You may have broken your shoulder if you are experiencing a great deal of pain in your shoulder joint and have difficulty moving your arm after a fall or injury.
The only way to know for sure is to get evaluated at a medical facility where they can take an X-ray. If they identify a fracture, you’ll get referred to a surgeon for recommendations on how to manage the injury and whether surgery is needed.
There are many variables that I take into consideration when determining how to treat a shoulder fracture: the patient’s age, their medical history, their activity level, the location of the fracture, and the type of fracture.
Most proximal humerus fractures (breaks that occur at the head of the upper arm bone) are treated conservatively, especially when seen in the elderly population. About 80-85% of these fractures can be treated with sling immobilization, followed by physical therapy.
Younger, active patients have a higher chance of having high energy trauma that may have led to fracture displacement. An X-ray will show us how displaced the different fracture fragments are and the quality of the articular or joint surface, so we can determine if surgical intervention is necessary.
Sometimes it can. It is my job as an orthopedic surgeon to provide information to patients regarding their injury and the outcomes they can expect from both a conservative, non-surgical treatment route versus operative intervention. I want to help them make the most informed decision.
As we work through the details of the options with each patient, I never tell them they have to have surgery. The decision ultimately comes down to them. How a patient wants to proceed with treatment will be based on their goals and the outcome they hope to receive from their treatment.
Conservative (non-operative) treatment involves 6 weeks of sling immobilization. As soon as internal healing is underway and pain has begun to subside, typically after a few weeks, we start range of motion exercises and physical therapy to prevent stiffness and promote as much motion as possible. Complete recovery from a conservative approach is roughly 3-4 months, depending on how quickly the patient can regain their range of motion and begin building their strength.
I always caution patients that there may be some drawbacks to conservative treatment. Although their pain will subside and they will be able to return to their normal daily activities, they may have some limitations, such as range of motion and strength deficits compared to how their shoulder functioned prior to the injury.
For patients who end up needing surgical intervention, the healing timeline is similar. They will spend the first 6 weeks after surgery in a sling, and they’ll start physical therapy a couple of weeks after surgery to work on range of motion and to prevent stiffness. At 3 months, they’ll begin strengthening exercises. One benefit of surgical intervention is that those patients can move earlier because the hardware holds the fracture together and prevents further displacement. That means those patients tend to regain more of their normal range of motion and have more positive functional outcomes.