Shoulder Fracture: Cause, Diagnosis and Treatment
Shoulder fracture usually means fracture of the upper part of the humerus bone that forms the shoulder joint.
This fracture is more common in middle aged people. In these people it occurs as a complication of osteoporosis.
Before knowing in detail about shoulder fracture is important to know about the structure of the upper end of the humerus bone.
The upper end of the humerus can be divided into three parts
- the part covered with cartilage called the head of humerus
- a smaller bony prominence called the lesser tuberosity
- a larger bony prominence called the greater tuberosity
The two tuberosities are separated from each other by the groove for the tendon of biceps muscle called bicipital groove.
The part between the head and the two tuberosities is called the anatomical neck of the humerus.
The part between the shaft and the two tuberosities is called the surgical neck of the humerus.
Thus when the upper part of the humerus fractures the bone may separate into 4 parts namely
- Head fragment
- Greater tuberosity fragment
- Lesser tuberosity fragment
- the remaining part of the shaft of humerus
Shoulder fracture can be classified into two types
- Undisplaced in which the fracture pieces have not separated from each other
- Displaced in which the fracture pieces have separated from each other.
Displaced fractures can further be divided into 3 types (after Neer)
- 2 part fracture meaning 2 bone fragments are present that may be head and remaining bone of greater tuberosity and remaining bone
- 3 part fracture meaning 3 bone fragments are present that may be head and greater tuberosity and remaining bone
- 4 part fracture meaning 4 bone fragments are present that may be head and greater tuberosity and lesser tuberosity and remaining bone
The more the separation of fragments, the more the parts, the more is the severity of injury and the worse is the final out come.
- history of injury
- loss of movement
- passive movements are painful
- tenderness over the shoulder area
- reddish bluish discolouration of the skin due to seepage of blood
Diagnosis is confirmed by x rays of the shoulder joint taken in different position.
Treatment of shoulder fracture depends upon
- classification of the fracture
- age and activity level of the patient
- presence of osteoporosis
Treatment methods used include
- use of a sling for support and exercises as pain subsides
- traction to align the fragments
- external fixation of the fracture with a frame applied over the shoulder
- internal fixation with plates, screws, rods and wires
- replacement of the fractured part with a metallic prosthesis
As about 75% of shoulder fractures are undisplaced or only mildly displaced hence they only require treatment in a sling and shoulder exercises as pain subsides.
Treatment method to be used varies from patient to patient and the treating doctor has to use his experience, judgement, and knowledge to decide which treatment method is best for a particular patient. In my opinion doctors should refrain from over treatingthese fractures.
If a 70 year old female having a low activity level with osteoporosis comes to me with a four part fracture then I would treat her with a sling, painkiller drugs and early gentle exercises to bring back early movement of the shoulder joint. A similar patient who is active with satisfactory general health may be considered for shoulder replacement.
If a 55 year old male who plays golf every Sunday, exercises 4 times a week comes with a 2 or 3 part fracture then I would treat him surgically because he needs a strong and stable shoulder joint.
- non-union when the fracture fails to unite
- mal-union when the fracture unites in a wrong position that significantly limits over head movement of the shoulder
- avascular necrosis (death) of the head fragment for complete disruption of its blood supply
- arthritis of the shoulder joint
- nerve injury
- stiffness of the shoulder joint or frozen shoulder
Fequently Asked Questions
How long does this fracture take to unite?
Undisplaced and mildly displaced fractures unite in 6 to 8 weeks
. Displaced fractures can take longer or they may go into non-union if the head undergoes avascular necrosis.
How is a non-union treated?
A non-union with no symptoms or mild symptoms (mild pain) and satisfactory movement of the shoulder joint is left as such.
A symptomatic non-union with good and strong bone is treated by bone grafting and stabilization of the fracture with plate and screws or other implant.
A symptomatic non-union with poor weak and osteoporotic bone is treated by shoulder replacement surgery or stabilization with a locking plate and bone grafting.
What is done if mal-union occurs?
A mal-union that limits the movement of the shoulder joint requires surgical correction.
How is avascular necrosis (death) of the head managed?
A symptomatic avascular necrosis is treated by shoulder replacement surgery. If symptoms are mild or absent then no treatment is required.
I hope the information provided was helpful. If you have any query you can ask me at the contact me page.
This page was last updated on 1st April 2009.
Other causes of shoulder pain...
Rotator Cuff Tendinitis
Recurrent Shoulder Dislocation
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