Shoulder
Fractures
Description
The glenoid is a part of the shoulder blade that forms the socket of the “ball and socket” joint.
What are the causes?
Glenoid fractures are caused by trauma. Shoulder dislocations are a common cause of glenoid fractures, as well as falls, motor vehicle accidents and sports injuries.
What are the symptoms?
Glenoid fractures cause pain and swelling in the shoulder. Patients may have a dislocated shoulder or will have a difficult time lifting their arms over their heads or across their bodies. A click may be heard or felt with shoulder motion.
How is it diagnosed?
Your surgeon will perform a physical exam and obtain X-rays. A CT scan may be obtained to better visualize the fracture. An MRI may be ordered to determine the effect of the fracture on the stability of the joint and assess the rotator cuff.
How is it treated?
Non-operative
Certain glenoid fractures can be treated without surgery. Your surgeon will prescribe a sling for up to six weeks. Periodic X-rays will be obtained to be sure the fracture is healing.
Operative
Glenoid fractures that are displaced or that will result in instability of the “ball and socket” joint will require operative repair. This is generally accomplished with screws placed across or anchors with sutures around the fracture.
Description
A proximal humeral fracture is a break in the upper part of the arm bone that forms one part of the glenohumeral joint. The proximal humerus consists of four parts, any of which can be fractured: the humeral head, the greater tuberosity, the lesser tuberosity and the shaft (aka-diaphysis).
What are the causes?
Patients that are older or those with weakened bone (osteoporosis, osteopenia, tumors, etc.) are susceptible to fracture after trauma or falls.
What are the symptoms?
Patients with proximal humerus fractures have pain and loss of function. They have difficulty lifting the arm and usually have a bruise on the shoulder. Numbness in the shoulder area is a possibility. After a few days, swelling and bruising may extend down the entire arm into the hand and fingers. Patients will often experience clicking when they try to move their shoulder.
How is it diagnosed?
Your surgeon will perform a physical exam and obtain X-rays. Your surgeon may order additional diagnostic tests to evaluate all shoulder structures (CT/”CAT” scan) to better evaluate the fracture or MRI to evaluate the muscles, tendons and ligaments.
How is it treated?
Non-operative
Certain proximal humerus fractures can be treated without surgery. Your surgeon will prescribe a splint or a sling for up to six weeks. Physical therapy to maintain shoulder range of motion begins as soon as the patient can tolerate it. This prevents stiffness in the shoulder. Periodic X-rays will be obtained to be sure the fracture is healing.
Operative
Certain proximal humerus fractures that cannot be treated with non-operative management are treated depending on how the bone is fractured. Restoring the function of your shoulder after proximal humerus fracture is accomplished by one of five surgeries: percutaneous pinning, open reduction internal fixation (ORIF), partial shoulder replacement (aka-hemiarthroplasty), full shoulder replacement (total shoulder arthroplasty) or reverse total shoulder replacement. Your surgeon will determine the best course of action based on the fracture pattern, the ability of your bones to heal and the function you wish to achieve after surgery. See the animations on this page for in-depth descriptions of each of these surgeries.
Description
The clavicle, more commonly known as the “collarbone” can be fractured anywhere along the bone. Fractures are classified as proximal (close to the middle of the chest), mid-shaft (in the middle) or distal (towards the outside of the shoulder).
What are the causes?
Clavicle fractures occur because of trauma, either directly to the bone or landing on the outer aspect of the shoulder. Sports, falls from bicycles and motor vehicle accidents are common causes of clavicle fractures. The mechanism of injury is similar to the cause of AC sprains.
What are the symptoms?
Clavicle fractures cause pain, swelling and possible deformity of the bone. Bruising at the fracture site is common and the fracture is tender to the touch. Patients will have a difficult time lifting their arms over their heads or across their bodies. A click may be heard or felt with shoulder motion.
How is it diagnosed?
Your surgeon will perform a physical exam and obtain X-rays. Your surgeon may order additional diagnostic tests to evaluate all shoulder structures (CT/”CAT” scan) to better evaluate the fracture or MRI to evaluate the muscles, tendons and ligaments.
How is it treated?
Non-operative
Many clavicle fractures can be treated without surgery. Your surgeon will prescribe a splint or a sling for up to six weeks. Periodic X-rays will be obtained to be sure the fracture is healing. A bump caused by bone healing may be present for several months to years after the fracture is healed and will usually resolve over time.
Operative
Clavicle fractures that are displaced and are at risk for not healing will require surgery. Recent scientific literature suggests that patients treated with an operation may have improved long-term outcomes over those that are treated non-operatively. Surgery to fix the clavicle fracture can be accomplished by placing a plate and screws around the fracture to bring the bones close to each other to allow healing.
Description
The acromion is an extension of the shoulder blade that forms one part of the AC joint and covers the top of the “ball and socket” joint.
What are the causes?
Acromion fractures occur due to trauma (motor vehicle accidents, falls, etc.) or as a complication of reverse total shoulder replacement due to irregular forces placed on the shoulder in conjunction with poor bone quality. Certain patients may also experience pain from an os acromiale, an area where two pieces of bone didn’t fuse during their childhood.
What are the symptoms?
Acromion fractures cause pain and swelling over the fracture. There is often a visible bump where the fracture is located. Bruising at the fracture site is common and the fracture is tender to the touch. Patients will have a difficult time lifting their arms over their heads or across their bodies. A click may be heard or felt with shoulder motion. Acromion fractures after reverse total shoulder replacement often cause pain and loss of function though they had previously recovered from the surgery. Because of its proximity to the rotator cuff, patients with acromion fractures or an os acromiale may experience inflammation of their rotator cuff.
How is it diagnosed?
Your surgeon will perform a physical exam and obtain X-rays. A CT scan may be obtained to better visualize the fracture. An MRI may be ordered to determine the effect of the fracture on the rotator cuff.
How is it treated?
Non-operative
Many acromion fractures can be treated without surgery. Your surgeon will prescribe a splint or a sling for up to six weeks. Periodic X-rays will be obtained to be sure the fracture is healing.
Operative
Surgical treatment is limited only to widely displaced fractures and those that impinge the rotator cuff. Surgical options include screws, suture or a plate. Os acromiales, if symptomatic, can be treated with screws, arthroscopic decompression, or excision of the fragment if it is small.
Description
The scapula, or shoulder blade, consists of three distinct parts: the body, the acromion and the glenoid. It connects the arm to the back. The body of the scapula is not frequently predisposed to fracture.
What are the causes?
Scapula fractures are caused by trauma. Falls, motor vehicle accidents, sporting injuries and direct blows to the upper back are common causes. Electrocution or seizures may also cause scapular fractures.
What are the symptoms?
Scapula fractures cause pain, swelling and bruising over the shoulder blade. Patients will have a difficult time lifting their arms over their heads. A click may be heard or felt with shoulder motion.
How is it diagnosed?
Your surgeon will perform a physical exam and obtain X-rays. A CT scan may be obtained to better visualize the fracture.
How is it treated?
Non-operative
Scapula fractures rarely require surgery. The shoulder blade is encased in muscle tissue, which helps to hold fracture fragments in position. Your surgeon will prescribe a sling for up to six weeks. Periodic X-rays will be obtained to be sure the fracture is healing.
Operative
Only high-energy fractures of the shoulder blade, or those associated with displacement of the glenoid require surgery. Contoured plates and screws are used for fixation.
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