Shoulder Fracture

The shoulder is a complex joint that connects the arm to the body. The shoulder bone comprises the humerus (arm bone), the scapula (shoulder blade), and the clavicle (collar bone). Furthermore, the shoulder includes three joints - glenohumeral (ball and socket joint), acromioclavicular, and sternoclavicular. Trauma can cause fractures of any of these bones, significantly impacting your mobility and causing severe pain.

Shoulder fractures are either displaced (when the bone fragments move out of their position) or non-displaced (when the bone cracks but stays in the correct position). Non-displaced fractures are more common - nearly 80% of all shoulder fractures. These types of fractures can often be treated with non-surgical methods. On the other hand, displaced fractures may require surgical intervention to realign the bones. 

The types of shoulder fractures include:-

1. Clavicle fracture: The clavicle or collarbone is a long, thin bone located at the base of the neck and extends to the shoulder. It is the most common shoulder fracture that results from a fall, contact sport, or direct hit. 
2. Proximal humerus fracture: The humerus is a long bone that runs from your elbow to the shoulder. It is a fracture to the top of the humerus bone, at or below the humeral head (ball in the shoulder’s socket).
3. Scapula fracture: It is a flat, triangular bone situated in the upper back. Fractures of the scapula are rare. These fractures often result from high-energy trauma such as falls or motor vehicle accidents.

The symptoms of shoulder fracture include:-

1. Swelling or bruising
2. Shoulder pain
3. Tenderness and redness
4. Deformity or bump at the fracture site
5. Shoulder instability (it feels like the shoulder is slipping out of its socket)
6. Discolouration around the upper arm
7. Inability to move the arm without pain

The clavicle or proximal humerus fractures can be caused by a direct blow to the area, resulting from:-

1. A fall onto the upper arm and shoulder
2. Collision
3. Motor vehicle accident

Scapula fractures are the least common because the back muscles protect the bone. They are usually associated with injuries to the chest caused by high-energy trauma like a high-speed motor vehicle accident.

Some factors that can increase your risk of breaking the shoulder bone include:-

1. People older than 65 have a greater risk of shoulder fracture. 
2. Having osteoporosis (bones becoming brittle and fragile from loss of tissue)
3. Participating in contact sports, such as football
4. Engaging in activities with chances of falls from an elevated height, such as climbing ladders, horse riding, and cycling.

While diagnosing your shoulder fracture, the doctor will ask about your medical history and conduct the following tests:-

1. Physical exam: Your provider will examine your shoulder to assess the amount of bruising, swelling, and deformation. He/she will enquire about your symptoms and previous shoulder injuries to accurately diagnose your condition. 
2. X-ray: The doctor uses X-ray images to reveal the exact fracture location in the shoulder. It also helps the doctor analyse whether the break affects the surface or goes through the bone. 
3. CT scan: The doctor may recommend a CT scan if the X-ray reveals that the fracture has occurred in more than one place in the bone or if the bone pieces have separated from each other. Two or three-dimensional images of the shoulder are created during a CT scan to help the doctor examine the fracture from different angles. 
4. MRI: The doctor may recommend an MRI if a shoulder fracture is severe that could have affected the nearby tendons, ligaments, or nerves. An MRI uses a magnetic field to capture detailed images of the tissue surrounding the joint, revealing whether ligaments or tendons are torn or strained. 

Several non-surgical and surgical methods are used to treat non-displaced and displaced shoulder fractures. While some shoulder fractures can be treated with non-invasive procedures, others may need complex surgical procedures to repair the broken bone. Most non-displaced fractures can be treated with conservative techniques, including:-

1. Icing: The doctor may ask you to ice the bruised area to relieve pain and swelling. 
2. Immobilisation: Your doctor might use an arm sling or wrap for a few days or weeks to keep your shoulder from moving while the bone heals. 
3. Medication: Your doctor may prescribe pain relievers or muscle relaxants to help alleviate pain while your shoulder heals. 
4. Physical therapy: Your provider may recommend physical therapy and range-of-motion exercises once your bone starts to heal. You should perform the exercises only under the close supervision of a physical therapist. 

The doctor may recommend surgery to treat the broken bone in severe shoulder fractures. There are several types of shoulder fracture surgeries, which include:-

1. Shoulder Fracture Fixation Surgery: If the bones in your shoulder are displaced, or there is an open fracture, the surgery is essential to repair the fracture and any other damage to the ligaments, muscles, and tendons. In this procedure, the surgeon uses metal instruments such as pins, plates, or screws to repair a broken bone in the shoulder. 
2. Partial Shoulder Replacement Surgery: You may require a partial shoulder replacement surgery if you have a severe shoulder fracture. In this procedure, the humerus (arm bone) is replaced with a shoulder replacement device made of a metal ball and stem. Glenoid, the other half of the shoulder joint, is left intact. 
3. Reverse Total Shoulder Replacement: In severe cases of fractures, the doctor may use reverse total shoulder replacement. During this procedure, the surgeon removes the rounded head of the humerus. He/she then uses special tools and screws to attach a plastic socket to the rest of the bone. Next, he/she removes the part of the socket of the scapula and replaces it with a metal ball. This procedure results in reduced pain and an increased range of motion. 
4. Non-Union and Malunion Shoulder Fracture Surgery: A non-union results from a broken bone that did not heal properly. A malunion occurs when a broken bone heals in the wrong position, causing a deformity. The surgery involves the removal of infection to better stabilise the fracture or stimulation of bone growth with a bone graft. 

However, please note that the procedure selection is based on your condition and your doctor’s opinion. 

Call your healthcare professional anytime you think you have a broken bone. Seek medical attention if you experience the following symptoms:-

1. Shoulder pain
2. Swelling or bruising
3. Tenderness or redness
4. Shoulder instability
5. Deformity of the shoulder

Complications of a Shoulder Fracture

Some potential complications of a shoulder fracture include:-

1. Stiffness in the shoulder
2. Limited range of motion in case the fracture doesn’t heal properly
3. Risk of developing shoulder arthritis