CONDITION - Shoulder Fracture
Shoulder fractures are very complicated fractures, because the shoulder joint has so much mobility. They are typically classified by how many pieces the shoulder is broken into, e.g., 2-part, 3-part, and 4-part fractures. They are also classified by which bone is broken, e.g., proximal humerus, clavicle, scapula, acromion, glenoid. When most orthopedic surgeons speak of a "shoulder fracture", though, they are referring to fractures of the upper part of the humerus.
Physical examination reveals that the patient has pain over the bone, and often swelling or bruising is present. X-rays usually show the fracture. Three dimensional imaging, such as CT scans or MRIs are often ordered to better get a 3D picture of the fracture type or pattern.
Thankfully, many shoulder fractures can be treated with a simple sling. he bone is allowed to heal, and once it has healed enough, physical therapy is begun to regain motion and strength. We often tell our patients that this is like walking on a tightrope; we can leave the patient in a sling for a long time and the bone will heal, but their shoulder function will never recover. Or we can start moving the shoulder too early and the bone will not heal properly. Striking the right balance is up to your orthopedist. We definitely recommend a home exercise program once you are allowed to move your shoulder. Our shoulder rehabilitation kit is perfect for this.
Some fractures are severe enough that they require surgery. There are many different types of surgery for the different fractures. Some involve putting pins in the bone (percutaneous pinning); others involve opening up the fracture, realigning the bones, and putting a plate and screws to hold them together (open reduction, internal fixation — ORIF). Finally, some fractures are in so many pieces that the best option is to replace the shoulder — shoulder hemiarthroplasty. Again, proper rehabilitation is paramount to good success and improvement of pain and function after shoulder surgery for a fracture.
Pain after shoulder fracture
Whether surgery is selected, or treatment is in a sling, shoulder fractures can be quite painful. Methods to treat this pain include
- Narcotics — prescribed by your surgeon
- Non-steroidal anti-inflammatory medications — discuss with your surgeon prior to taking these as they can cause bleeding and may delay bone healing to an extent.
- Other medications — (e.g., tramadol) that act as pain killers, but are not necessarily classified as a narcotic.
- Rest — putting the arm into a sling can help with pain.
- Elevation — many patients will feel better sleeping in a recliner or with several pillows under their upper back.
- Cryotherapy — essentially cooling the area. This is a time tested way of decreasing pain after shoulder surgery. First, the cooling helps to decrease swelling and pain from the bleeding, as well as swelling that can happen from arthroscopic treatments. In addition, we think that cooling acts as a counter-irritant; it tricks your nerves into reporting the cold on the skin as opposed to reporting the deep seated pain in the joint. Cryotherapy can be delivered by something as simple as a bag of frozen peas. However, more modern treatment involves the use of cryotherapy, or ice machines. These continuously circulate cold water through a pad to maintain a constant temperature at your joint. In addition, the pads often have a compressive effect, which further helps to decrease swelling. Read more about the cryotherapy units available at JointHealing.com.