Shoulder Fractures

A shoulder fracture is a break in one of the bones around the shoulder and upper arm: the collarbone, the rounded upper end of the arm bone, the shoulder blade, or the inner end of the collarbone where it meets the breastbone. Each one breaks under different forces and in different patients. Most shoulder fractures heal well, and for many people a sling and physical therapy are enough. Identifying which bone is broken is the first step in planning care.

Most shoulder fractures cause sharp pain, swelling, and difficulty using the arm. Common symptoms include:

• Sharp pain, swelling, and trouble lifting or rotating the arm
• Pain and a visible bump or deformity along the collarbone
• Pain at the front of the shoulder with bruising spreading down the upper arm
• Deep tenderness over the back of the shoulder after a high-energy injury

Your provider examines the whole shoulder region and checks that the nerves and circulation in the arm are intact. X-rays from several angles confirm the fracture and show which bone broke. A CT scan is the usual next step for planning surgery on the upper arm bone and for injuries near the breastbone where major blood vessels are nearby.

Most shoulder fractures heal without an operation. Nonsurgical care rests on:

• A sling to protect the bone while the surrounding muscle holds the pieces in position
• Early protected motion to prevent the shoulder from becoming stiff
• Follow-up X-rays to confirm the bone is holding its position

Surgery is offered when the bone will not heal in a position that supports reliable function, such as significantly displaced or shortened breaks, breaks in several pieces, or a fracture where the bone is pressing against the skin. The operation is matched to the bone and the fracture pattern, most often a plate and screws.

For a fuller explanation, including anatomy, diagnosis, and the full range of treatment:

• Shoulder Trauma (Fractures and Dislocations) — AAOS OrthoInfo