Fractures of the Shoulder and Collarbone

The shoulder joint is composed of three bones, which can break independently or in combination:

• The clavicle (collarbone)
• The scapula (shoulder blade)
• The top of the humerus (upper arm bone), known as the humeral head

Collarbone fractures

A broken collarbone (clavicular fracture) is a common injury that is often caused by a fall from a bicycle or injury during a contact sport like football. Symptoms include:

• Pain and tenderness
• A bump over the midpoint of the bone
• A lowered or sagging shoulder

In children, the injury may occur at the growth plate, closer to the end of the bone. Any child who experiences a growth plate injury should receive specialized care by a pediatric orthopedic surgeon to avoid future problems with bone growth and function.

A doctor's exam of the shoulder will usually show a visible deformity or bump at the site of the fracture. There may also be grinding between the broken segments (this is called "crepitus"). If the skin is being pushed outward by a sharp bony spike, this is a surgical emergency that requires immediate evaluation by an orthopedic trauma surgeon. An X-ray will reveal the type of fracture and guide the appropriate treatment.

Usually, a broken collarbone will heal without surgery by immobilizing it in a sling and treating the patient with ice (to reduce swelling) and pain medication. In some cases where this nonsurgical treatment is used, an excess of new bone growth will occur and create a bony prominence or bump at the healing site. This bump will gradually get smaller over time.

However, if the break results in an overlapping of the bone ends, or if the bone is broken into multiple pieces, surgery may be necessary to prevent a nonunion of the break or shortening of the bone, either of which can reduce shoulder function.

Shoulder blade fractures

The scapula (shoulder blade) is a strong, triangular-shaped bone that is well-protected by muscle. Breaks in this bone are usually caused by a high-impact trauma such as a vehicle collision, rather than by a fall or sports injury. Most breaks occur along the scapular body – the large flat section toward the bottom that makes up most of the scapula. Less often, breaks occur in the knobby, upper portions of the scapula. The main symptoms are intense pain while moving the arm and swelling at the back of the shoulder. A simple X-ray will usually reveal the type of fracture and guide the appropriate treatment, however, a CT scan can be useful to assess more severe or complex breaks.

Most breaks in the scapular body heal without surgery by immobilizing it in a sling. Breaks in the knobby upper portions of the bone (the glenoid, scapular neck or acromion) may require surgical realignment. In some cases, this may include fixation by metal plates and/or screws.

Humeral head fractures

The humeral head is located at the upper tip (proximal region) of the humerus (upper arm bone). It forms the "ball" of the ball-and-socket shoulder joint. Breaks in this area are quite common, especially in older patients who have low bone density due to osteoporosis. Most breaks in humeral head are nondisplaced, meaning the bone is broken but still properly aligned. These types of breaks usually heal without surgery by immobilizing the humerus in a sling for two to three weeks. This will be followed by physical therapy to regain range of motion and strengthen the muscles not used during the immobilization.

In displaced breaks (where the pieces of broken bone are out of alignment), surgical realignment is necessary and may require fixation by metal plates and/or screws. Severe cases may require a partial or total shoulder replacement. In such cases where the rotator cuff is also torn, or if the person had a prior tear, a reverse shoulder replacement may be appropriate.

Related conditions

• Fractures / Broken Bones
• Shoulder Dislocation
• Shoulder Separation