What Are Shoulder and Clavicle Fractures?
The shoulder is a meeting of three bones: the clavicle (collarbone), the scapula (shoulder blade) and the upper humerus (arm bone). Any of these bones can sustain a fracture, or break. Due to shoulder and chest anatomy, humerus and clavicle fractures are more common than scapula fractures.
Causes
Most fractures of the shoulder area occur due to a fall, a direct blow or a high-energy trauma event like a car accident. Because the scapula is protected by the chest, it does not break easily. A scapula fracture is most often due to a high-energy injury to the chest, such as in a motor vehicle accident.
Symptoms
Some symptoms will depend on which bone is broken, but in general, symptoms of a fractured humerus, clavicle or scapula include:
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Deformity
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Difficulty or inability to move the shoulder
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Grinding sensation if the shoulder is moved
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Pain
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Swelling and bruising
A broken clavicle will have swelling around the middle of the collarbone, and there may be a bump that is actually the broken end of the bone. The range of motion will also be limited. A scapula fracture will cause bruising around the shoulder blade. A broken humerus is extremely painful, causing severe swelling and very restricted range of motion.
Diagnosis
Fractures in the shoulder area can be diagnosed by a physical examination, looking for signs and symptoms of a break in one of the bones, and with a medical history to determine if there was an injury that could be causing the symptoms. An X-ray will usually determine the presence and nature of the fracture. At times, a computed tomography (CT )scan can help provide a better three-dimensional look at a complex fracture.
Treatment
Many fractures around the shoulder can be treated nonsurgically. The shoulder will have to be held in place, usually with a sling or a shoulder immobilizer, while the break heals. Physical therapy is usually necessary to help regain flexibility and strength.
Surgery may be necessary if the broken ends of the bone are not aligned or if the fracture is more severe. Determination of whether or not surgery is necessary can also depend on a patient’s age, health history and activity level. In such cases where surgery is necessary, surgeons can realign the bone pieces and hold them together with pins, screws or plates. Occasionally, severe fractures of the upper humerus can be treated with a shoulder replacement.
Patients with less severe fractures have usually healed enough in four to six weeks to begin physical therapy, though more severe fractures may take longer. The aim of physical therapy is to strengthen the muscles around the shoulder and to return the shoulder to its standard range of motion.
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