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Shoulder X-ray

The shoulder is made up of a group of bones that work together to allow the shoulder and arm to function. The shoulder bones include the upper arm bone (humerus), the collarbone (clavicle) and the shoulder blade (scapula). The shoulder includes the glenohumeral joint (ball and socket joint), acromioclavicular joint and sternoclavicular joint.

A fracture of any of the bones in the shoulder can greatly impair your mobility and cause severe pain. Shoulder fractures occur as a result of trauma or injury to the shoulder from a fall, sports injury, car accident or any direct blow to the shoulder. Penn orthopaedic specialists treat every type of shoulder fracture using the latest diagnostic and treatment techniques that offer the best possible outcomes.

Types of Shoulder Fractures

Shoulder fractures can be non-displaced (when the bones stay in the correct position) or displaced (when pieces of the bone are broken and fragments have moved out of position).

Non-displaced fractures are the most common and make up about 80 percent of shoulder fractures. These types of fractures are often treated using nonsurgical methods. Displaced fractures may require surgery to realign the bones.

Types of shoulder fractures include:

  • Clavicle fractures: Known as the collarbone, the clavicle is the long, thin bone located at the base of the neck.
  • Humerus fractures: The humerus is the upper arm bone that runs from the shoulder to the elbow.
  • Scapula fractures: Known as the shoulder blade, the scapula is a flat, triangular bone located in the upper back. The glenoid (the socket of the shoulder joint) is a part of the scapula. These fractures are associated with falls or motor vehicle collisions and may result in shoulder dislocation or shoulder instability.

If you experience any of the following symptoms, see a Penn orthopaedic specialist to determine if you have fractured your shoulder:

  • Shoulder pain
  • Swelling or bruising in the shoulder area
  • Tenderness, pain to the touch, redness
  • Your shoulder feels like it is slipping out of the socket (shoulder instability)
  • Your shoulder looks deformed or seems out of place

Diagnosing Shoulder Fractures

To diagnose a shoulder fracture, an orthopaedic specialist orders advanced imaging tests to determine the exact location of your fracture and the severity of your condition. We offer the latest advancements in imaging tests and diagnostic tools to evaluate for shoulder fractures, including:

  • X-rays
  • CT scan
  • MRI
  • Musculoskeletal ultrasound

Our advanced imaging technology allows Penn musculoskeletal radiologists to make an accurate diagnosis to create the best possible treatment plan to care for your shoulder fracture.

Shoulder Fracture Treatment Options

Penn orthopaedic specialists are experts at treating both non-displaced and displaced shoulder fractures using the latest nonsurgical and surgical techniques. Some shoulder fractures can be treated with noninvasive methods, while others may require more complex surgical treatments to repair the fractured bone(s). Your treatment plan may require both conservative and surgical techniques.

Most non-displaced shoulder fractures can be treated with conservative techniques, such as:

  • Icing
  • Immobilization with an arm sling or wrap while bones heal
  • Oral medications to help alleviate pain
  • Physical therapy and range-of-motion exercises (to begin once the bones have started to heal and under the close supervision of a physical therapist)

Shoulder Fracture Surgery

We have the expertise to treat complex surgical cases, including fracture non-union or malunions (broken bones that haven’t healed or haven’t healed in proper alignment) and other serious traumatic shoulder fractures.

We regularly treat injuries that require multiple surgeries at the same time. Penn orthopaedic shoulder surgeons are experts in performing bone-grafting procedures, as well as muscle and ligament reconstruction or repair.

For certain shoulder fractures with extensive damage to the surrounding skin and muscles, we collaborate with plastic surgeons who have specialized training in helping reconstruct soft tissues in the shoulder. We consistently combine highly advanced surgical specialties that ensure the best possible outcome for more serious shoulder fractures. Penn surgeons are actively working on techniques and technologies to make shoulder surgeries faster and easier for patients.

Because there are many different types of shoulder bones, treatment for shoulder fractures will vary depending on which area of the shoulder has been injured and the severity of the fracture.

Types of shoulder fracture surgeries we perform include:

Shoulder Fracture Fixation Surgery

If the bones are displaced or there is an open fracture (where the bone has come through the skin), surgery is necessary to repair the fracture and any damaged ligaments, tendons and muscles. To lock the bones back into the correct position, orthopaedic surgeons will use specialized hardware such as plates, screws or pins. In some cases, surgeons will perform bone grafting and repair of soft tissues such as ligaments and tendons. In some severe fracture cases, the shoulder will require a joint replacement.

Partial Shoulder Replacement Surgery

If you suffer from a severe shoulder fracture, you may require a partial shoulder replacement. For this procedure, a conventional shoulder replacement device, made up of a metal ball and stem, replaces the damaged ball and upper portion of the arm bone. Individuals who receive a partial shoulder replacement experience less pain, improved function and increased range-of-motion that allows for a greater quality of life.

Reverse Total Shoulder Replacement

In some cases a severe shoulder fracture will require a reverse total shoulder replacement. In a reverse total shoulder replacement, the socket and the metal ball are switched: The metal ball is attached to the socket and the plastic cup is fixed to the humerus. Individuals who undergo a reverse total shoulder replacement experience reduced pain and improved function and range of motion.

Non-Union and Malunion Shoulder Fracture Surgery

A non-union is a broken bone that did not heal properly. A malunion is a broken bone that has healed in the wrong position, often causing a deformity. Treatment may involve surgery to remove an infection (if present), to better stabilize the fracture or to stimulate bone growth with a bone graft. Our orthopaedic surgeons work closely with specialists from the Penn Orthoplastic Limb Salvage Center to repair the most complex non-union and malunion cases.

Penn orthopaedic surgeons perform complex non-union surgical repair with vascularized bone grafting. Vascularized bone grafts allow living bone tissue to be transplanted to replace damaged bone tissue. Penn is one of the few medical centers in the nation that perform vascularized bone grafting.

Shoulder Fracture Surgery Recovery

The goal of recovery from surgery is to regain as much strength, range of motion and function in the shoulder as possible. After surgery, you will need plenty of rest and to keep your shoulder and arm immobilized in a sling or wrap. Once the bones begin to heal, you will work with a physical therapist who will recommend exercises to restore mobility and function.

Personalized Shoulder Fracture Rehabilitation Programs

Penn physical therapists, orthopaedic specialists and pain management specialists create personalized recovery plans that help you get back optimal function in your shoulder and significantly reduce or eliminate pain caused from a shoulder fracture. Your recovery will depend on a variety of factors, including the severity of your shoulder fracture, where it was located and the type of surgery you had. Because treatment is individualized, recovery will be different for everyone. Your doctor will discuss what your recovery will entail, taking into account your lifestyle, unique needs and personal goals.

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