adequate motion and strength.
  • Return to work: This will depend on the nature of your job. Desk jobs may be possible sooner than physically demanding jobs.
  • Daily life activities: You’ll gradually be able to resume tasks like dressing, cooking, and personal care.
  • Sports and Hobbies: Returning to more strenuous activities or sports will be a longer process and requires clearance from your doctor and therapist.

Patience and perseverance are key during the shoulder fracture recovery period.

Conclusion: Key Takeaways for Your Shoulder Fracture Journey

Dealing with a shoulder fracture can be challenging, but understanding your condition and treatment options is empowering.
Key takeaways include:

  • Shoulder fractures can involve the clavicle, scapula, or, most commonly, the proximal humerus.
  • Symptoms like severe pain, swelling, and limited movement warrant immediate medical attention for proper shoulder fracture diagnosis.
  • Shoulder fracture treatment ranges from non-surgical methods like slings and pain relief to surgical interventions such as open reduction internal fixation or, in some cases, shoulder replacement.
  • Physical therapy and a dedicated program of shoulder fracture rehabilitation exercises are vital for a successful shoulder fracture recovery, restoring range of motion and strength.
  • Healing takes time, and patience is crucial. Follow your healthcare provider’s advice closely to ensure the best possible outcome.

If you have experienced a shoulder injury or are seeking expert advice on shoulder fracture treatment, we are here to help.

To book an appointment or for further information, please visit: https://www.circlehealthgroup.co.uk/consultants/david-shields
Or contact us via email at: info@theupperlimbclinic.co.uk

We are committed to helping you on your path to recovery.