A shoulder fracture happens when one of the shoulder bones breaks into two or more pieces.
Shoulder fractures may occur at the
Shoulder fractures may be categorized as
Thankfully, in most cases, a broken shoulder does not require surgery.
What is normally done for stable undisplaced shoulder fractures, the patient's affected arm will be supported in a sling initially to
- followed with a shoulder fracture physiotherapy rehab program under the guidance of our senior physical therapist.
The most common shoulder fracture in children is a fractured clavicle aka broken collar bone.
For us adults, the most common shoulder fracture is a proximal humerus fracture which is a break in the upper arm bone; and the least common shoulder bone to break is the scapula bone which is commonly known as the shoulder blade.
Our clavicle/collar bone is a thin, long-ish bone found at the front of the shoulder just in front of the top of the rib cage. It connects our sternum (which is our breastbone) to our scapula (the shoulder blade).
Thankfully again, clavicle fractures typically heal really well without the need for surgery, although they can be very painful for a couple of weeks, and during this time, can cause a lot of discomfort and inconvenience.
What Causes Clavicle Fractures?
Most of the time, collar bone fractures are caused by:
A simple fall either
In fact, patients don’t have to fall very far to break their collarbones, it's moreso falling at a
Even falling onto the side by accident can cause it!
A sudden, strong direct blow to the collar bone can break it such as
Once in a while, babies can get shoulder fractures (especially clavicular fractures), during childbirth. What happens is that when babies are born in breech position (our 1st kid, Olivia was a breech baby too!) where the babies bottom comes out first instead of their head.
For collar bone or clavicle fractures, there are three general groups/types: depending on which part of the bone is broken. The most common is a type 1 fracture, where the break is located in the middle third of the bone, as this is the weakest part of the bone.
Our humerus is the long bone in the upper arm that is located between our elbow and our shoulder. The very top of the humerus forms a ball shape known as the humeral head that rests in a socket formed by the shoulder blade.
Causes Of Humeral Fractures
Most of the time...humerus fractures happen by falls and falling over.
You see, our body's natural protective mechanism ensures that whenever we fall, we reflexively and automatically extend our hands to "break our fall" to prevent injury to our head (yeah it's something like a "sacrificing something to protect the more important stuff"), but falling onto an outstretched arm typically leads to humeral fractures.
A direct blow to the humerus or torsion-type force (rotational force) through it can also cause the bone to break, if the force is strong enough.
Most of the time, humeral fractures
What happens is that with age and time, our bone density becomes lesser, meaning that our bones becomes more weak and brittle, and less force is required to have bone fractures. If there is any low bone density issues, or worse, osteoporosis - it makes the bones much easier to fracture.
To make matters worse, as we age, our muscles shrink a little and our balance becomes worse and vision/eyesight too, and in some cases, increased risks of dizziness - all adding to increased falls and fracture risks.
Compared to younger people, their bones are healthier and stronger so it'd require a high energy trauma for the humerus to break, such as
and that's why when it involves the younger population, their injuries tend to be more serious.
Shoulder Blade Fractures
Also known as scapular fractures, shoulder blade fractures are really rare amongst all the shoulder fractures.
The reason for this is because the bone is:
Most of the time, our shoulder blades are very rarely damaged by itself in isolation; they tend to be coupled with other hand, chest or back injury which can be very serious such as
Although any parts of our shoulder blade can be broken or fractured, but most of the time, it is the body of the scapula that is injured rather than the neck or spine (the body of the scapular is weaker compared to the other 2).
Causes Of Scapular Fractures
Shoulder blade fractures are typically caused by
The shoulder blade can also break during a seizure or from an electric shock as these can cause the muscles that control the shoulder blade to contract powerfully in different directions, pulling on the bone.
If you have a shoulder fracture, you will likely already be aware of it and highly likely you can pinpoint or recall what exactly caused the injury. Regardless, whichever bone you have broken, patients will always experience a sharp pain at the time of injury which gives way to an ongoing dull ache.
The pain from shoulder fractures typically worsens with forms of arm movement, especially with shoulder involvement eg
Arm movement will almost certainly be restricted with presence of extensive bruising.
Typically, if the shoulder fracture is stable and has zero or very minimal displacement, then most likely do not require corrective shoulder surgery. In that case, patients will require conservative management which will include:
Patients should have their affected shoulder protected and immobilized in a shoulder sling for at least 14 days (usually extended to up to 4-6 weeks), to
Depending on which bone is broken, the type of sling will differ:
After a shoulder fracture the arm will be immobilised in a sling for at least the first 10-14 days and often 3-4 weeks, sometimes more, to allow the fracture to heal.
If you have consulted a doctor, he or she will likely have prescribed some pain relieving medication after you've been diagnosed with a shoulder fracture.
The reason for this is that typically shoulder fractures are often painful the first few weeks so it is important to take your painkillers regularly to manage the pain and still participate in daily activities and moving around.
In the beginning or early stages, you need to be very patient and cautious - you need to rest your shoulder and not move it at all until your doctor have given you the go-ahead to start moving your shoulder.
Of course you will be encouraged to move all your non-injured joints and body parts, such as your elbow, wrist, fingers, neck and body etc. You can go for walks and move around in a sling, or even go to work if it's safe for you to do so and if your work is moreso sedentary or desk bound.
Once you review with your shoulder shoulder and as soon as your doctor is medically and professionally satisfied that your shoulder fracture is healing well (typically you will need to review and meet up with them regularly as well as do regular x-rays to see how your fracture is healing), then your shoulder doctor will refer you to our senior physiotherapists for shoulder fracture physiotherapy.
We will then start you on a range of mobility exercises to improve and ultimately restore the range of movement in your affected shoulder. Most of the time that begins in about 2 - 4 weeks after the injury happened.
We will typically start with shoulder pendular exercises (passive ranging) and then active assisted exercises (active assisted mobilization) where you use your good arm to support and move the broken arm.
In some cases, you may be placed onto a pulley system to help stretch out your affected shoulder.
Our senior physiotherapists will start you immediately on hand, forearm, wrist and finger strengthening exercises immediately, and within a few weeks after we may start gentle and protected shoulder strengthening exercises.
To be safe, we will start with isometric strengthening (where the muscles contract without shortening or lengthening) where there is no shoulder movement.
Within 6 - 10 weeks, if your shoulder fracture is healing well, we will progress you onto advanced shoulder strengthening exercises.
Fortunately, only around 10-20% of shoulder fractures injuries end up requiring corrective surgery. Shoulder surgery is required if:
Following corrective shoulder surgery, treatment is very similar to the non-surgical treatment with a period of immobilization in a sling and then progressing through a shoulder physiotherapy program under the guidance of our senior physiotherapists.
Also, there is a constant battle and struggle between:
Typically, younger patients (below 45 years of age) will be able to achieve 100% of shoulder strength and movement, as compared to older patients above 45 years of age tends to not always achieve full shoulder strength and movement. Of course, our senior physiotherapists will always strive for 100% recovery back to normal.
Yes we get it too, that many patients and individuals are often afraid of moving their shoulder after a shoulder fracture for fear of:
Some of shoulder physiotherapy modalities that we will provide includes:
1) Showering And Washing Up
It's usually very ok and safe to remove your sling to shower after a shoulder fracture. Unless you have a recent shoulder fracture and a wound, then get your wound covered with a water-proof dressing first or replace the wound dressing after.
Do try to be seated to shower as your balance may be impaired
due to the shoulder injury. It's always very refreshing to be able to
shower and clean up - the best way to wash your arm pit is to lean
forward such that your affected arm is away from your body (similar to
pendulum exercises) and then you wash using your unaffected hand.
2) Wound Care
you have had corrective shoulder surgery please understand that you
have to keep the wound clean and dry for the first 7-10 days. If you wet
the dressing, please connect with us for an orthopedic wound care session.
3) Changing Clothing And Getting Dressed
Again, most of the time it'd be fairly ok but it's just something you need to wrap your mind around and practice a little - you'll get the hang of it very quickly.
Firstly you need to think about stuff you're gonna wear.
Generally tight clothing is tougher as it "sticks" to your body so it can be challenging to wear or remove.
At the core of what we do is medically safe and proven exercises to protect and improve movement and health. Our senior physiotherapists will assess your shoulder and teach and guide your shoulder physiotherapy rehabilitation and exercises.
Our senior physiotherapists will also teach you shoulder exercises which you should do at least 2-4x per day to
Yes we know sometimes it is painful and not fun (we'll try our best to make it engaging and fun ok =D) and preservere with us as we help you to achieve 100% shoulder strength and movement.
6) Can I Drive?
Usually the doctors and us will not recommend driving for a while, and the reason being:
Be patient and we will help you to get back to normal living, driving, working as per normal as soon as we can ok =)
You may be able to go back to work earlier if your work can be done with 1 hand or is deskbound or consultative in nature.
Typically patients cannot go back to work for at least 6 weeks to 12 weeks, but in some cases, if the work is less physically demanding and moreso consultative or deskbound, it may be a good idea to return to work on a part time or full time basis.
Of course it also matters if it's your dominant hand that has the shoulder fracture compared to non-dominant hand.
We prefer to be very safe and conservative, so we recommend no contact sports for at least 6 months until your shoulder fracture has 100% healed.