Shoulder Fracture

Overview

A shoulder fracture refers to a break in one or more bones that make up the shoulder complex, which includes the humerus (upper arm bone), clavicle (collarbone), and scapula (shoulder blade). The most common shoulder fractures involve the proximal humerus (upper end of the arm bone near the shoulder joint) and the clavicle.

Shoulder fractures can range from simple, non-displaced breaks that heal well with conservative treatment to complex, multi-part fractures that require surgical intervention. The shoulder joint is one of the most mobile joints in the body, making it particularly susceptible to injury from falls, sports activities, and trauma.

These injuries can significantly impact daily activities and quality of life, as the shoulder is essential for arm movement and function. Early diagnosis and appropriate treatment are crucial for optimal recovery and preventing long-term complications such as stiffness, chronic pain, or loss of function. With proper medical care and rehabilitation, most people with shoulder fractures can expect to regain good function and return to their normal activities.

Symptoms

Shoulder fracture symptoms can vary depending on the location and severity of the break. Some fractures may be obvious immediately, while others might develop symptoms gradually or be initially mistaken for other injuries.

Primary Symptoms

Additional Signs and Symptoms

• Arm stiffness or tightness
• Neck swelling (in some cases)
• Bones are painful to touch
• Visible deformity or abnormal positioning of the shoulder
• Inability to lift or move the arm normally
• Grinding sensation (crepitus) when moving the shoulder
• Numbness or tingling in the arm or fingers
• Weakness in the arm or hand

Emergency Warning Signs

Seek immediate medical attention if you experience:

• Severe deformity of the shoulder or arm
• Bone protruding through the skin (open fracture)
• Complete loss of sensation in the arm or hand
• Signs of circulation problems (cold, blue, or pale arm)
• Inability to move fingers or hand
• Signs of infection (if treatment is delayed)

Symptom Variations by Fracture Type

• Clavicle fractures: Often cause a visible bump or tent-like deformity
• Proximal humerus fractures: May cause more generalized shoulder pain and swelling
• Scapula fractures: Often associated with other chest injuries

Causes

Shoulder fractures result from various types of trauma that apply force to the shoulder bones. Understanding the common causes can help in prevention and risk awareness.

Traumatic Causes

Falls

• Falls onto an outstretched arm (most common mechanism)
• Direct falls onto the shoulder
• Falls from height (stairs, ladders, roofs)
• Slip and fall accidents on ice or wet surfaces
• Falls in elderly individuals due to balance issues

Sports Injuries

• Contact sports (football, hockey, rugby)
• Cycling accidents
• Skiing and snowboarding falls
• Skateboarding and rollerblading accidents
• Gymnastics and other high-impact activities

Motor Vehicle Accidents

• Car crashes with direct shoulder impact
• Motorcycle accidents
• Pedestrian accidents
• Bicycle accidents involving vehicles

Other Causes

• Direct blow: Impact from falling objects or assault
• Repetitive stress: Overuse in athletes (stress fractures)
• Pathological fractures: Weakened bones due to underlying conditions
• Birth trauma: Clavicle fractures during difficult deliveries

Age-Related Patterns

• Children and adolescents: Often from sports or playground injuries
• Young adults: High-energy trauma from sports or accidents
• Elderly: Low-energy falls due to osteoporosis or balance issues
• Middle-aged adults: Work-related injuries or recreational activities

Risk Factors

Several factors can increase the likelihood of sustaining a shoulder fracture. Some are modifiable through lifestyle changes, while others are inherent characteristics that require awareness and precaution.

Age-Related Risk Factors

• Advanced age: Increased risk due to osteoporosis and falls
• Pediatric age: Active children prone to falls and sports injuries
• Adolescent athletes: High activity levels and risk-taking behavior
• Young adults: Participation in high-risk activities

Medical Conditions

• Osteoporosis: Weakened bones more prone to fracture
• Osteopenia: Reduced bone density
• Bone cancer: Weakens bone structure
• Metabolic bone diseases: Various conditions affecting bone strength
• Previous fractures: May indicate bone weakness
• Balance disorders: Increase fall risk

Lifestyle Factors

• Contact sports participation: Football, hockey, rugby
• High-risk recreational activities: Skiing, skateboarding, cycling
• Occupational hazards: Construction, roofing, manual labor
• Sedentary lifestyle: Poor bone density and muscle strength
• Alcohol use: Increases fall risk and affects bone health

Gender Considerations

• Males: Higher rates of traumatic fractures from sports and risky activities
• Females: Increased risk after menopause due to hormonal changes
• Elderly women: Highest risk due to osteoporosis and falls

Environmental Factors

• Icy or slippery conditions
• Poor lighting conditions
• Uneven walking surfaces
• Workplace safety hazards
• Home safety issues (loose rugs, stairs)

Medications

• Corticosteroids (long-term use weakens bones)
• Anticoagulants (increase bleeding risk)
• Sedatives or medications causing drowsiness
• Blood pressure medications that may cause dizziness

Diagnosis

Accurate diagnosis of shoulder fractures involves a comprehensive evaluation combining clinical assessment and imaging studies. Early and precise diagnosis is essential for appropriate treatment planning.

Clinical Evaluation

Medical History

• Mechanism of injury and circumstances
• Time since injury occurred
• Previous shoulder injuries or surgeries
• Current medications and medical conditions
• Dominant hand and occupation
• Pain severity and location

Physical Examination

• Visual inspection for deformity, swelling, or bruising
• Palpation to identify areas of tenderness
• Assessment of range of motion (if safe to do so)
• Neurological examination of arm and hand
• Vascular assessment (pulse, circulation)
• Skin integrity evaluation

Imaging Studies

X-rays

• First-line imaging for suspected fractures
• Multiple views (AP, lateral, axillary)
• Can identify most shoulder fractures
• Shows fracture location, displacement, and pattern
• Helps classify fracture severity

CT Scan

• Detailed view of complex fractures
• 3D reconstruction for surgical planning
• Better visualization of joint involvement
• Useful for comminuted (multi-fragment) fractures

MRI

• Evaluation of soft tissue injuries
• Assessment of rotator cuff damage
• Detection of occult fractures
• Evaluation of blood supply to bone

Classification Systems

• Neer Classification: For proximal humerus fractures
• AO Classification: Comprehensive fracture classification
• Allman Classification: For clavicle fractures
• Displacement assessment: Minimal vs. significant displacement

Differential Diagnosis

• Shoulder dislocation
• Rotator cuff tear
• Acromioclavicular joint separation
• Soft tissue contusion
• Referred pain from neck or chest

Treatment Options

Treatment for shoulder fractures depends on factors including fracture location, displacement, patient age, activity level, and overall health. Options range from conservative management to complex surgical procedures.

Emergency Management

• Pain control: Immediate pain relief with medications
• Immobilization: Sling or splint to prevent further injury
• Ice application: Reduce swelling and pain
• Neurovascular assessment: Ensure nerve and blood vessel integrity
• Wound care: For open fractures

Conservative (Non-Surgical) Treatment

Immobilization

• Arm sling for 2-6 weeks
• Sling and swathe for more stability
• Figure-of-8 harness for clavicle fractures
• Gradual progression to active movement

Medications

• Pain relievers: Acetaminophen, NSAIDs
• Muscle relaxants: For muscle spasm
• Narcotic pain medications: For severe pain (short-term)
• Bone health supplements: Calcium and vitamin D

Surgical Treatment

Indications for Surgery

• Significantly displaced fractures
• Multi-fragment (comminuted) fractures
• Open fractures
• Fractures with nerve or vessel injury
• Failed conservative treatment
• Young, active patients

Surgical Options

• Open reduction and internal fixation (ORIF): Plates and screws
• Intramedullary nailing: Rod placed inside the bone
• External fixation: For severe injuries
• Shoulder replacement: For complex fractures in elderly
• Minimally invasive techniques: Smaller incisions when possible

Rehabilitation and Recovery

Phase 1: Protection (0-2 weeks)

• Immobilization in sling
• Pain and swelling management
• Gentle pendulum exercises
• Hand and wrist movements

Phase 2: Early Motion (2-6 weeks)

• Progressive range of motion exercises
• Passive and active-assisted movements
• Gradual weaning from sling
• Light daily activities

Phase 3: Strengthening (6-12 weeks)

• Progressive strengthening exercises
• Resistance training
• Functional movement patterns
• Return to normal activities

Phase 4: Return to Full Activity (3-6 months)

• Sport-specific training if applicable
• Advanced strengthening
• Full range of motion goals
• Return to work or sports

Prevention

While not all shoulder fractures can be prevented, many risk factors can be modified to reduce the likelihood of injury. Prevention strategies focus on bone health, fall prevention, and safety practices.

Bone Health Optimization

Nutrition

• Adequate calcium intake (1000-1200mg daily for adults)
• Vitamin D supplementation (800-1000 IU daily)
• Protein-rich diet for bone health
• Limit excessive alcohol consumption
• Avoid smoking (impairs bone healing)

Exercise

• Weight-bearing exercises to strengthen bones
• Resistance training for muscle strength
• Balance and coordination exercises
• Regular physical activity
• Sport-specific conditioning

Fall Prevention

Home Safety

• Remove tripping hazards (loose rugs, clutter)
• Install handrails on stairs
• Improve lighting throughout the home
• Use non-slip mats in bathrooms
• Keep frequently used items within easy reach

Personal Safety

• Wear appropriate footwear
• Use assistive devices if needed
• Be cautious on wet or icy surfaces
• Regular vision and hearing checks
• Medication review for fall risk

Sports and Activity Safety

• Use proper protective equipment
• Follow safety guidelines for activities
• Proper technique training
• Gradual progression in training intensity
• Adequate rest and recovery
• Environmental awareness during activities

Medical Management

• Regular bone density screening
• Treatment of osteoporosis if present
• Management of underlying medical conditions
• Medication review for fall risk
• Balance and gait assessment

Workplace Safety

• Follow occupational safety guidelines
• Use proper lifting techniques
• Wear appropriate protective equipment
• Maintain clean and organized work areas
• Report safety hazards promptly

When to See a Doctor

Prompt medical evaluation is crucial for shoulder injuries, as early diagnosis and treatment can prevent complications and optimize recovery outcomes.

Seek Immediate Emergency Care If:

• Obvious deformity of the shoulder or arm
• Bone protruding through the skin
• Complete inability to move the arm
• Severe pain that doesn't improve with rest
• Numbness or tingling in the arm or hand
• Cold, blue, or pale appearance of the arm
• Loss of pulse in the arm
• Signs of infection (fever, redness, drainage)

Schedule Urgent Medical Appointment If:

• Significant shoulder pain after trauma
• Inability to bear weight on the arm
• Limited range of motion in the shoulder
• Persistent pain that interferes with sleep
• Swelling that doesn't improve with rest and ice
• Weakness in the arm or hand
• Pain that worsens over time

Consider Medical Evaluation If:

• Persistent shoulder pain after minor injury
• Recurrent shoulder pain with activity
• Progressive weakness or stiffness
• Concerns about healing progress
• Need for work or activity clearance

What to Expect During Evaluation

• Detailed history of the injury
• Physical examination of the shoulder
• X-rays or other imaging studies
• Discussion of treatment options
• Pain management recommendations
• Follow-up care planning

Emergency Department vs. Urgent Care

Go to the emergency department for severe injuries with obvious deformity, open wounds, or circulation problems. Urgent care may be appropriate for less severe injuries without obvious deformity or neurovascular compromise.

Preparing for Your Appointment

• Document when and how the injury occurred
• List current medications and allergies
• Bring relevant medical records
• Note any changes in symptoms
• Prepare questions about treatment options

Related Conditions

Shoulder fractures may be associated with other injuries or conditions that require concurrent evaluation and treatment:

Associated Injuries

• Brachial plexus injury - Nerve damage affecting arm function
• Pneumothorax - Collapsed lung with high-energy trauma
• Rib fractures - Common with severe shoulder trauma
• Head injury - May occur with falls causing shoulder fractures
• Spinal injury - Requires evaluation in high-energy trauma

Complications

• Delayed union or nonunion of fractures
• Malunion resulting in deformity
• Post-traumatic arthritis
• Chronic pain and stiffness
• Loss of shoulder function
• Neurovascular injury
• Infection (especially with open fractures)

Underlying Conditions

• Osteoporosis - Increases fracture risk
• Bone cancer - Can cause pathological fractures
• Metabolic bone disease - Weakens bone structure
• Balance disorders - Increase fall risk

Frequently Asked Questions

References

1. American Academy of Orthopaedic Surgeons. Shoulder Fractures. AAOS. 2024.
2. Neer CS. Displaced proximal humeral fractures. J Bone Joint Surg Am. 1970.
3. Court-Brown CM, et al. The epidemiology of proximal humeral fractures. Acta Orthop Scand. 2001.
4. Rowe CR. Fractures of the scapula. Surg Clin North Am. 1963.
5. Allman FL Jr. Fractures and ligamentous injuries of the clavicle. J Bone Joint Surg Am. 1967.
6. Rockwood CA, et al. Fractures in Adults. 8th ed. Lippincott Williams & Wilkins. 2015.