Shoulder Fractures

Active patients and the elderly are most at risk for shoulder fractures. Shoulder fractures are caused by trauma, usually from a fall on an outstretched arm, or a direct blow to the shoulder, as in a traffic accident, and contact sports.

Common fractures involve the clavicle (collar bone), humerus (upper arm bone), and/or scapula (shoulder blade). Clavicle fractures are most common. Shoulder fractures are more common in women. Women with osteoporosis are at an increased risk.

Shoulder Anatomy

The shoulder is made of three bones: the shoulder blade (scapula), the collar bone (clavicle) and the top of the arm bone (humerus). In addition, there are soft tissues, including muscles, tendons, ligaments and the joint capsule, which hold the bones of the joint together. The rotator cuff is a group of tendons that go around the shoulder joint, and are designed to keep the upper arm bone in the shoulder socket.

Types of Shoulder Fractures

Clavicle fractures are the most common type of shoulder fracture. They occur from a fall onto the point of the shoulder. Symptoms include sharp pain, swelling and bruising in the area of the collarbone injury, a bump may be present where the fracture is pushing against the skin, and limited range of motion. Movement generates a painful, grinding sensation. If caused by a traumatic event, the bone may protrude from the skin (an open fracture). At South County Orthopedic Specialists (SCOS) in Orange County, Dr. Youderian, Dr. Kadakia and Dr. Veneziano are experts in clavicle fracture repair and have helped endless numbers of patients who sustain these injuries from mountain biking, skiing, snowboarding, and horseback riding, get back to their sports quickly.

Humerus fracture are more common in people over the age of sixty-five. Symptoms include a severely swollen shoulder, limited range of motion, and severe pain. Upon movement there may be a cracking or popping sound called crepitus. People with osteoporosis often experience a humerus fracture as they are one of the top four common fractures associated with osteoporosis. This injury can result from a fall or an accident.

Scapula fractures are rarer. They are caused by high impact auto accidents and falls from high places. Symptoms include sharp pain with motion, swelling, and severe bruising around the shoulder blade. This bone is not broken as often because it is surrounded by muscles and does not break easily.

Shoulder Fracture Symptoms

Pain
Swelling
Bruising
Complete inability to move the shoulder
Grinding sensation when the shoulder is moved
Deformity- it looks wrong

Diagnosis

Physical exam, x-rays and other diagnostic imaging studies are used to diagnose a shoulder fracture.

Displace and Non-Displaced Fractures

Non-displaced fractures. A non-displaced fracture means that surgery is unnecessary because the broken bones and bone fragments remain in the correct position, and the skin is unbroken. Treatment involves immobilization (with a sling) to support the bone while it heals. Restoration of full range of motion will require physical therapy. Early mobilization, while the shoulder is healing is important to reduce pain and allow for faster recovery. About eighty percent of shoulder fractures are non-displaced.

A displaced fracture occurs when bones are in pieces and aren’t in the proper alignment. Displaced fractures will often require surgical intervention to reposition the bones into the anatomically correct position for normal shoulder movement. Surgery will realign the bones, and may involve fixing the bones together with metal plates, screws, rods or wires. Restoration of full range of motion will require physical therapy. Surgical options depend on the type of fracture, amount of displacement of the pieces, bone quality, and the patient’s expectations and activity levels prior to the injury.

Depending on the severity of the injury, a displaced fracture may require a partial or full shoulder replacement. Restoration of full range of motion, will require physical therapy. About twenty percent of shoulder fractures are displaced.

A broken shoulder can also involve injury to muscles, tendons, ligaments and nerves.

Treatment Approach Depends on the Location of the Break.

Clavicle breaks can be treated without surgery, if the bone is not out of place and has not broken through the skin.

Humerus fracture can also be treated without surgery so long as bone fragments are not displaced. If the bone fragments are out of position, surgery is necessary.

Scapula fractures can also be treated without surgery most of the time, with immobilization. About ten to twenty percent of these fractures will require surgery when bone fragments are evident in the shoulder joint or there is a clavicle break, in addition to a scapula fracture. Surgery in that case involves fixation of the fractured bones with screws and plates.

Nonsurgical Treatment of Shoulder Fractures

Immobilization, ice and pain medication are nonsurgical treatments for shoulder fractures. Recovery generally requires weeks to months. Most shoulder fractures require a period of immobilization and physical therapy.

Surgical Treatment of Shoulder Fractures

Open reduction and fixation are surgical treatments for shoulder fractures. This procedure is used to repair displaced fractures of the clavicle or humerus. The incision is made over the broken bone. Debris is removed. The bone is placed back in the correct position, and is fixed with wires, plates and screws or rods to permanently keep the bones in place while the fracture heals. If needed, any soft tissue injury is also repaired. Pain management will keep the patient comfortable while the bone heals. Physical therapy will be necessary to restore range of motion.

At South County Orthopedic Specialists (SCOS) in Orange County, California our fellowship trained shoulder surgeon, offers expert care to assure that these injuries are treated rapidly to promote proper

healing. We utilize all available testing and surgical procedures to provide our patients with safe, effective treatments and physical therapy to assist the patient in regaining strength and mobility. Treatments are customized for each patient’s individual needs. Dr. Ari Youderian, our shoulder surgery expert, will work with each patient to ensure the proper treatment plan is provided. When surgery is required, he is skilled at minimally invasive fracture repair, as well as shoulder replacement surgery, when the bone is not amenable to repair.