Shoulder Fracture

Overview of shoulder fracture

Musculoskeletal injuries are common in professional athletes and common people. The World Health Organisation (WHO) reveals that nearly 50% of the current global population suffers from musculoskeletal injuries of some form or the other. While some may resolve in a very short time, others may take a long time to heal. A common type of musculoskeletal injury observed on a regular basis is “shoulder fracture”. This may result not only from accidental injuries or stress, but may also arise from certain bone diseases.

The NCBI statistics show that an estimated 1.5 million people all over the world suffer from a bone fracture due to some bone disease. This necessitates a proper addressing of the existing bone diseases along with maintaining a healthy diet in order to prevent bone fractures in the shoulder and other parts of the body.

What is shoulder fracture?

A shoulder fracture is a clinical condition characterized by the loss of continuity of a particular bone or multiple bones in the shoulder due to accidental injury or some bone disease. The principal bones involved in this case are the ones located in the scapula, the clavicles, and the upper humerus. Shoulder fracture often arises from rotator cuff disorders. Poorly treated shoulder fractures may give rise to impingement syndrome, shoulder dislocation, frozen shoulders, and arthritis.

These fractures are also accompanied by soft tissue injuries and damage to the underlying structures. Shoulder fracture may even arise from a trauma injury, high-force impact or stress. It may also be an outcome of diseases like osteogenesis, osteoporosis or bone cancer. In such cases, the fracture is termed as a pathologic bone fracture. A daily diet deficient in essential minerals and micronutrients can also lead to the bone fracture in any part of the body.

What factors can give rise to shoulder fracture?

Shoulder fracture may arise from multiple factors. The most common causes of shoulder fracture are as follows-

• Repetitive stress
• Overuse injuries
• Accidental injuries
• Injuries due to sports activities
• Alterations in structures and properties of the major bones
• Loss of minerals due to aging
• Deficiency of Vitamins A, C, and K in the body
• Deficiency of calcium in the regular diet
• Sudden lifting of heavy loads, especially one that is beyond one’s capacity
• Presence of bony protrusions that may make the bones prone to injury and fracture
• Anatomical defects that are present from birth
• Diseases like Arthritis, Diabetes, and Gout
• Addictive practices like smoking and alcohol consumption

What are the main symptoms of shoulder fracture?

Shoulder fracture typically presents with the following symptoms-

• Break in the continuity of periosteum
• Discontinuity in the endosteum
• Edema of the adjoining soft tissues
• Bleeding of the periosteal blood vessels
• Pressure pain
• Muscle spasms and cramps
• Damage to the neighboring structures such as nerves, blood vessels, spinal cord, nerve roots or cranial contents
• Temporary immobility or difficulty moving the fractured part(s)
• Delayed regeneration of the affected tissues and blood vessels

Shoulder fractures associated with rotator cuff disorders may show the following symptoms.

• Pain and inflammation in the shoulders
• Pain during normal shoulder movements such as lifting the arms
• Weakness and heaviness of shoulder and arm muscles
• Generation of crackling or popping noise during shoulder movements (Crepitus)
• Limited movements of the shoulder
• Frozen shoulder syndrome
• Sharp pinching pain that radiates to the arms and neck

What are the different types of shoulder fractures?

Based on the location of the fracture, shoulder fractures are classified into three main categories. These will be discussed under separate subheadings.

Clavicle fracture

Fracture, in this case, occurs in the collarbone or the clavicle. It may occur due to accidental falling on an outstretched shoulder. The main signs and symptoms of clavicle fracture are as follows-

• Pain in the frontal portion of the upper ribs
• Swelling and inflammation
• Fracture palpable through the skin
• Piercing pain during minor movements
• Pain radiating to the adjoining areas, particularly to the surrounding muscles
• Nausea and dizziness

Humerus fracture

Humerus fracture is defined as the fracture of the bone of the upper arm known as the humerus. The most general symptoms of humerus fracture are- swelling, bruising and discoloration of the affected region. Humerus fractures are classified according to the location and type of fractures. Based on location, these are of three types-

• Proximal location: Here, the site of injury is the top portion of the humerus, close to the shoulder. It may be of four types namely- greater tubercle fracture, lesser tubercle fracture, surgical neck fracture and anatomical neck fracture.
• Middle: The bones located in the middle portion of the humerus, which is also known as the shaft of the humerus are affected in this case.
• Distal location: It indicates an injury of the base of the humerus, close to the elbow. It may restrict the flexing capacity of the elbow and may eventually lead to deformity. It has two subtypes-
• Supracondylar fracture: It is a fracture of the distal humerus, just above the epicondyles.
• Intercondylar fracture: It is a T or Y-shaped fracture that bifurcates the condyles.

Scapular fracture

It is a fracture of the shoulder blade or the scapula. It leads to pain, tenderness, swelling and snapping sensation in the scapula. It has the following subtypes-

• Body fractures
• Neck fractures
• Coracoid process fractures (affect the coracoclavicular ligament)
• Acromion fractures (non-displacement or displacement fractures)
• Glenoid fossa fractures

Which diagnostic tests are available?

The following diagnostic tests are ideal for shoulder fractures-

• X-rays (to detect the presence of bone spurs)
• Ultrasound scan (to detect soft tissue injuries)
• MRI scan (to determine the age of the injuries)

How can you treat shoulder fracture?

The treatment and healing of shoulder fractures is a slow and progressive process. For temporary pain relief, the doctors may recommend ibuprofen, acetaminophen, and codeine. For temporary immobilization of the affected bone, a plaster or a fiberglass cast or a splint that holds the displaced bones in position are used.

Shoulder fracture should be dealt with very carefully since it often involves some of the sensitive bones of the neck, rib cage, and shoulder. Surgical interventions are necessary when the fractures do not heal even after repeated treatments. These conditions should be handled very carefully especially in children. Failure to do so may result in permanent plastic deformation of the bones. Additional systemic complications may also arise in future if diagnosis and treatment are delayed.

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