What Is a Shoulder Fracture? What Are the Symptoms? How Is It Diagnosed and Treated?

A shoulder fracture is a common condition resulting from daily falls, sports injuries, or traffic accidents. The shoulder area contains different bones such as the upper arm, shoulder blade, and collarbone. A shoulder fracture occurs when one or more of these bones break.

While the risk of fracture increases in elderly individuals due to osteoporosis, sports activities are at the forefront in young people. In this article, you will find answers to questions such as shoulder fracture symptoms, shoulder fracture diagnosis, shoulder fracture treatment, and how long it takes for a shoulder fracture to heal.

What Is a Shoulder Fracture and What Are Its Types?

There are three main bones in the shoulder area: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). A fracture of any of these bones is defined as a shoulder fracture. Each type of fracture is seen with different frequency, and treatment approaches vary.

Shoulder Bone Fracture

A shoulder bone fracture is a condition where the integrity of the bones forming the shoulder joint is disrupted. It is named according to which bone the fracture occurs in. The most common shoulder fractures occur in the upper part of the arm bone and the collarbone.

Proximal Humerus Fracture

The upper part of the arm bone near the shoulder joint is called the proximal humerus. Fractures occurring in this region are called proximal humerus fractures. They account for approximately 5% of adult fractures. They are frequently seen, especially in individuals over 60 years of age.

80% of these fractures can be treated without surgery. Fractures can occur in different forms. Greater tuberosity fractures are usually seen during anterior shoulder dislocations. Additionally, 3-part or 4-part fractures may occur. Even simple falls can cause fractures in elderly patients.

Scapula (Shoulder Blade) Fracture

Scapula (shoulder blade) fractures are rare. They account for only 1% of all fractures. They usually occur as a result of high-energy trauma. Situations such as traffic accidents or falls from a height lead to these fractures.

Scapula fractures can be of different types:

• Scapular body fracture
• Scapular neck fracture
• Acromion fracture
• Coracoid process fracture
• Fracture of the shoulder joint socket (glenoid cavity)

Thanks to the protective effect of the surrounding muscle tissue and the rib cage, many scapula fractures can be treated without surgery. On the other hand, surgical fixation may be required when the fracture extends to the shoulder joint surface.

Clavicle (Collarbone) Fracture

The collarbone (clavicle) is a thin, "S"-shaped bone that connects the breastbone to the shoulder bone. It accounts for approximately 35% of fractures around the shoulder. Most fractures occur in the middle part of the bone.

Clavicle fractures usually occur after a fall or a direct blow to the shoulder. After the fracture, severe pain, deformity in the shoulder, and limited movement are observed. In some cases, a bony prominence can be noticed under the skin. Treatment is determined according to the type of fracture and the degree of displacement.

Causes of Shoulder Fracture

Multiple reasons lead to the formation of shoulder fractures. The severity of the trauma, the person's age, and bone health play a decisive role in this process. While a significant force is required to break the shoulder bone of a young and healthy individual, even a much simpler fall can cause a fracture in people with osteoporosis.

Falls and Accidents

Falls are among the leading causes of shoulder fractures. Simple accidents such as tripping over a carpet at home, losing balance while getting up from a chair, or slipping in the bathroom can lead to a fracture. Slippery surfaces, inadequate lighting, and uneven terrain increase the likelihood of falling.

Falls from a height cause more serious fractures. Stair accidents, falls at construction sites, or bicycle accidents fall into this category. Especially clavicle and scapula fractures occur as a result of high-energy trauma. Falling directly onto the shoulder leads to a fracture in the collarbone, while falling on an outstretched hand also produces the same result.

Traffic accidents create high-energy impacts. Motor vehicle accidents, motorcycle accidents, or bicycle accidents can cause serious fractures in the shoulder area. In such accidents, proximal humerus or scapula fractures are mostly seen. Crushing blows received directly to the back lead to scapula fractures.

Sports Injuries

The shoulder often receives blows during sports activities. Contact sports increase the risk of fracture. In sports such as football, basketball, volleyball, and ice hockey, collisions between players can create direct trauma to the shoulder. Traumatic shoulder fractures can be seen in young individuals due to such sports activities.

Winter sports such as skiing and snowboarding are also in the high-risk category. Falls at high speed or collisions with obstacles can cause proximal humerus fractures. Similarly, those who engage in extreme sports carry a high risk of fracture. In addition, falls resulting from loss of balance in cycling and motorcycle sports lead to clavicle fractures.

Osteoporosis and Bone Loss

Osteoporosis significantly increases the risk of shoulder fracture. Osteoporosis increases the risk of fracture due to a decrease in bone density and quality. Bone mineral density decreases, and the internal structure of the bone becomes porous. This reduces the bone's resistance to impacts.

Elderly individuals are at higher risk due to decreased bone density and muscle strength. Approximately one in every 3 women and one in every 5 men over the age of 50 carry the risk of osteoporosis-related fractures throughout their lives. Half of women and one-third of men carry the risk of fracture throughout their lives.

Women are at higher risk, especially in the post-menopausal period. The drop in estrogen levels accelerates bone loss. Osteoporosis weakens bones so much that a fracture occurs even as a result of a minor fall or bump that would not normally cause a fracture. In some advanced cases, the bone can even break under the influence of body weight while standing, without the person falling.

Lifestyle choices play an important role in bone health. A diet low in calcium and vitamin D weakens bones. A sedentary lifestyle leads to muscle weakness, increasing the risk of falling. Smoking and excessive alcohol consumption also negatively affect bone density.

What Are the Symptoms of a Shoulder Fracture?

After a fall or impact, the body gives clear signals. Recognizing these symptoms is vital for early diagnosis. Shoulder fracture symptoms are usually too obvious to be ignored.

Severe Pain and Tenderness

When a fracture occurs, sudden and severe pain is felt. This pain does not decrease with rest and increases further with movement. When trying to move the arm, the pain becomes unbearable.

Extreme tenderness is observed when the fracture area is touched. A crunching or grinding sound may be heard when trying to move the shoulder. This sound is caused by the broken bone ends rubbing against each other. This condition, called crepitus in medical literature, is a clear sign of a fracture.

Swelling and Bruising

Rapidly developing swelling occurs in the fracture area. Damaged small blood vessels cause blood to leak under the skin. Significant bruising that can spread to the shoulder, chest, and arm occurs.

Especially in proximal humerus fractures, severe swelling is seen in the shoulder. Within a few days, this swelling descends towards the arm and elbow. Bruising can spread to the elbow over time. In scapula fractures, excessive bruising occurs around the shoulder, armpit, back, and chest wall.

Limited Movement

It becomes difficult to lift or move the arm on the fractured side. A state of inability to move the arm occurs. The patient cannot lift their arm up, open it to the side, or move it backward.

Weakness, numbness, or tingling may develop in the affected arm. These findings may indicate nerve damage. If nerve compression has occurred, significant numbness is felt in the hand and arm. Limited movement is experienced during daily life activities.

Deformity

A visible distortion or depression may occur in the normal shape of the shoulder. As a result of the displacement of the broken bone, a deformity occurs in the shoulder.

In a clavicle fracture, a sharp protrusion can be felt on the bone, just under the skin. In some cases, the broken ends that become visible under the skin are noticed. In scapula fractures, the pain is mostly concentrated in the back area, and there may be a stabbing sensation even when breathing.

How Is a Shoulder Fracture Diagnosed?

Doctors follow a systematic path when diagnosing a shoulder fracture. The diagnostic process begins with an interview with the patient and is finalized with imaging methods. Each stage is critical for the correct determination of the treatment plan.

Physical Examination

First, it is learned how the injury occurred, when it started, and whether there was a previous problem with the shoulder. General health status and daily life expectations are also questioned. The patient's age, activity level, and general health status are noted.

During the physical examination, the shoulder area is carefully examined. It is checked for swelling, bruising, and deformity. Skin integrity is checked because the presence of an open fracture changes the treatment approach. Sensitive areas are determined by palpation.

The shoulder's range of motion and strength are tested. Active and passive movements are evaluated as much as the pain allows. Blood circulation and nerve functions in the arm are checked. This examination is extremely important. Pulses are checked, and sensation and muscle strength are evaluated.

X-ray and Imaging Methods

X-ray is the clearest, fastest, and primary diagnostic tool that shows bone structures. It is the first choice in the diagnosis of shoulder fractures. Usually, a few X-ray films taken from different angles are sufficient to confirm the presence, location, and type of the fracture.

With images taken from at least two right angles, the location, type, degree of fragmentation, and amount of displacement of the fracture are determined. For the upper arm bone, anterior-posterior, lateral, and axillary views are taken. Special views may be required for the collarbone and shoulder blade. The procedure takes an average of 10-15 minutes.

X-ray uses low-dose radiation to produce images of the bony structures of the shoulder. All bones, including the humerus, clavicle, and scapula, are evaluated. It reveals fractures, dislocations, and abnormalities.

Tomography and MRI Examination

Computed tomography (CT) is requested when the fracture extends to the joint surface, is comminuted, or has a complex structure. It is used especially in fractures involving the inside of the joint, in multi-part fractures, or in situations requiring surgical planning. It creates a three-dimensional and detailed map of the bone. It guides the determination of the surgical strategy.

Magnetic resonance imaging (MRI) is generally not necessary for acute fracture diagnosis. It is resorted to when accompanying soft tissue injuries are suspected. It is the best method to understand whether there is a tear in the rotator cuff, which is an important muscle group of the shoulder. It shows conditions such as rotator cuff tears accompanying the fracture. It provides detailed information about bones, muscles, tendons, and ligaments.

How Is a Shoulder Fracture Treated?

The treatment method is determined according to the type of fracture, the patient's age, and lifestyle. Where the fracture is, the degree of displacement of the fragments, and the patient's general health status play a role in the decision-making process.

Conservative Treatment Methods

According to current data, approximately 70-80% of proximal humerus fractures can be treated with non-surgical methods. Conservative treatment is preferred in cases where the fracture ends have not displaced or have displaced very little.

The shoulder is immobilized with a shoulder sling or Velpeau bandage. This method helps the fracture heal by keeping it immobile. The bandage or sling is usually used for 3-6 weeks. It is checked with regular imaging whether the fracture is healing in the correct position.

Painkillers and anti-inflammatory drugs are used. Cold application can be applied to the shoulder area to reduce swelling for the first few days. Especially in elderly patients, if the general health status cannot tolerate surgery, conservative treatment is a very effective option.

Surgical Treatment Options

If the fracture fragments have significantly displaced, surgical treatment may be required. Also, if the fracture extends to the joint surface or the blood circulation of the shoulder head is impaired, surgery becomes inevitable.

In pediatric patients, stabilization can be performed using wires. In adult and elderly groups, plate and screw application is preferred. By placing screws and plates on the broken bone ends, the bone is ensured to heal again.

In severe shoulder injuries, it may not be possible to bring the bones together using screws and plates. If the fracture is multi-part and the probability of healing is low, shoulder replacement surgery is preferred. In this case, the shoulder joint that can no longer perform its function is removed, and a prosthesis is placed in its place.

How Many Days Does a Shoulder Fracture Take to Heal?

Bone healing usually occurs within 6-8 weeks. However, full functional recovery takes an average of 3-6 months. Depending on the severity of the fracture and the treatment method, the recovery time usually varies between 6 and 12 weeks.

It may be kept in a sling for a few weeks after surgery. In the first periods, rest and simple exercises are at the forefront. In the following weeks, a more active rehabilitation process comes into play.

Physical Therapy and Rehabilitation

Whether the patient is operated on or not, the shoulder joint needs to remain immobile for a while as part of the treatment. A shoulder joint that remains immobile for a long time can freeze, which can make the recovery process difficult.

Usually, movements are started between 2 and 4 weeks after shoulder fracture surgery. First, passive shoulder movement is given. Then, active shoulder movements are started. Exercise programs specific to the patient are arranged.

During the physical therapy process, supportive methods such as manual therapy, hot-cold applications, and electrotherapy can also be used. Rehabilitation is necessary for the shoulder to regain its former range of motion.

Frequently Asked Questions

The intensity of the pain is at its highest level in the first 48-72 hours. This process can be relieved with the use of painkillers. The pain gradually decreases within a few weeks, but mild discomfort may continue before the bone fully heals.

The vast majority of fractures heal without surgery. Especially if the bone fragments have not moved, a bandage and rest are sufficient. Conservative methods are preferred when the surgical risk is high in elderly patients.

If you work in desk jobs, returning after 4-6 weeks is possible. In professions requiring heavy physical labor, it may be necessary to wait 3-6 months. Your doctor will decide according to the healing status of the fracture.

If you have severe pain in your shoulder after a fall, you should apply to the emergency department. If you cannot move your arm or see a clear deformity in your shoulder, do not delay. Also, if you feel numbness or coldness in your hand, there may be nerve or vascular damage.

Osteoporosis increases with age. When muscle strength decreases, balance problems arise. Even a simple fall can lead to a fracture. This risk increases even more in women after menopause.

Avoid lifting your arm in the first weeks. Do not carry heavy loads and do not make sudden movements. Do not drive without your doctor's approval. You can gradually increase your movements after starting the physical therapy program.

The risk of re-fracture is low after the bone has fully healed. However, if osteoporosis continues, new fractures may occur in the other shoulder or in different bones. You can protect your bone health with calcium supplements and exercise.

Bones heal faster in children. Usually, stabilization with wires is sufficient. If the growth plates have not been damaged, full recovery is expected. Return to normal activities is possible within six weeks.

In Summary: Shoulder Fracture

Although a shoulder fracture may seem like a serious injury, full recovery is possible with the right treatment. The vast majority of cases heal without surgery, and the patient returns to their former life. If you are experiencing severe pain, swelling, or difficulty moving after a fall or impact, you should consult a doctor immediately. Early diagnosis reduces the risk of complications and accelerates the recovery process. By participating in your physical therapy program regularly, you can ensure that your shoulder regains its former strength. Pay attention to calcium intake to protect your bone health and exercise regularly. Especially if you are elderly, do not neglect bone density tests.

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