Shoulder Trauma

Trauma to the shoulder is incredibly common. Traumatic shoulder injuries include a separated shoulder (AC joint dislocation), shoulder dislocation (glenohumeral joint dislocation), and fractures of the proximal humerus, collarbone (clavicle), and shoulder blade (scapula). Rotator cuff tears also frequently occur as a result of trauma.

The shoulder is made up of three bones: the humerus (arm bone), the clavicle (collarbone), and the scapula (shoulder blade).

Soft tissues (ligaments, tendons, muscles, and the joint capsule) join these bones together to form a cohesive unit for the arm to work.

The shoulder has three joints: the glenohumeral joint, the acromioclavicular joint, and the sternoclavicular joint. The glenohumeral joint is the main joint of the shoulder, and it comprises a ball (the humeral head) and a socket (the glenoid of the scapula).

Several layers of soft tissues cover the bones of the shoulder. The top layer, located just beneath the skin, is the deltoid muscle. This muscle helps to bring the arm overhead, and it gives the shoulder its rounded appearance. Beneath the deltoid muscle is the subdeltoid bursa, a fluid-filled sac similar to a water balloon.

An AC (acromioclavicular) joint injury is an injury to the top of the shoulder where the front of the shoulder blade (acromion) attaches to the collarbone (clavicle). Traumatic events such as a fall directly onto the point of the shoulder typically cause this type of injury.

The AC joint helps maintain the position of the shoulder and is important for shoulder control, motion, and strength. A capsule and ligaments stabilize the AC joint. When an injury occurs, these structures are damaged, and the joint can become unstable and painful, affecting shoulder function.

This injury is also commonly referred to as a separated shoulder and it usually results in severe shoulder pain, shoulder or arm weakness, shoulder bruising or swelling, limited shoulder movement, and a bump and swelling at the top of the shoulder.

The severity of an AC joint injury depends upon the amount of trauma sustained to the AC joint; mild trauma results in a sprain without structural damage to the joint and severe trauma results in varying degrees of structural damage and may result in complete tearing of the capsule and ligaments. Severe trauma to the AC joint may result in a very obvious deformity of the shoulder where the shoulder appears to sag down and the lateral end of the clavicle is very prominent.

A separated shoulder often heals with conservative treatment, such as rest, ice, and pain relievers. Severe AC joint injuries may be treated with surgery which may involve reconstruction of the torn ligaments.

Shoulder dislocations represent 50 percent of all major joint dislocations. The shoulder joint is the most mobile joint in the body. It is an easy joint to dislocate because its stability is very dependent upon soft tissues which can be injured relatively easily.

The shoulder joint can dislocate forward, backward, or downward, and may dislocate partially or completely. In a partial shoulder dislocation (subluxation), the humeral head partially and painfully shifts out of the socket (glenoid) and then typically pops back in place. In a complete shoulder dislocation, the humeral head dislocates all the way out of the socket and typically remains dislocated until it is manually manipulated back in place, which is typically performed in an ER. Learn More

A fracture is a broken bone. A fracture can range in severity from a hairline fracture, which is a small, non-displaced crack in the bone, to an “open” fracture, where the broken bone displaces significantly and punctures the skin. Bone can break into many pieces, which is called “comminution.”

If you sustain a shoulder fracture, you will likely hear or feel a snap or a grinding noise as the injury happens and experience instant, severe pain. You may also have swelling, bruising, and tenderness and you will likely feel severe pain with pressure or movement.

Shoulder fractures commonly involve the proximal humerus (top of the upper arm bone), the clavicle (collarbone), and the scapula (shoulder blade).

Humerus Fracture. A fracture of the proximal humerus (top of the upper arm bone) can be caused by a direct blow to the area from a fall, collision, or motor vehicle accident. Symptoms specific to a proximal humerus fracture include severe shoulder pain associated with the sudden inability to lift or move your shoulder after a traumatic injury.

A fracture can also occur in the middle portion of the humerus (the humeral shaft) as well as the lower portion (the distal humerus). These fractures result in pain and disability as well.

Clavicle Fracture. The majority of clavicle fractures occur in the middle portion (the midshaft). Sometimes the bone will break near its attachment at the shoulder blade or sternum. Clavicle fractures are most often caused by a direct blow to the shoulder, which can happen during a fall onto the shoulder, a fall onto an outstretched arm, or in a car collision.

Scapula Fracture. Fractures of the scapula are most often caused by direct trauma from the back or side. The scapula is a large, triangular-shaped bone that lies in the upper back. Seventeen muscles attach to the scapula. Symptoms of a scapula fracture include pain, swelling, and bruising.

Depending on the severity of your shoulder injury, Dr. Jurek will recommend either nonsurgical or surgical treatment options.

Most people recover from a separated shoulder with conservative treatment, including rest, ice, a sling, over-the-counter pain medications, and physical therapy to improve range of motion and shoulder strength.

In severe injuries, ligaments may be torn and require surgery to repair or reconstruct the torn soft tissue. After surgery, you may need to keep your arm in a sling for about 6 weeks.

If you have suffered a shoulder dislocation, you will need immediate emergency treatment to have someone (usually the ER doctor) place the humeral head back into the joint socket. This process is called a closed reduction and is typically performed under sedation. Once the shoulder joint is relocated back in place, the severe pain of a shoulder dislocation typically improves immediately.

Sometimes a first-time shoulder dislocation can be successfully treated with nonoperative management, but surgery may be indicated depending on the patient’s age and activity level.

If a patient's shoulder repeatedly dislocates or subluxates despite physical therapy, surgery may be necessary to repair or tighten the torn or stretched ligaments that help stabilize the shoulder joint. The repair usually involves inserting a special implant called a “suture anchor” into the bone and using sutures attached to the suture anchor to secure the injured tissue back in place.

If you have suffered a fracture of your proximal humerus, treatment depends upon the severity of the fracture. Many of these fractures are best treated with nonoperative measures. Surgery is typically reserved for fractures with significant displacement, where the bony fragments are no longer in anatomic alignment.

Surgical treatment of a proximal humerus fracture usually involves fixation of the fracture fragments with a plate and screws. This procedure is called a proximal humerus ORIF (ORIF = open reduction internal fixation). Depending upon the type and severity of the fracture, some proximal humerus fractures may be best treated with a shoulder replacement.

Many clavicle fractures can heal without surgery as long as the broken ends of the bones have not shifted out of place significantly. You may need to wear a sling to support your arm while it heals. Once your bone begins to heal, Dr. Jurek will have you start physical therapy to improve range of motion and strength in your shoulder.

If the bones of your broken collarbone are significantly displaced, Dr. Jurek may recommend surgery to align the bones exactly and hold them in an anatomic position while they heal. Clavicle surgery typically utilizes a plate and screws to secure the bone fragments together.

Most fractures of the shoulder blade can heal without surgery. Conservative treatment options include wearing a sling to immobilize the shoulder, cold therapy to reduce swelling, and pain medication. As the fracture heals and the pain subsides, physical therapy will be initiated to increase shoulder range of motion and improve shoulder strength.

If surgery is required, this typically involves fixation of the fracture fragments with plates and screws. The glenoid is a part of the scapula and if this is fractured (which may occur as the result of a glenohumeral dislocation), surgical repair of the fracture may be necessary.

Recovery from an AC joint injury, shoulder dislocation, or shoulder fracture typically requires a period of immobilization in a sling or immobilizer followed by rehabilitation. This is the case for both non-operative and operative treatment. You will see Dr. Jurek in clinic regularly until your shoulder injury has healed.

Shoulder injuries typically take months to heal. After shoulder trauma, patients can generally return to normal gentle daily activities within 3 months of their injury. Dr. Jurek will advise you when your injury is stable enough to do so.

After surgery for shoulder trauma, the shoulder is typically immobilized in a sling or immobilizer for 2 to 6 weeks to allow for healing. Physical therapy is started after the initial period of immobilization and usually continues for about 3 to 5 months.

If you have experienced trauma to your shoulder resulting in a shoulder injury, contact Dr. Sara Jurek at (206) 386-2600 to discuss treatment options.