Shoulder fractures are further differentiated by the involvement of specific anatomical sites [1]. Among the most commonly encountered shoulder fractures in the clinical practice are proximal humerus and humeral head fractures, mainly seen in the elderly population [2] [3] [4]. In fact, up to 70% of all fractures of the humeral head are seen in patients over 60 years of age [2]. The mechanism of injury could be a low-energy trauma after falling on the shoulder. A high-energy trauma that occurs in vehicle accidents and during contact sports is a frequent cause in younger patients [2] [3] [5]. In addition to reduced mobility of the shoulder and the relevant arm, accompanying manifestations are the pain and swelling [4]. In some patients, manifestations such as digital ischemia and hypotension can develop in the case of vascular injury [3]. Distal clavicle fractures, which are diagnosed in patients younger than 25 years of age in virtually all cases, is an important type of shoulder fracture that stems from high-energy trauma [1] [6]. The clinical presentation of clavicle fractures is centered around the typical stance of the patient, with the arm usually being placed in adduction [6]. Fracture of the scapula is also an important representative of the shoulder injury, although it is quite rare compared to proximal humerus and clavicle fractures [7]. Scapular fractures are rarely isolated, meaning that severe trauma is usually the underlying cause [7].

• Swelling

  Swelling may be visible over the front of the shoulder joint. [sportsinjuryclinic.net]

  Symptoms include significant, sharp shoulder pain when you attempt to move the arm, as well as swelling, bruising, and tenderness in the skin over the injury. [nyulangone.org]

  Depending on the type of hip arthritis, symptoms can range from pain and swelling in the joints to difficulty using or moving the joint in a normal way. [northwell.edu]

  Bruising, swelling, and pain over the clavicle region are common symptoms. A bump may also form over the site of injury due to hematoma (swelling confined to a specific area) or deformity of the bone. [sports-health.com]

• Weakness

  Weakness is being unable to use the arm or hand normally no matter how hard you try. Pain or swelling may make it hard to move, but that is not the same as weakness. [northshore.org]

  Very Weak Bone Quality: When the patient is elderly and the bone is very weak with a poor likelihood of success with a hemi-arthroplasty, a reverse shoulder arthroplasty is the best first surgical option. [rocmd.com]

  Quality of the evidence Most of the 31 studies had weaknesses that could affect the reliability of their results. [cochrane.org]

  On physical exam, patients with a radial nerve injury may have wrist drop (loss or weakness of wrist extensors), loss or weakness of finger extension, and decreased or absent sensation to the posterior forearm, digits 1 to 3, and the radial half of the [ncbi.nlm.nih.gov]

• Arm Pain

  Signs of shoulder fractures may include: Bruising around the shoulder (may travel down the arm over time) Swelling of the shoulder and arm Pain with simple shoulder movements Deformity of the joint If you have these symptoms, an x-ray will likely be obtained [verywellhealth.com]

  History and Physical Patients will present with arm pain after traumatic injury. Also, patients may have a deformity to the upper arm, shortening of the extremity, swelling, and/or bruising. [ncbi.nlm.nih.gov]

  Your shoulder will be quite painful for the first two weeks. Pain relieving tablets may help to reduce your pain. Ask your doctor for advice. [physioworks.com.au]

  Pain, loss of shoulder/arm function, swelling and bruising. Assessment Determine the injury mechanism. Establish whether osteoporosis is likely. Assess for associated injuries to the arm/shoulder/chest wall/lungs. [patient.info]

• Ecchymosis

  After several days, there may be intense purple bruising ( ecchymosis ) around the shoulder and down the arm. This is to be expected and you should not necessarily be alarmed. Significant swelling commonly occurs from the shoulder to the hand. [midwestbonejoint.com]

  After 18 days the patient was admitted to our burn centre, complaining of pain, ecchymosis, and bilateral swelling in the arms and shoulders. On physical examination no entry or exit burns were noted. [medbc.com]

  […] likelihood in older patients most often occur at level of surgical neck or with subcoracoid dislocation of the head Anatomy Osteology Vascular anatomy Classification Evaluation Symptoms pain and swelling decreased motion Physical exam inspection extensive ecchymosis [orthobullets.com]

• Osteoporosis

  One centre had a formal fracture liaison service (FLS) responsible for screening fracture patients for osteoporosis. [ncbi.nlm.nih.gov]

  A fracture of the upper part of the arm (proximal humerus) is more common in elderly individuals with osteoporosis. In younger individuals high energy trauma is generally required to cause these fractures. [shouldersurgery.com.au]

  Causes Fractures of proximal humerus are common in elderly individuals, suffering from osteoporosis. Fractures may be caused by traumatic injuries such as a fall on outstretched hand, from greater heights or motor vehicle accidents. [oregonshoulder.com]

  They can occur at any age, but the risk increases with age and osteoporosis. There are two other types of humerus fractures. These fractures do not affect the shoulder joint as much as a proximal humerus fracture. [sports-health.com]

  In these people it occurs as a complication of osteoporosis. Before knowing in detail about shoulder fracture is important to know about the structure of the upper end of the humerus bone. [joint-pain-expert.net]

• Shoulder Pain

  An otherwise fit and well 27-year-old man presented with acute onset unexplained bilateral shoulder pain, and was found to have bilateral shoulder fractures and dislocations on imaging. [ncbi.nlm.nih.gov]

  Shoulder Fracture Fundamentals Download a Free Guide on Shoulder Pain Trauma may cause a fracture of the humerus (ball) or the glenoid (socket) of the shoulder joint. [my.clevelandclinic.org]

  What about the application shoulder pain exercises shoulder exercises shoulder physical therapy shoulder rehabilitation exercises [play.google.com]

• Frozen Shoulder

  For more information about Shoulder Arthroscopy, click on below tabs. Frozen Shoulder Frozen shoulder is a condition of painful shoulder with limited movement because of pain and inflammation. [eddielomd.com]

  Shoulder stiffness and frozen shoulder is also frequent after an undisplaced greater tuberosity fracture. This may require treatment, like a true frozen shoulder. In some cases it can take up to one year to fully recover. [shoulderdoc.co.uk]

  […] infection, consequently making a shoulder infection a rare occurrence. view Frozen Shoulder A Frozen shoulder also called adhesive capsulitis is a condition presenting with shoulder stiffness and severe shoulder pain when shoulder motion is initiated [rocmd.com]

  If the fractured upper arm bone is immobilized for too long, the patient may be unable to move the shoulder (a condition called frozen shoulder, or adhesive capsulitis). 7 See Frozen Shoulder Symptoms Surgical Treatment for a Proximal Humerus Fracture [sports-health.com]

  Frozen Shoulder Rotator Cuff Tear Shoulder Arthroscopy Shoulder Impingement Shoulder Instability Shoulder Joint Replacement If you have additional questions about shoulder surgery or would like to schedule an appointment to meet with one of our surgeons [gardenstateortho.com]

• Shoulder Swelling

  General symptoms include: pain decreased range of motion or inability to use or move the shoulder swelling around the shoulder or collarbone bruising the unnatural appearance of the joint including “lumps” or protruding areas grinding noises or sensations [austinshouldersurgery.com]

  Symptoms include significant, sharp shoulder pain when you attempt to move the arm, as well as swelling, bruising, and tenderness in the skin over the injury. [nyulangone.org]

  Pain with movement of the affected shoulder Swelling of the shoulder Bruising around the shoulder If shoulder pain fails to improve within 3-5 days Significant trauma to the shoulder, chest wall, back, or neck can cause severe injuries. [emedicinehealth.com]

• Osteopenia

  Poor bone quality in the form of osteopenia or osteoporosis is a major risk factor for complications following proximal humerus fracture. [orthopaedicsone.com]

  All occurred in patients older than 65 years with osteopenia and were associated with poor results. The most frequent complication was screw penetration after fracture collapse and loss of reduction. [emedicine.com]

• Tingling

  When the pressure becomes severe enough to disturb the way the nerve works, you can experience numbness, tingling and pain in your elbow, forearm, hand and fingers. [northwell.edu]

  You have tingling, weakness, or numbness in your hand or fingers. Your cast or splint feels too tight. You cannot move your fingers. The skin under your cast or splint is burning or stinging. [myhealth.alberta.ca]

  A doctor will also perform an examination, checking for signs of neural or vascular injury such as numbness, tingling, weakness or a reduced pulse in the arm. [sportsinjuryclinic.net]

• Paresthesia

  Patients may report paresthesias and/or diminished sensation distal to the injury. Complaints of weakness may be secondary to pain inhibition or nerve injury. [orthopaedicsone.com]

  Associated paresthesias and an enlarging mass must be viewed with caution. Most vascular injuries (84%) occur in patients older than 50 years; 53% are associated with brachial plexus injuries. [emedicine.com]

When it comes to shoulder fractures, the two critical components of the workup are a thorough patient history and a proper physical examination [1] [3] [4] [5] [6]. Patients must be asked about the events that preceded the injury and the exact mechanism of trauma, as well as the location of impact, which can be of great use for establishing a presumptive diagnosis. Once enough information is gathered during history taking, physicians should conduct a careful physical assessment. Clinical suspicion is solidified through inspection, palpation, and the assessment of joint mobility. Some authors advocate that this examination should be done when the patient is standing, the reason being that scapular and other fractures can be missed in the supine position [7]. In order to make a definite diagnosis, however, imaging studies need to be employed [2] [4] [5] [6]. Plain radiography is the first technique that should be used and two views (sometimes even three) are necessary to determine the exact location and extent of the injury, namely anteroposterior view, a scapular view, and an axial view [2] [4]. If inconclusive findings are obtained with plain radiography, computed tomography (CT) is a superior study that provides a definite description of the fracture type and severity [2] [4] [7]. For patients with suspected vascular compromise, digital subtraction angiography (DSA) must be conducted [3].

Several treatment options have also been proposed to address this type of injury, ranging from non-surgical methods to humeral head reconstruction procedures or arthroplasty with no clear consensus over definitive treatment guidelines, reflecting the [ncbi.nlm.nih.gov]

Cochrane 2012. full article. no best treatment. 5) Maier D et al. Proximal humeral fracture treatment in adults. JBJS 2014; 96: 251-61. full article. review. 6) Iyengar JJ et al. [bonetalks.com]

Anterior Dislocation of the Shoulder - Posterior Shoulder Dislocation - Proximal Humeral Fracture - Three Part Fracture Dislocation - Discussion: - frx dislocations may be considered an extension of two, three, and four part frx classifictions; - ultimate prognosis [wheelessonline.com]

Below are two examples of displaced fractures that require surgical fixation: 2 part displaced 3 part displaced The overall prognosis from proximal humerus fractures depends on numerous factors, including the following: Type of fracture (Neer type) Age [shoulderdoc.co.uk]

What Is the Prognosis for a Broken Shoulder Blade? Most fractures of the shoulder blade heal without complications within 6-8 weeks. Fractures that involve the shoulder socket or scapular neck develop more complications. [emedicinehealth.com]

In general, the more displaced parts, the worse the prognosis. The parts of the proximal humerus are called the tuberosities (the greater and lesser tuberosity), the humeral head (the ball of the shoulder), and the humeral shaft. [orthopedics.about.com]

Background and Etiology A fracture is defined as a partial or complete crack in a bone. [twinboro.com]

Multiple mechanisms have been implicated in the etiology of this traumatic entity most commonly resulting from forced muscle contraction as in epileptic seizures, electric shock or electroconvulsive therapy, major trauma such as motor vehicle accidents [ncbi.nlm.nih.gov]

Etiology The most common mechanism for proximal humerus fractures is a fall on an outstretched hand from a standing height. In younger patients, high-energy trauma is a more frequent cause, and the resultant injury is more devastating. [emedicine.com]

The epidemiology of peripheral fractures. Bone. 1996. 18:209S-13S. Pedrazzoni M, Abbate B, Verzicco I, Pedrazzini A, Benatti M, Cervellin G. [emedicine.medscape.com]

The book also provides updated epidemiologic and statistical data throughout and includes a section on biostatistics in physical medicine and rehabilitation. [books.google.com]

Proximal humeral fractures Epidemiology 4-5% of all fractures. Mechanism of injury Usually after a fall on to an outstretched hand from standing height. [patient.info]

Pathophysiology The most important clinical pearl associated with midshaft humerus fractures involves injury to the radial nerve. Radial nerve injury occurs in approximately 18% of closed mid-shaft or distal shaft humerus fractures. [ncbi.nlm.nih.gov]

Pathophysiology Humerus fractures are caused by direct trauma to the arm or shoulder or by axial loading transmitted through the elbow. [emedicine.medscape.com]

Handle your child gently to prevent more injury. Gently turn your baby or small child. Do not pick up your baby or child by the arm. Take your child to physical therapy as directed. [drugs.com]

Try to avoid falling on the shoulder to prevent any injuries from occurring. Rehab is a priority. It will prevent stiffness, reduce swelling, and improve strength to the shoulder. [rehabmypatient.com]

The plaster hardens when it dries, protecting the injured bone and preventing you from moving your elbow while it heals. [nyulangone.org]

The two articulating surfaces of the bones are covered with cartilage, which prevents friction between the moving bones. The cartilage is lubricated by synovial fluid. [ossmd.com]

1. Monica J, Vredenburgh Z, Korsh J, Gatt C. Acute Shoulder Injuries in Adults. Am Fam Physician. 2016;94(2):119-127.
2. Resch H. Fractures of the humeral head [Article in German] Unfallchirurg. 2003;106(8):602-617.
3. Murray IR, Amin AK, White TO, Robinson CM. Proximal humeral fractures: current concepts in classification, treatment and outcomes. J Bone Joint Surg Br. 2011;93(1):1-11.
4. Burkhart KJ, Dietz SO, Bastian L, Thelen U, Hoffmann R, Müller LP. The Treatment of Proximal Humeral Fracture in Adults. Dtsch Arztebl Int. 2013;110(35-36):591-597.
5. Jo MJ, Gardner MJ. Proximal humerus fractures. Curr Rev Musculoskelet Med. 2012;5(3):192-198.
6. Pecci M, Kreher JB. Clavicle fractures. Am Fam Physician. 2008;77(1):65-70.
7. Cole PA, Freeman G, Dubin JR. Scapula fractures. Curr Rev Musculoskelet Med. 2013;6(1):79-87.