Everything you need to know about shoulder fracture

Shoulder trauma is common these days. The injuries might be from a split shoulder from a fall to a high-speed car accident fracturing the collarbone or shoulder blade (clavicle). Everyone suffers from a shoulder injury at some point in their lives; that is clear.

What is a shoulder fracture?
Shoulders are among the most intricate joints in your body because they allow you to move your arm in all directions—around, back and forth, and from side to side. As a result, a shoulder fracture might significantly affect your daily activities. The glenohumeral joint, or shoulder, is where the top of your humerus (upper arm bone) fits into the socket of your scapula (shoulder blade). A break in the clavicle (collar bone), the proximal humerus (head of the humerus closest to the scapula), or the scapula describes as a fractured or broken shoulder.

Clavicle fractures are the most typical type of shoulder fracture and are typically caused by falling. Scapula fractures are the least prevalent of the three major fracture types, and proximal humerus fractures more usually affect older adults. Most shoulder fractures are non-displaced fractures, in which the bone breaks, but the fragments do not move; in contrast, a displaced fracture occurs when the ends of the fragmented bone move. Fractures that are not displaced heal faster and require less medical intervention.

What kinds of fractures occur in the shoulder?
At least one of the three shoulder bones—the scapula (shoulder blade), clavicle (collarbone), or humerus—is involved in shoulder fractures (upper arm bone). There are notable distinctions between the three types of fractures, but they can all result in shoulder pain, tenderness, swelling, and a reduction in the shoulder’s range of motion.

1. Clavicle Fracture

   The clavicle, also known as the collarbone, is a long, thin bone stretching from the neck’s base to the shoulder. Clavicle fractures can occur in people of any age, including babies and the elderly. These fractures typically result from falls, direct hits, contact sports (like football or hockey), or auto accidents. Common symptoms include bruising, swelling, and soreness near the collarbone. A hematoma (localised swelling) or a bone malformation may cause a bump to develop over the location of the injury. Patients who have clavicle fractures frequently have trouble raising their arms.

2. Proximal Humerus Fracture

   There is a long bone called the humerus from the elbow to the shoulder. A fracture at or just below the humeral head on the top of the humerus bone is known as a proximal humerus fracture. It’s common to refer to the humeral head as the ball that sits in the shoulder socket. The proximal humerus frequently fractures. While they can happen to anyone at any age, the risk rises with ageing and osteoporosis. Surgery is not always necessary to treat humeral fractures. The degree of displacement, the involvement of the joint’s cartilage, and the patient’s age and level of activity are all elements that can determine whether surgery is necessary.

3. Scapula Fracture

   A flat, triangular bone in the upper back is called the scapula, the main link between the arm and the chest. Less than 1% of all fractures and about 3% to 5% of shoulder fractures are uncommon scapula fractures observed in men between 25 and 45. Scapular fractures can result from trauma, such as an accident or a contact sport like football. Given the force required to fracture the scapula, a victim of this type of accident frequently has lung or nerve injuries and rib fractures.

What are the symptoms of shoulder fracture?
Pain is the main sign of a fractured shoulder, regardless of whether the scapula or the other bone is involved. Pain from shoulder fractures is typically terrible. Other common shoulder fracture symptoms include:

• Swelling around the shoulder
• A prominent bump or deformity of the shoulder
• Bruising around the shoulder
• Limited range of motion with your arm, much more if you have a proximal humerus fracture
• Weakness in the arm
• Tingling in the hand or arm
• Swelling in the middle of the collarbone area if you have a fractured clavicle

An urgent medical situation is a broken shoulder. Surgery may be necessary for some shoulder fractures to heal properly. If surgery is unnecessary, your doctor will fit you with a shoulder fracture sling. The sling will support your arm and aid in maintaining the correct alignment of the bones for healing.

What is the best way to diagnose a fractured shoulder?
The majority of fractures go through physical examination and localised X-rays. Additional imaging methods, including computed tomography, are sometimes required.

Treatment options

1. Clavicle Fractures

   Most clavicle fractures don’t require surgery to heal; surgery requires when a compound fracture has penetrated the skin, or the bone is significantly misaligned. Surgery usually entails placing plates, screws, or rods inside the bone to stabilise the fracture.

2. Proximal Humerus Fractures

   Most proximal humerus fractures are repaired without surgery (displaced) if the bone fragments are not misaligned. Surgery happens if the fragments are out of place, and surgery typically entails replacing the shoulder or fixing the fracture pieces with plates, screws, or pins.

3. Scapula Fractures

   The majority of scapula fractures can be treated non-operatively. Treatment options include ice, painkillers, and immobilisation with a sling or shoulder brace. Patients are assessed to rule out any more injuries. 10% to 20% of scapula fractures require surgery. Surgery is usually necessary for fractures that affect the shoulder joint or have additional clavicle fractures. The fracture fragments get repaired using plates and screws during surgery.

4. Shoulder Separations (Acromioclavicular Joint)

   According to the patient’s physical needs, shoulder separations can be treated. Surgery is typically unnecessary to repair less severe shoulder separations, and surgery is required for tough upward breaks or dislocations that go backwards or downward. The ligaments get repaired during surgery. Surgery treats manual labourers and professional sports, but the outcomes are unpredictable.

5. Shoulder Dislocations (Glenohumeral Joint)

   Reducing the dislocation is the first step in treating a shoulder dislocation. Mild sedation and painkillers are given to the patient via an intravenous line. To correct the joint, the doctor frequently tugs on the shoulder. After an X-ray confirms the reduction, the shoulder gets attached in a sling or other support. Based on the patient’s age, ongoing issues with the shoulder popping out of position, and the underlying linked soft-tissue injury, can be treated in the future (either to the rotator cuff or the capsulolabral complex).

Recovery from shoulder fracture surgery
The recovery depends on the type of surgery and the patient’s age. Overall, the elderly and people with other health conditions require a much longer recovery. For improved recovery, the surgeon must follow post-surgical instructions given by the surgeon to avoid complications. Rehabilitation is a must to regain the joint’s strength and range of motion. It includes targeted physical therapy sessions under the guidance of experienced professionals. Make sure not to perform restricted movements from the operated shoulder. Ignoring this may delay healing or displace the implant. Above all, the physiotherapy specialist will also suggest home exercises you need to perform as advised.

How does Sancheti Hospital Help you?
Sancheti Hospital is an experienced orthopaedic in Pune, India. Operating for many years, the hospital specialises in Arthroscopic Bankart repair for Shoulder dislocation. Sancheti is also one of the finest rehab centres in Pune.

Frequently asked questions

1. How long does a fractured shoulder take to heal?

   Most shoulder fractures recover in six weeks or less. The normal anatomy may need to be restored through manipulation in about 20% of shoulder fractures. Occasionally, a fracture and a tear to the rotator cuff muscles coincide, and this could make the treatment more challenging.

2. How do you treat a fractured shoulder?

   Shoulder fracture treatment options

   • Icing
   • Arm sling or wrap restriction during the duration of bone healing
   • Oral painkillers can reduce discomfort.
   • Exercises for a range of motion and physical treatment (to begin once the bones have started to heal and under the close supervision of a physical therapist)
3. Can a fractured shoulder heal without surgery?

   Treatment options for most non-displaced shoulder fractures include icing, arm sling, or wrap immobilisation during the bone healing process. Oral painkillers can assist in reducing discomfort.

4. How do you sleep with a broken shoulder?

   You can reduce swelling by holding the shattered bone above your heart to stop blood from collecting. First, try lying on your back with a few pillows supporting you. If this doesn’t work, try progressively adjusting to the side position. To avoid falling in the middle of the night, sleep in the middle of the bed.