Shoulder Fracture (Broken Shoulder)

First aid for a suspected broken shoulder

1. Support the arm against the body in the most comfortable position. A sling, a folded scarf or a pillow under the forearm helps. Do not try to straighten it or push anything back into place.
2. Apply ice wrapped in a cloth for 15 to 20 minutes to reduce swelling and pain.
3. Take a pain reliever such as acetaminophen (paracetamol), following the label, if you have no other injuries.
4. Remove rings and watches from that hand before swelling starts.
5. Get medical care: go to an ER or urgent care for X-rays. Call 911 for the emergency signs above, especially any breathing problem.

Types of shoulder fracture

Proximal humerus fractures

These are the third most common fracture in older people after hip and wrist fractures. Doctors describe them by how many "parts" the bone has broken into (the head, the two bony bumps where the rotator cuff attaches, and the shaft) and how far they have moved. Most are "one-part" fractures with little movement, which heal well without surgery. See humerus fracture for breaks lower down the arm.

Clavicle fractures

The collarbone usually breaks in its middle third. The broken ends often form a visible bump under the skin. See clavicle fracture for more detail.

Signs and symptoms of a shoulder fracture

• sudden, severe pain at the time of injury
• pain that is much worse when you try to move the arm
• swelling and tenderness over the break
• bruising that appears over 1 to 3 days and often spreads down the upper arm toward the elbow or across the chest
• holding the arm against the body with the other hand
• a bump, a step or an abnormal shape over the collarbone or shoulder
• a grinding feeling when moving
• numbness or tingling if a nerve is stretched

Pain alone cannot tell a fracture from a dislocated shoulder, a severe sprain or a rotator cuff tear. An X-ray is needed.

Breathing problems after a shoulder injury

A fall or crash hard enough to break the shoulder can also break ribs or the shoulder blade. A broken rib can puncture the lung and cause a pneumothorax (collapsed lung). Warning signs are pain on breathing in, shortness of breath, rapid breathing, crackling under the skin or unusual breath sounds. These need emergency assessment.

Causes and risk factors

• Falls from standing height, especially with osteoporosis
• Contact sports, cycling, skiing and horse riding
• Road traffic collisions and falls from height
• Seizures or electric shocks, which can cause unusual fracture-dislocations
• Birth injury, for collarbone fractures in newborns

Diagnosis

A doctor examines the shoulder, checks the pulses, skin and nerves of the arm, and looks for other injuries. X-rays are taken from several angles, including a view from above or from the armpit to check the joint is not dislocated. A CT scan helps plan surgery for complex fractures. In anyone over 50 with a fracture from a minor fall, a bone density (DEXA) scan is recommended.

Treatment

Non-surgical treatment

Most shoulder fractures are treated without surgery:

• a sling for 2 to 6 weeks
• pain relief, and ice in the first few days
• sleeping propped up, which many people find more comfortable
• gentle pendulum exercises, often starting within 1 to 2 weeks, to prevent stiffness
• repeat X-rays to make sure the bones have not moved

Surgery

Surgery is considered when the bone ends are widely separated or shortened, the joint surface is broken, the skin is threatened, blood vessels or nerves are injured, or the shoulder is also dislocated. Options include:

• plates and screws, or a rod inside the bone
• shoulder replacement (hemiarthroplasty or reverse shoulder replacement) for shattered humeral heads in older adults

Recovery and rehabilitation

• Weeks 0 to 6: sling, pendulum and elbow, wrist and hand exercises.
• Weeks 6 to 12: the bone is usually healed enough for active movement, with physical therapy to restore range of motion.
• Months 3 to 6: strengthening. Most people regain good function for daily activities, though some stiffness or loss of overhead reach is common after severe fractures in older adults.

Driving is usually possible once you are out of the sling and can control the wheel safely. Return to contact sport typically takes 3 months or more.

Complications

• shoulder stiffness, the most common long-term problem
• malunion or nonunion (healing in the wrong position or not healing)
• avascular necrosis, loss of blood supply to the humeral head after complex fractures
• nerve injury, especially the axillary nerve, causing numbness over the outer shoulder and weakness lifting the arm
• arthritis of the shoulder joint later in life

Frequently asked questions

What are the signs and symptoms of a shoulder fracture?

The main signs are severe pain after a fall or blow, swelling, bruising that spreads down the arm, an inability to lift the arm, and sometimes a visible bump or deformity. Numbness or a cold hand suggests nerve or blood vessel injury and needs urgent care.

Can you move your arm with a broken shoulder?

Sometimes. With small, stable fractures you may still move your fingers, wrist and elbow, and even lift the arm slightly, though it hurts. Being able to move the arm does not rule out a fracture. An X-ray is the only reliable way to tell.

How long does a broken shoulder take to heal?

The bone usually heals in 6 to 12 weeks. Regaining movement and strength takes longer, often 4 to 6 months, and up to a year after surgery or complex fractures. Starting gentle exercises early, as advised by your doctor or physical therapist, reduces stiffness.

How should I sleep with a fractured shoulder?

Most people sleep best semi-upright in a recliner or propped on pillows for the first few weeks. Keep the sling on unless told otherwise, and place a pillow under the forearm for support. Avoid lying on the injured side.

Does a shoulder fracture need surgery?

Most do not. Surgery is used when the bone pieces are widely separated, the joint surface is broken, the shoulder is also dislocated, or nerves or blood vessels are injured. Age, activity level and bone quality also guide the decision.