Proximal humerus fracture (fractured shoulder)

The shoulder is made up of three bones, the clavicle (collarbone), the scapula (shoulder blade) and the humerus (upper arm bone). The upper part of the humerus is called the proximal part of the bone. Many muscles surround your shoulder. These include the rotator cuff muscles, deltoid muscle, pectoral muscles and several strong back muscles. The arteries and nerves that supply your arm come out from under your collarbone and travel down your arm in front of your shoulder.

Mechanism and epidemiology

The proximal humerus is one of the most commonly broken bones in the elderly. It can occur after a normal fall or trip. Because it is weaker in older people, the bone often breaks in several pieces.

In children and younger adults, a higher-energy injury (such as car accidents, falls from heights and sports) is required to fracture the proximal humerus bone. Because of the many muscles that attach to this part of the humerus, it can fracture in many different ways, and you need to talk to your doctor about the specific type of fracture you have.

Initial treatment

Proximal humerus fractures usually hurt a lot, especially when you try to move your arm. Even breathing causes pain. There may be severe swelling and bruising in the armpit, chest and arm. You may even have bruising in your hand or fingers. When you first see a doctor, he or she will examine your shoulder and arm and take x-rays. If you have no other injuries, in most cases you can go home and do not need to be hospitalized. You will likely receive a sling that you will need to wear. Lying flat in bed after a proximal humerus fracture can cause pain, so sleeping in a recliner may be more comfortable. It is important to move your elbow, wrist and hand to avoid stiffness. You should make an appointment with an orthopedic surgeon or your primary care physician for follow-up care.

General treatment

Most proximal humerus fractures can be treated without surgery. It takes 3 to 4 months for the broken bone to heal. During this time, you will need to do exercises to regain range of motion and strength and return to normal activities. Even if surgery is performed, it often takes up to 18 months to regain full function. If surgery is not needed, you may have limited movement and lifting for a while. This decision will be made by your doctor based on your specific fracture.

Surgery is appropriate for some proximal humerus fractures. An orthopedic surgeon can discuss your specific injury and the pros and cons of surgery. Non-surgical treatment. Surgery is needed if the bone has broken through the skin (open fracture) or is about to break through the skin. Surgery may also be needed if your shoulder is dislocated. Otherwise, there are few absolute reasons to have surgery. If you decide to have surgery, the surgeon will make an incision over your shoulder, realign the bones, and repair the broken bone with metal plates and screws. If your shoulder is broken into too many pieces and is unlikely to heal even if put back together, your surgeon may recommend replacing the shoulder instead of repairing it.

Postoperative care

While your proximal humerus fracture is healing, you probably won't be able to fully move your shoulder or lift objects that weigh more than 1 or 2 pounds. This may be due to pain and/or instructions from your surgeon. Many surgeons will ask you to avoid certain movements after surgery until the bone has begun to heal. You will often be prescribed physical therapy to help with movement, lifting, and pain after surgery. A sling may also be used for relief. It is important to remove the sling several times a day and move the elbow, wrist and hand to avoid stiffness. Your ability to move your shoulder and lift more weight will improve as your bone heals. For best results, it is important to follow your surgeon's instructions.

Long-term problems

Long-term problems after a fracture of the proximal humerus can include stiffness, pain, and the inability to regain full strength before the injury. You may need several months of physical therapy to resume your previous activities. Your shoulder may always feel and move differently than on the uninjured side.

Most proximal humerus fractures heal, but some do not heal or heal in a position that causes discomfort or limits movement. Some people may develop arthritis, which can lead to increasing pain and stiffness. These complications may occur with or without surgery. For older patients, shoulder replacement may be recommended if pain becomes too severe. For younger patients, your surgeon may recommend removal of the material or another surgical procedure.