Written By: Chloe Wilson BSc (Hons) Physiotherapy
A shoulder fracture is where one of the shoulder bones breaks into two or more pieces.
Shoulder fractures may occur at the clavicle, aka collar bone, humerus, aka upper arm bone or the scapula, aka shoulder blade.
Shoulder fractures may be classed as non-displaced, where the broken bone remains in its usual position, or displaced, where it has moved out of position by more than 1cm. If the bone has broken in to three or more pieces it is known as a comminuted shoulder fracture.
In most cases, a broken shoulder does not require surgery. The arm will be supported in a sling initially to allow it to heal and then a rehab programme is followed under the guidance of a physical therapist.
Here we will look at the different types of shoulder fracture, what causes them, how they present and how to treat them.
The collar bone is a thin, long bone found at the front of the shoulder just in front of the top of the rib cage. It links the sternum (breastbone) to the scapula (shoulder blade).
Clavicle fractures are not only the most common type of shoulder fracture in children, the collar bone is actually the most common bone in the whole body that kids break. Luckily, they usual heal really well without the need for surgery, although they can be very painful for a couple of weeks.
Collar bone fractures are commonly caused by:
There are three types of clavicle fracture, depending on which part of the bone is broken. The most common is a type 1 fracture, where the break is located in the middle third of the bone, as this is the weakest part of the bone.
You can find out loads more information about the causes, symptoms, treatment and recovery in the clavicle fractures section.
The humerus is the long bone in the upper arm that sits between the elbow and the shoulder. The top of the humerus forms a ball shape known as the humeral head that rests in a socket formed by the shoulder blade.
Humerus fractures fall into three categories:
Humerus fractures are most typically caused by falling over. Your body’s natural reaction when you fall is to put your arms out to catch yourself, but falling onto an outstretched arm often leads to humeral fractures. A direct blow to the humerus or torsion (rotating force) through it can also, if strong enough, cause the bone to break.
Humeral fractures typically affect people over the age of 65 and are twice as common in women as men. Bone density decreases with age and bones become more brittle meaning less force is require to break them, particularly if there are osteoporotic changes. In younger people, high energy trauma is required for the humerus to break, such as falling from a tree, and as a result the injury is likely to be more serious.
A broken shoulder blade, aka scapula fracture, is the least common type of shoulder fracture. The bone is strong and well protected so it takes a great deal of force to break it.
The shoulder blade is rarely damaged in isolation and scapula fractures are typically accompanied by injuries to the chest region which may be severe such as broken ribs and lung damage. Scapula fractures are rare and account for less than 1% of all fractures.
Any part of the shoulder blade may break, but most commonly it is the body of the scapula that is injured rather than the neck or spine.
Shoulder blade fractures are usually caused by RTA’s, either in a car, on a motorbike or high speed bike collisions. Then can also be caused by a fall from a great height, a hard blow to the back of the shoulder region such as in sporting injuries, or a crush injury.
The shoulder blade can also break during a seizure or from an electric shock as these can cause the muscles that control the shoulder blade to contract powerfully in different directions, pulling on the bone.
Shoulder blade fractures are most common between the ages of 25 and 40.
If you have a shoulder fracture, you generally know about it instantly and will be able to recall a specific incident. Whichever bone you have broken, there is usually a sharp pain at the time of injury which gives way to an ongoing dull ache.
The pain from shoulder fractures tends to get worse with any arm movement, especially when trying to lift your arm above your head, when any pressure is placed on the affected area or when taking a deep breath. Arm movement will almost certainly be restricted. There is usually extensive bruising.
Specific symptoms for the different types of shoulder fracture include:
In most cases, as long as the fracture is stable and minimally displaced, shoulder fractures do not require surgery. Non-operative treatment for a shoulder fracture involves:
After a shoulder fracture the arm will be immobilised in a sling for at least the first 10-14 days and often 3-4 weeks, sometimes more, to allow the fracture to heal. The type of sling will depend on which bone has been broken:
Your doctor will prescribe pain relieving medication following a shoulder fracture. Shoulder fractures are often very painful the first few weeks so it is important to take your painkillers regularly to stay on top of the pain.
Initially, it is very important not to move the shoulder as the bone needs time to heal. If you keep moving it, your shoulder fracture may either heal in the wrong position or not heal at all. But it is important to keep the fingers, wrist and elbow moving regularly by doing simple exercise or else they will get very stiff. In most cases it is fine to take your arm out of the sling to do these.
As soon as the doctor is happy that the shoulder fracture is healing well (they will perform regular x-rays to check how things are progressing), your physiotherapist will start you on a range of mobility exercises to restore the range of movement in the shoulder.
This usually happens after 2-3 weeks and typically start with pendular exercises and then active assisted exercises where you use your good arm to support and move the broken arm. You may also be given a pulley system to use.
In terms of strengthening, hand and forearm strengthening exercises are started immediately and after a few weeks you can start gentle shoulder strengthening exercises. You will often start with isometric exercises where you strengthen the arm without moving the shoulder.
At around 6-8 weeks, if everything is healing properly, you will progress on to more advanced strengthening exercises. You can find a whole range of exercises that will help in the early stages in the shoulder mobility exercises section.
Surgery for a shoulder fracture involves realigning the bones and then fixing them in place with either plates, screws or rods.
If there is significant damage to the humeral head which can’t be fixed, then the top part of the humerus is replaced, known as a hemiarthroplasty or partial shoulder replacement.
Following surgery, treatment is very similar to the non-surgical treatment with a period of immobilisation in a sling and then progressing through a rehab programme under the guidance of a physical therapist.
Only around 10-20% of shoulder fractures will require surgery. Shoulder fracture surgery is indicated if:
Full recovery from a shoulder fracture, where it is treated surgically or not, can take 6-12 months. It is very important to get the right balance between allowing the fracture time to heal while also trying to prevent stiffness.
Younger patients should regain full range of movement and function in their arm after a broken shoulder. Elderly patients however do not always regain full movement but in most cases they will regain enough function to do their day to day activities.
Many people are scared to move their arm after a shoulder fracture but you make the best recovery when you follow the advice of your physical therapist. If they have given you the all clear to get the shoulder moving, diligently stick to your rehab programme.
Moving a stiff joint is often painful, but the only way to get the movement back is to be doing your exercises, aiming to regain more movement each week.
It may help to apply a heat pack prior to exercise to help loosen up the shoulder, and to time when you do your exercises around your painkillers. Your physical therapist will be able to advise you on how much to push things.
Exercises are such an important part of the rehab process when recovering from any type of shoulder fracture. Visit the shoulder mobility exercises and the shoulder rehab section for a whole range of exercises that will help
If you want to know more about the different types of shoulder fracture, visit the:
Page Last Updated: 09/12/2020
Next Review Due: 09/12/2020