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].
Entire Body System
- Pain
Pain Management Pain after an injury or surgery is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover faster. [orthoinfo.aaos.org]
Ice is used for swelling, and pain medications are used for pain control. The shoulder is immobilized in a shoulder sling for 3-4 weeks until the pain goes away. [emedicinehealth.com]
Always seek medical advice if pain is severe or you are in any doubt. [sportsinjuryclinic.net]
- Surgical Procedure
Total Shoulder Replacement Shoulder joint replacement is a surgical procedure performed to replace the damaged shoulder joint with the artificial implants. [eddielomd.com]
Shoulder Conditions & Surgical Procedures For more information about the specific shoulder conditions our doctors treat and surgical procedures we offer, we encourage you to click on the links below to access educational resources on each topic. [gardenstateortho.com]
Treatment of shoulder fractures is quite variable ranging from simple immobilization to complex surgical procedures. You should discuss treatment options with your surgeon who can advise you on the pros and cons of different methods of treatment. [verywellhealth.com]
Surgical If the fracture fragments are displaced, surgical procedures may be necessary to bring the pieces together and fix them with wires, pins, plates or screws. [my.clevelandclinic.org]
- 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]
- 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]
Today, we successfully completed "Boot Camp' running, hopping and jumping! We appreciate all that you have done. We will truly miss you all, but you have taught us well. We are forever grateful." Denise M. [twinboro.com]
- Chills
Your child has a fever or chills. Your child's splint becomes damaged. You have questions or concerns about your child's condition or care. Care Agreement You have the right to help plan your child's care. [drugs.com]
Musculoskeletal
- Fracture
The evidence does not cover the treatment of two-part tuberosity fractures, fractures in young people, high energy trauma, nor the less common fractures such as fracture dislocations and head splitting fractures.There is insufficient evidence from RCTs [ncbi.nlm.nih.gov]
CONDITION/DISORDER SYNONYMS Proximal humeral fracture Shoulder fracture 812.00 Fracture of unspecified part of upper end of humerus closed 812.01 Fracture of surgical neck of humerus closed 812.02 Fracture of anatomical neck of humerus closed 812.03 Fracture [accessphysiotherapy.mhmedical.com]
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. [symptoma.com]
fractures: These fractures are rare. [shouldersurgery.com.au]
- 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]
- 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]
- Joint Dislocation
were applied to treat type Ⅲ acromioclavicular joint dislocation. [dict.cnki.net]
Poor Bone Quality: A three or four part fracture, with or without a joint dislocation or a break involving the joint surface, is indicated for a shoulder replacement (hemi-arthroplasty). [rocmd.com]
Dislocations occur when the bones on opposite sides of a joint do not line up. Dislocations can involve any of three different joints. A dislocation of the acromioclavicular joint (collar bone joint) is called a "separated shoulder." [orthoinfo.aaos.org]
- Hip Pain
I was injured all throughout the cross-country and winter track season with stress fractures and a little bit of hip pain. When spring track came along, I was finally free from all injuries and began falling in love with the sport.... [ranawatorthopaedics.com]
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
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]
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
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]
Epidemiology
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
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]
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]
References
- Monica J, Vredenburgh Z, Korsh J, Gatt C. Acute Shoulder Injuries in Adults. Am Fam Physician. 2016;94(2):119-127.
- Resch H. Fractures of the humeral head [Article in German] Unfallchirurg. 2003;106(8):602-617.
- 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.
- 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.
- Jo MJ, Gardner MJ. Proximal humerus fractures. Curr Rev Musculoskelet Med. 2012;5(3):192-198.
- Pecci M, Kreher JB. Clavicle fractures. Am Fam Physician. 2008;77(1):65-70.
- Cole PA, Freeman G, Dubin JR. Scapula fractures. Curr Rev Musculoskelet Med. 2013;6(1):79-87.