What Is Shoulder Fracture

Understanding shoulder fractures

The shoulder is a complex and highly mobile joint which plays a pivotal role in our daily activities. It is comprised of three main bones:

• the clavicle (collarbone)
• the scapula (shoulder blade)
• and the humerus (upper arm bone)

These bones work in conjunction with an intricate network of muscles, ligaments, and tendons to facilitate a wide range of movements, including rotation, flexion, extension, adduction and abduction of the upper arm.

Unfortunately, like any other joint of the body, it is susceptible to injuries such as dislocations and fractures. A shoulder fracture can have a significant impact on a person's mobility and overall quality of life. In this article, we will delve into what a shoulder fracture is, its various types, causes, symptoms, and the treatment options available.²

Anatomy of the shoulder

The shoulder is a complex joint consisting of the clavicle, scapula and humerus (figure 1). 

1. Clavicle (Collarbone): The clavicle is a long, slender bone that runs horizontally between the sternum (breastbone) and the acromion (a bony process of the scapula). It plays a crucial role in stabilising the shoulder and supporting arm movements.^3,4

2. Scapula (Shoulder blade): The scapula is a flat, triangular bone located on the back of the ribcage. It has several important features, including the glenoid, a shallow socket where the head of the humerus fits to form the shoulder joint.⁵

3. Humerus (Upper arm bone): The humerus is the largest bone in the arm and connects the shoulder to the elbow. It forms the ball-and-socket joint of the shoulder with the glenoid of the scapula.⁶

What is a shoulder fracture?

A shoulder fracture, also known as a broken shoulder, occurs when one or more of the bones in the shoulder joint are cracked or broken. Fractures can occur in any of these bones and they may range from partial cracks to complete breaks.

The most common shoulder fractures are anterior and can be seen in the clavicle, however, proximal humeral fractures are noted to be more common in the elderly and are known to account for 5 to 6% of all fractures in over 65’s. The scapula is posterior and therefore not prone to fractures and is therefore the least common.² 

Types of shoulder fractures

1. Clavicle fracture

Due to the anterior nature of the clavicle fractures, its fractures often occur due to a fall onto the shoulder or an outstretched arm. These fractures can result in pain, swelling, and limited arm movement.^7,8

2. Scapula fracture

Fractures of the scapula, though less common, can occur as a result of high-impact accidents, such as motor vehicle collisions or falls from significant heights. Symptoms may include pain, swelling, and difficulty moving the arm.^9,10

3. Humerus fracture

Fractures of the humerus can occur near the shoulder joint (proximal humerus), in the middle of the bone (diaphyseal humerus), or near the elbow (distal humerus). These fractures often result from falls, direct blows, or traumatic injuries. Depending on the location and severity of the fracture, treatment options may vary.^11,12

Causes of shoulder fractures

Falls

Falling onto an outstretched arm is a common cause of shoulder fractures. This may happen during slips, trips, or falls from a height.

Trauma

High-impact events like car accidents or sports injuries can exert tremendous force on the shoulder, leading to fractures.

Direct impact

A direct blow to the shoulder, for instance during a collision, can cause fractures.

Osteoporosis

Weakening of bones due to conditions like osteoporosis can make them more susceptible to fractures even with minimal force.

Repetitive stress

Overuse or repetitive stress on the shoulder, common in certain sports or occupations, can lead to stress fractures over time and can lead to repetitive strain injury (RSI).

Symptoms of shoulder fractures

The symptoms of a shoulder fracture may include:²

• Intense pain in the shoulder region, which may worsen with movement or touch
• Visible swelling and bruising around the shoulder area
• Difficulty in moving the arm or performing everyday tasks
• In severe cases, a visible deformity or misalignment of the shoulder may be present
• The affected area may be tender to touch

Diagnosis of shoulder fractures

If a shoulder fracture is suspected, a medical professional will perform a thorough examination, which may include:^4,5

Physical examination

The doctor will assess the shoulder for signs of tenderness, swelling, bruising, and deformity.

Imaging

This imaging technique provides detailed images of the bones, allowing for a clear view of any fractures. Examples include the following: Computed tomography scans (CT scans), magnetic resonance imaging (MRI) and X-ray.

In complex fractures, these imaging techniques can offer a more detailed view of the injury.

Treatment options

The treatment for a shoulder fracture largely depends on factors such as the type, location, and severity of the fracture. Options may include:^8,9,10,13

Immobilisation

For stable fractures, immobilisation with a sling or brace may be sufficient. This allows the bones to heal naturally over time as you allow the injured bone to rest and recover

Closed reduction

In cases of displaced fractures, a procedure known as a closed reduction may be performed. This involves manipulating the bones back into their proper position without surgery.

Surgery

Severe or complex fractures may require surgical intervention. This may involve the use of plates, screws, or rods to stabilise the bones during the healing process. An example is a shoulder arthroscopy.

Rehabilitation

Following treatment, physical therapy and rehabilitation exercises are crucial for regaining strength, flexibility, and range of motion in the shoulder.

Summary

A shoulder fracture can significantly impact a person's daily life, but with timely and appropriate treatment, most individuals can recover fully. If you suspect a shoulder fracture, seeking prompt medical attention is crucial. Remember, early intervention can lead to a smoother and more successful recovery.

In all cases, it is important to consult with a qualified healthcare professional for accurate diagnosis and treatment options tailored to your specific situation.