About Medicine: Shoulders Fractures and What to Expect

Bitterroot Orthopedics and Sports Medicine
A service of Marcus Daly Memorial Hospital
Michael Dolecki, MD
1200 Westwood Drive
Hamilton, MT 59840
(406) 375-4868

Shoulder Fractures
A fracture of the shoulder is more specifically a fracture of the top of the humerus or upper arm bone. The humerus has an upper ball portion which helps form the shoulder joint. The area that fractures most often is just below the ball called the humeral neck. These fractures occur from injuries ranging from a simple fall onto the shoulder to high energy injuries such as a motor vehicle accident.

Diagnosis of most shoulder fractures can be achieved with simple X-rays. Sometimes in order to get a better visualization of the fracture pattern, a CT scan is performed. A 3D reconstruction can then show how the humerus bone has broken and into how many pieces. On occasion an MRI scan is also ordered to see if there is an injury to surround soft tissue structures such as the rotator cuff. When the humerus breaks, the rotator cuff can also tear with the same injury.

When one breaks the upper or proximal humerus, a significant amount of bleeding usually occurs causing the shoulder to turn purple like a large bruise. It is not uncommon for the blood to then drain down the arm to cause major swelling and discoloration of the entire arm. Usually when the bone breaks one is not able to move the shoulder without causing significant pain. Therefore any fall which causes pain in the shoulder with motion warrants an X-ray evaluation.

Treatment of shoulder fractures is determined by how severely the bone has broken and whether any displacement or shift in the position of the bone has occurred. If the fracture is a simple break without any displacement, non-surgical treatment is usually performed. The arm is placed in a sling for 4-6 weeks with no motion allowed. Once adequate bone healing is visualized on follow-up X-rays, some gentle motion is allowed. Referral is then made to a Physical Therapist to increase motion and strengthening activities. A typical fractures with take 4-6 months to heal and regain full function.

If the fracture has shifted or displaced, surgery is necessary to realign the bone into proper position and secure it with pins, plates, screws, or rods. That metal which is placed with generally remain for life, but on occasion will have to be removed in a later second operation. If the fractures bone has shifted and broken into multiple pieces, sometimes the best surgery is to remove all the broken pieces, and replace the ball of the shoulder with a metal ball. All these types of surgery are followed with immobilization for 4-6 weeks in a sling and subsequent rehabilitation with a physical therapist.

In summary a shoulder or proximal humerus fracture is a common injury, and can occur from a simple fall. Non-surgical and surgical treatments are available depending on how badly the bone has broken and if any shift has occurred. Despite the severity of the injury, good results and return of most shoulder function can occur with appropriate treatment and rehabilitation.

Questions and or comments regarding this week's health column please contact Michael Dolecki, MD at Bitterroot Orthopedics and Sports Medicine, a service of Marcus Daly Memorial Hospital, 1200 Westwood Drive, Hamilton, MT 59840. Working together to build a healthier community!