Leaflet number: 444
Expiry date: January 2018
What is a fracture?
A fracture is a break through all or part of a bone. In the shoulder, a fracture is usually in the collar bone (clavicle), or in the upper arm bone (humerus).
Humerus fractures are divided into three types of injury:
Proximal humerus fractures: These occur near the shoulder joint. The shoulder joint is a ball and socket joint and the ball is at the top of the humerus. These fractures may affect the tendons that help to hold the shoulder in place and are important for shoulder movement.
Mid-shaft humerus fractures: These fractures occur away from the shoulder and elbow joints, they can involve injury to one of the nerves in the arm, called the radial nerve. This nerve wraps around the humerus and travels down to the hand. Injury to this nerve can cause an altered sensation over the back of the hand and some weakness to some of the muscles of the hand and wrist. The damage to this nerve is almost always temporary and complete recovery of the nerve is usually within 3 to 4 months for 90% of patients.
Distal humerus fractures: These fractures occur near the elbow joint and are more common in children than in adults. Fractures to the distal humerus in an adult often require surgical treatment.
What causes a fractured clavicle or fractured humerus?
A fracture to the collar bone (clavicle), or the upper arm bone (humerus) is usually caused by a fall, or a blow to the shoulder, especially through playing sports.
What are the symptoms?
Clavicle: Pain and swelling over the fractured bone. A slight deformity may be seen over the fracture. The affected arm will be very painful to move.
Humerus: Severe pain over the fractured bone with swelling. The affected arm will be very painful to move, you may notice altered sensation to the back of the hand and some weakness to the arm and wrist if there has been some damage to the radial nerve.
How is it diagnosed?
The practitioner will examine your shoulder and upper arm for any tenderness over the surrounding muscles and bones and will assess the movement of your shoulder. Sometimes an x-ray will be performed if the practitioner is concerned there may be an injury to any of the bones in the shoulder.
How is it treated?
Most humerus and clavicle fractures will heal in time with a sling or other device to keep the bones in place.
A fracture to the humerus will be very painful so good pain control is important whilst the bone is repairing.
After the bone has healed, exercises will be needed to gradually improve range of movement and strengthen the muscles. A medical professional will advise on these exercises and will be tailored to your specific injury.
Surgery may be required if the bone fragments are far out of their normal alignment. However, mid-shaft fractures to the humerus rarely require.
For any of the above shoulder injuries, you may take over-the-counter anti-inflammatory medicines, such as ibuprofen which will reduce the swelling and pain. Make sure you always read the patient information leaflet that comes with the medicines. It is likely that you will be prescribed some in the Emergency Department. If you find that these are not strong enough, please see your GP.
What is the prognosis or expected outcome of treatment?
Over the next few weeks your injury should start to repair itself, however full recovery may take several weeks and in some instances much longer.
Following a fracture to the clavicle or the humerus you will probably have follow up through the fracture clinic. If physiotherapy is indicated this will be arranged through the fracture clinic. You will be given these details before you leave the A&E department.
You are advised to come back to the A&E department if:
- Your pain suddenly becomes worse, or
- You notice any altered sensation or weakness to the arm and hand.
If you have any other concerns about your shoulder fracture, please contact your GP or the A&E department on 01271 322480.