Shoulder Fractures

Shoulder Fracture Fundamentals

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Trauma may cause a fracture of the humerus (ball) or the glenoid (socket) of the shoulder joint. The majority of these injuries can be treated without surgery with a good, long-term result. Some fractures are better treated with surgery because they may carry a high risk of arthritis if left alone. Some are unlikely to heal, or may heal in the wrong position if not treated surgically.

Fractures are either described as being displaced or non-displaced. Fortunately, nearly 80 percent of all shoulder fractures are non-displaced. This implies that the broken pieces remain near their anatomic position and treatment merely requires immobilization in a sling until the bone fragments heal. Most shoulder fractures heal in about six weeks. About 20 percent of shoulder fractures are displaced and may require some type of manipulation to restore normal anatomy.

Occasionally the rotator cuff muscles are injured or torn at the same time as the fracture. This can further complicate the treatment.

What are the symptoms?

• Shoulder Pain
• Swelling
• Tenderness
• Deformity or "bump" at the site of the fracture
• Discoloration around the upper arm
• Inability to normally move the arm without pain

What are my treatment options?

Medical

Most non-displaced fractures require immobilization in a sling until the fracture heals enough to be comfortable and permit motion without risk of dislodging the fracture fragments. X-rays are used to determine if sufficient healing has occurred to permit motion exercises.

It is vital to maintain flexibility of the elbow, wrist and fingers while resting the shoulder. With your doctor’s guidance, you may commence shoulder movement as the fracture heals. If the arm is moved too early, this can delay healing, but too little movement will result in stiffness.

Surgical

If the fracture fragments are displaced, surgical procedures may be necessary to bring the pieces together and fix them with wires, pins, plates or screws.

If the ball portion of the upper arm is broken, split or crushed, a shoulder replacement may become necessary.

Because the majority of shoulder fractures are non-displaced, recovery of good to excellent motion and function is often achieved. Displaced fractures often require surgery and may result in injury to the adjacent muscles. This can result in more shoulder pain, weakness and residual discomfort.

What are the risks of surgery?

Some of the risks of surgery of shoulder replacement include infection, wound healing problems, bleeding and injury to nerves and vessels near the fracture. Sometimes the shoulder gets very stiff. Occasionally, the fracture does not heal, and another operation may be recommended.

How do I prepare for surgery?

• Complete any pre-operative tests or lab work prescribed by your doctor.
• Arrange to have someone drive you home from the hospital.
• Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
• Call the appropriate surgery center to verify your appointment time. If your surgery is being done at Cleveland Clinic, call:

* Main Campus: 216.444.HAND (4263)* Lutheran Hospital: 216.363.2311

• Refrain from eating or drinking anything after midnight the night before surgery.

What do I need to do the day of surgery?

• If you currently take any medications, take them the day of your surgery with just a sip of water.
• Do not wear any jewelry, body piercing, makeup, nail polish, hairpins or contacts.
• Leave valuables and money at home.
• Wear loose-fitting, comfortable clothing.

What happens after surgery?

We will ensure that you are comfortable and that you have adequate shoulder pain relief. You will receive prescriptions, etc., and your arm will be rested in a sling. Your surgeon and/or physical therapist will let you know whether any exercises are required.

How long is the recovery period after surgery?

This is often affected by the severity of your original injury. You may need assistance with dressing, bathing, washing and eating for five to 10 days. We will ensure that you have adequate amounts of pain medication to keep you comfortable.

Your doctor will examine you and evaluate your X-rays to determine your progress. Your return to work will be earlier for a desk job, and later for labor-related occupations.

What is the rehab after surgery?

Physical therapy to benefit motion and strength is often required to maximize recovery and improve outcome. Your doctor and therapist will work together and advise you on when to progress your activities and exercises.

How can I manage at home during recovery from the procedure?

This will depend on you and the presence of other injuries. You will be able to dress, feed and bathe yourself within a few days. You should keep the wound dry for the first five to 10 days.

How frequently should I schedule follow up appointments with my doctor following surgery?

You will be informed about the timing of your check-ups. Your doctor will review your progress and your X-rays periodically to let you know when to progress to the next level of activity.