Is your shoulder broken too? (Shoulder Fracture) Don't worry, let's talk about this!

Oh my shoulder... does it feel like you can't even move it? After a fall or some accident, have you experienced severe pain and swelling in your shoulder, making it impossible to even lift your arm? Then you may have a shoulder fracture, which is a broken bone in the shoulder . Let's talk about this in detail and very simply. Don't worry, this information will help you a lot.

What is a Shoulder Fracture?

Simply put, a shoulder fracture is a break in the bone in your shoulder joint, which is what we call a "broken bone" in everyday speech.

Did you know that our shoulder is an amazing joint? It's the joint that allows us to move our arms, lift them, and rotate them in a wide range of motion. It's made up of three main bones. A fracture of one or more of these three is what we call a shoulder fracture.

What are the main bones that make up the shoulder? How can they be broken?

The shoulder joint is made up of three main bones. Any one of these three can break. That's when we call it a 'shoulder fracture.'

• Proximal Humerus: This is the top part of the long bone in your upper arm that connects to your shoulder. It can break, such as in a fall.
• Scapula: This is the flat, triangular bone that we feel when we put our hand on the back of our shoulder. It is less likely to break because it is well covered with muscle.
• Clavicle: Also known as the 'collar bone', this is the small, long bone that runs from the base of the neck to the shoulder. This is the bone that is most likely to break if you fall while playing sports.

A fracture of any of these bones is considered a shoulder fracture.

How common are these shoulder fractures?

Compared to other shoulder injuries, such as shoulder dislocations, shoulder fractures are not as common. However, they are more common in some cases:

• Clavicle fractures: These are quite common among young children, especially those who play sports. For example, if you fall suddenly while playing, this can happen.
• Proximal Humerus Fractures: These are common in people over the age of 65, especially those with bone-thinning diseases (such as osteoporosis) . They can happen even if you slip and fall at home.
• Scapula Fractures: This is very rare because it is well protected by the muscles in the chest and back. It does not break easily unless there is a major accident.

What are the symptoms of a broken shoulder?

If you have a broken shoulder, you may have one or more of these symptoms. If you notice any of these, you should definitely seek medical advice.

• Severe shoulder pain: This is the main symptom. The pain can sometimes be unbearable.
• Swelling: There may be significant swelling around the fracture site.
• Bruises or skin discoloration: The broken area may turn blue/purple.
• Inability to move or use the shoulder: It may be very difficult, or impossible, to raise or rotate the arm.
• An unusual lump, bump, or change in shape can be seen on the shoulder: If you see a difference when looking at it from the other shoulder, that is also a symptom.

Important: If you have these symptoms, do not try to fix your shoulder or arm yourself. See a doctor immediately.

Why do these shoulder fractures happen?

Most shoulder fractures occur when there is a sudden, forceful blow or trauma to the shoulder. Consider situations like these:

• Sports accidents: Falling while playing, colliding with someone else, being hit by something like a ball.
• Falls: Slipping and falling through a doorway, slipping in the bathroom, falling from a height (e.g., from a tree, ladder). Sometimes it can even happen while walking on the street.
• Vehicle accidents: Direct impact to the shoulder in car, bicycle, or three-wheeler accidents can fracture it.

Who is at higher risk of shoulder fractures?

Anyone can break a shoulder. However, some people are at a slightly higher risk:

• Children and young people: are more likely to be involved in accidents because they are active.
• People over 65 years of age: are at higher risk of falls and may also develop weaker bones.
• People with weak bones: People with osteoporosis or osteopenia are at a higher risk of breaking a bone, even with a minor fall. Osteoporosis is a disease in which bones become thin, weak, and easily brittle. Many people only find out they have the disease after they break a bone. This is because it doesn't have any major symptoms at first.

What are the possible complications of a broken shoulder?

A broken shoulder is not a simple matter. Sometimes it can lead to other problems:

• Persistent Stiffness: Many people may continue to have some stiffness in the joint even after their shoulder fracture heals.
• Arthritis: A shoulder fracture may increase the risk of developing arthritis in that shoulder in the future.
• Infections: If a broken bone breaks through the skin (an open fracture), meaning the wound is open, there is a high risk of bone infection ( osteomyelitis ).
• Damage to other tissues: Very rarely, the same accident that caused the shoulder fracture can also cause damage to other parts of the shoulder. For example:
• Muscles
• Ligaments
• Tendons
• Nerves
• Blood Vessels

How do you know for sure if a shoulder is broken?

A doctor will examine your shoulder and perform special imaging tests to determine if you have a broken shoulder. If you go to the Emergency Department (ETU) after an accident, the doctors there can diagnose this.

What are these imaging tests?

• X-rays: This is the first thing that is done. An X-ray can confirm any fractures and see how much damage has been done to the bones.
• Magnetic Resonance Imaging (MRI): Sometimes, an MRI may be done to look for damage, especially to soft tissues (such as ligaments and tendons). This can provide a full picture of the damage to the bones and the condition of the surrounding tissues.
• Computed Tomography Scan (CT Scan): A CT scan can look at the bone and surrounding tissue in more detail than an X-ray. This is very important if you are having surgery, as it allows the surgeon to get a clearer picture of the fracture.

Are the broken bones displaced? (Displaced vs. Non-displaced Fractures)

When your doctor describes your fracture, they will say whether it is 'displaced' or 'non-displaced'.

• A displaced fracture is when the two broken pieces are very far apart, creating a large gap between them. It's like a broken bone in the middle of the road. These types of fractures often require surgery.
• In a non-displaced fracture , the bone is still broken, but the broken pieces haven't moved very far, they are still aligned. These can sometimes be treated without surgery.

Is the wound open or closed? (Open vs. Closed Fractures)

The doctor will also classify this fracture as 'open' or 'closed'.

• In an open fracture , the broken bone breaks through the skin and sticks out. This is also called a 'compound fracture'. This is an emergency! The risk of infection and other complications is much higher in open fractures. Just think, when the bone is exposed, germs can easily enter, right?
• A closed fracture is also serious, but the bone does not come out of the skin.

How is a shoulder fracture treated?

The treatment for your shoulder depends on which bone is broken, how severe it is (such as displaced or open), and whether you have other injuries.

Immobilization

If the fracture is not too severe, meaning the bones are not too far apart (non-displaced fracture), you may only need to use a sling or a brace. How long you need to wear this will depend on the cause of the fracture and the type of fracture. It will usually last for a few weeks. You may also need to have regular X-rays to make sure your bones are healing properly.

Most of the time, clavicle and scapula fractures only require immobilization like this, followed by physical therapy to regain shoulder movement.

Shoulder Fracture Surgery

Some shoulder fractures require surgery, especially:

• If the broken bone pieces have moved too far (Displaced Fracture).
• If the fracture is open (Open Fracture).
• If the glenoid, the socket where your upper arm bone (humerus) rests, is damaged.

The most common types of shoulder fracture surgeries are:

1. Open Reduction and Internal Fixation (ORIF)

This is where the surgeon sets your broken bones into their correct positions, then fixes them so they can grow together properly. This is usually done through an 'internal fixation'. This means that the surgeon inserts metal plates, screws, or pins into your bone to hold it in place until the bone heals. Sometimes these metal pieces can stay in your body for life. Some people may need to have another surgery to remove them later.

2. Joint Replacement (Arthroplasty)

Arthroplasty is a joint replacement surgery. If your shoulder joint is severely damaged by a fracture, you may need to have shoulder replacement surgery. The surgeon will remove the damaged joint and replace it with an artificial joint (prosthesis).

Are there any possible complications from surgery?

Complications from shoulder fracture surgery are rare, but sometimes the following can occur:

• Acute Compartment Syndrome (ACS): If the pressure inside your muscles increases and blood flow to the tissues stops, it can cause permanent damage to the muscles and nerves.
• Malunion: This happens when your broken bones don't align properly as they heal.
• Nonunion: Sometimes the bones may not fit together completely, or may not fit together at all.
• Common surgical complications such as infections, excessive bleeding, and problems related to anesthesia.

How long does it take to heal from a broken shoulder? What should I expect?

Many people who break their shoulder will need to do physical therapy for several months while they recover. A physical therapist can help you regain strength and range of motion (how far you can move your shoulder). Doing these exercises correctly is important for a speedy recovery.

Severe shoulder fractures may cause permanent stiffness or reduced range of motion in the shoulder. Your doctor or surgeon will explain this to you.

Time to heal

How long it takes for your shoulder to heal depends on several factors:

• Which bone was broken?
• How serious the breakup is.
• What treatment did you need (surgery or not).
• Your age and overall health.
• How well you do physical therapy exercises.

It can take anywhere from a few weeks to a few months to fully recover. In some severe cases, it can take longer. Ask your doctor or surgeon about a time frame that is appropriate for your situation.

Ask your doctor when you can resume exercising and playing sports. You should keep your shoulder moving to keep it from getting stiff while it heals, but don't use your broken shoulder for sports or heavy lifting until your doctor says it's okay . Doing so could cause the injury to return.

How to protect yourself from shoulder fractures?

"It's better to prevent an accident than to regret it after it happens." So follow these safety tips:

• Always wear a seatbelt when riding in vehicles.
• Wear appropriate safety equipment (e.g. helmet, shoulder pads) during any sport or work.
• Keep your home and workplace tidy and free of items that could slip and fall. Be careful if the floor is wet.
• When picking up anything from above, always use the appropriate tool or equipment . Never climb on chairs or tables.
• Follow a diet and exercise plan rich in calcium and vitamin D to help maintain good bone health.
• If you are over 65 years old, or if someone in your family has osteoporosis, talk to your doctor about a bone density test.
• If you have difficulty walking or are at high risk of falling, use a cane or walker .

When do you need to go to the Emergency Treatment Unit (ETU) ?

If you think you have a broken shoulder (or any other bone) , go to the emergency room immediately . If you have one or more of the following symptoms, you should definitely go to the ER:

• Very severe pain.
• If you can't shrug your shoulders normally.
• If your shoulder or arm looks abnormal or has changed position (deformity).
• If your bone is visible through the skin (Open Fracture).
• Severe swelling.
• Along with these other symptoms, new bruises are visible.
• If you have numbness or paleness in your hand (this could be a sign of damage to the blood supply or nerves).

What are the important questions to ask the doctor?

When you see your doctor, don't be afraid to ask any questions you have. Getting a clear understanding is very important to the healing process. For example, you might ask these questions:

• What bone is broken? How serious is it?
• Do I need surgery? What will happen if I have it?
• How long will I have to wear a sling or brace?
• What can be done about pain?
• When can I start exercising and playing sports again?
• Will physical therapy be necessary? If so, when should it start?
• Can I move my elbow, wrist, and fingers to keep them from getting stiff until my shoulder heals?
• Are there any special things I should be careful of at home?

Can you move a broken shoulder?

When you break a shoulder, you may or may not be able to move it. But if you do, you will feel a lot of pain . You will not be able to move your shoulder normally.

Never try to forcefully use your shoulder after an accident. If you have been in an accident and think you have a broken bone, go to the emergency room immediately.

Your doctor or surgeon will tell you when you can start moving your arm and shoulder again after your fracture has healed. Your physical therapist will teach you exercises and stretches to strengthen the muscles around your shoulder as you recover. While your shoulder is healing, you may be able to move the other parts of your arm, such as your elbow, wrist, and fingers, without straining them. Ask your doctor about this as well.

So, what are the final things to remember? (Take-Home Message)

A shoulder fracture is a break in the bone in the shoulder joint. These injuries often happen suddenly, when we least expect it. So it can be a bit scary, but that's normal.

The most important thing is to get proper medical care and follow your doctor's instructions exactly. Even with surgery, your shoulder joint should heal in a few months. You may feel some stiffness in your shoulder for a while. However, most people can regain most of their strength and range of motion with physical therapy.

So don't panic, be patient, follow the doctor's instructions, and seek treatment. May you recover quickly!

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