Shoulder fractures are usually caused by impact injuries such as direct blows, falls or vehicular accidents. When one or more of these bones fracture, severe pain occurs and movement is impaired. When a shoulder is fractured, soft tissues may be damaged as well.
Anatomy of the Shoulder
There are three bones in the shoulder: the clavicle or collarbone, the proximal humerus or top of the arm bone, and the scapula or shoulder blade. There are also three joints where these bones connect: the glenohumeral joint, acromioclavicular joint and the sternoclavicular joint. The ball and socket arrangement of the shoulder enables a wide range of motion. It also, unfortunately, includes a complex arrangement of bones, muscles and ligaments that may be damaged.
Causes of Shoulder Fractures
There are varying causes for shoulder fractures, depending on the particular bone damaged, as follows.
Fractures of the Humerus
Called proximal humeral fractures, these often occur when a person falls on an outstretched arm. These are most common in elderly people suffering from osteoporosis.
Collarbone fractures are a common injury in children and athletes. The collarbone doesn’t completely harden until people reach the age of about 20, so it is fairly easy for the bone to break in babies during childbirth or in children after a direct blow or fall. Athletes may fracture the bone from a direct blow or from a hard fall, where the jolt of impact travels up the arm to the clavicle.
Fractures of the Scapula
Shoulder blade fractures are very rare. Because of the joint’s mobility and the number of muscles protecting it, it is well protected from fracture. It takes a significant amount of force to break the scapula. Scapular fractures are usually only seen after a high-speed vehicular accident or a fall from a great height and are frequently accompanied by other, often life-threatening, injuries. Crushing injuries, such as those resulting from factory or forestry accidents, can also cause a scapular fracture, as can direct contact injuries which occur during boxing.
Symptoms of Shoulder Fractures
Symptoms of shoulder fracture include impaired mobility and severe pain worsened by arm movement. To some degree the location of the pain and limited range of mobility are diagnostic since they vary according to where the fracture has taken place. Symptoms of a clavicle fracture, for example, include downward and forward sagging of the shoulder and a bump or tent over the injury site. All shoulder fractures involve one or more of the following symptoms:
- Severe pain
- Swelling or bruising of the shoulder
- Deformity at the site of the fracture
- Inability to move the arm without increased pain
- Grinding sensation when the shoulder is moved
Diagnosis of Shoulder Fracture
Shoulder fractures are usually diagnosed through X-rays. Sometimes more sophisticated imaging techniques, such as CT scans are used. It is important for the diagnosis to be accurate and for the distinction between a shoulder fracture and a dislocation to be made.