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
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!