Shoulder (Proximal Humeral) Fractures

Shoulder (Proximal Humeral) Fractures web based movie

Overview

The upper part of the arm bone (or “humerus”) is commonly involved in fractures of the shoulder. The “proximal” or upper part of the humerus is ball-shaped and fits into a socket on the side of the shoulder blade to form the shoulder joint. There are two bumps on the side of the ball called “tuberosity’s” that are attachment sites of the rotator cuff tendons that help to stabilize the shoulder. Proximal humeral fractures can disrupt normal shoulder function by altering normal anatomy, detaching the tuberosities and thereby affecting rotator cuff function, and creating stiffness or loss of motion in the shoulder.

Most proximal humeral fractures are due to direct injury, either a fall on to the outside of the shoulder or onto an outstretched arm.

Symptoms

Pain in the upper arm or shoulder is the most common symptom of proximal humeral fractures. Patients may have significant swelling and bruising around the area of the shoulder, which may move down and into the hand over several days due to gravity. Occasionally patients may complain of intermittent numbness and tingling in the arm.

Diagnosis

Diagnosis of proximal humeral fractures is made based on a history of the patient’s fall and location of their symptoms via a physical examination. X-rays are used to confirm the diagnosis and to determine the nature and severity of the injury. A CT scan may be ordered to fully evaluate complex fractures.

Treatment

Treatment of proximal humerus fractures depends on the severity of the injury and the age and activity level of the patient. Most of these injuries are treated successfully non-operatively with rest and use of a sling, icing, and anti-inflammatories. Physical therapy is often needed after the fracture has healed to regain motion and strength in the shoulder. More severe injuries may require surgery to help restore the normal anatomy of the proximal humerus during healing of the fracture. Healing in a normal or near-normal anatomic position improves functional outcome after shoulder fractures. Occasionally, a special type of joint replacement may be used to restore the proximal humerus after a significant injury, particularly in older patients with poor bone quality.

Additional Information

For more information, visit orthoinfo.aaos.org/topic.cfm?topic=A00394.