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Shoulder Fracture

Fracture Proximal Humeral

Shoulder fracture is a term encompassing several types of fractures developing in the shoulder region. Fractures of the distal clavicle, the scapula, and the proximal humerus are the three most important types. Trauma, either through falls (typical in the elderly population) or high-velocity trauma (for example, in contact sports or accidents) is the universal risk factor and cause of all shoulder fractures. The diagnosis rests on a thorough patient history and a detailed physical examination, whereas imaging studies such as plain radiography and computed tomography (CT) are used to confirm the exact type.


Presentation

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].

Epilepsy
  • Although features were atypical, a nocturnal seizure causing the bilateral shoulder fractures was suspected and EEG showed features compatible with epilepsy.[ncbi.nlm.nih.gov]
Camping
  • He was out the entire offseason leading up to training camp after a knee procedure in the spring. Here is a site with some information on shoulder fractures.[arrowheadpride.com]
Constipation
  • Also, narcotic painkillers tend to cause constipation unless you drink plenty of water and eat fiber-rich foods, such as fresh fruits and vegetables. 4. Don’t be too proud (or modest) to ask for help with personal care.[osteodiet.com]
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]
Tendon Disorder
  • Disorders Shoulder pain is the most common presenting shoulder complaint in an orthopedic practice. view Shoulder Infection The shoulder is one of the most well perfused areas of the human body and because of this ample blood supply to the shoulder which[rocmd.com]
Suggestibility
  • BACKGROUND: Tuberosity repair in shoulder fracture prosthesis implantation still remains a challenge often leading to poor functional outcomes, despite a variety of materials and suggested suture patterns.[ncbi.nlm.nih.gov]
  • Your doctor will then suggest a treatment plan. It depends on the location of your break.[webmd.com]
  • You are encouraged to consult with your primary care physician to discuss any course of treatment presented or suggested.[dd-clinic.com]
  • One trial (45 participants) found no important effects of tenodesis of the long head of the biceps for people undergoing hemiarthroplasty.Very limited evidence suggested similar outcomes from early versus later mobilisation after either surgical fixation[ncbi.nlm.nih.gov]
Nocturnal Seizure
  • Although features were atypical, a nocturnal seizure causing the bilateral shoulder fractures was suspected and EEG showed features compatible with epilepsy.[ncbi.nlm.nih.gov]
Excitement
  • One day, in a major downpour I fell while walking, breaking my upper arm and … Continue reading Hoverboard Hazards The exciting new phenomena of Hoverboarding has made Hoverboards one of the most popular technological “toys” on the market today.[anationinmotion.org]
Amnesia
  • Patients seem to suffer from amnesia after shoulder surgery in one specific area: driving.[anationinmotion.org]
Sleep Disturbance
  • Patients with proximal humerus fractures experience pain, sleep disturbance, swelling, and restricted motion of the shoulder. Bruising may extend across the chest wall and down the arm.[shouldersurgery.com.au]

Workup

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].

Treatment

  • Approximately 50% and 85%, respectively, were receiving treatment for osteoporosis 6 months following their fracture.[ncbi.nlm.nih.gov]
  • 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]
  • […] one death was explicitly linked with the treatment.[ncbi.nlm.nih.gov]
  • Simultaneous treatment of both the shoulders by 2 different surgical teams in bilateral shoulder fracture dislocations that need surgical treatment has the advantages of reduced overall hospitalization time, reduced anesthetic risk, faster return to work[ncbi.nlm.nih.gov]
  • As each patient may have specific symptoms or associated problems, the treatment regimen for a specific patient may not be the proper treatment for another.[dd-clinic.com]

Prognosis

  • 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]

Etiology

  • 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 A fracture that occurs at the midshaft of the humerus usually occurs due to a direct blow to the upper arm. Most frequently, fractures are a result of trauma, such as a fall, motor vehicle accident, or motorcycle accident.[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]

Epidemiology

  • The book also provides updated epidemiologic and statistical data throughout and includes a section on biostatistics in physical medicine and rehabilitation.[books.google.com]
  • The epidemiology of peripheral fractures. Bone . 1996. 18:209S-13S. Pedrazzoni M, Abbate B, Verzicco I, Pedrazzini A, Benatti M, Cervellin G.[emedicine.com]
  • Epidemiology Peak incidence occurs in males aged 21 to 30 and females aged 60 to 80, although a humerus fracture could happen in persons of any age or gender with the right mechanism of injury.[ncbi.nlm.nih.gov]
  • 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]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • Pathophysiology In attempting to reduce tuberosity fragments, it is vital to take into account the regional differences in the proximal humerus. The cortex of the proximal humerus near the greater tuberosity becomes progressively thicker distally.[emedicine.com]

Prevention

  • 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]
  • During the time that the patient wears the sling, it is important that one comes out of the sling to practice hand, wrist and elbow exercises to prevent stiffness from setting in.[orthosports.com.au]

References

Article

  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.

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Last updated: 2019-06-28 11:54