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 Shoulder and Elbow Trauma/Fractures1

Shoulder Anatomy

The shoulder is the most flexible joint in the body, enabling a wide range of movements. It is a ball-and-socket joint made up of three bones, namely the humerus (upper arm bone), scapula (shoulder blade) and clavicle. The head of the humerus articulates with the socket of the scapula called the glenoid cavity. The clavicle bone or collarbone is an S-shaped bone that connects the scapula to the sternum or breastbone. It forms two joints:

  • The acromioclavicular joint, where it articulates with the acromion process of the scapula
  • The sternoclavicular joint, where it articulates with the sternum or breastbone.

Tendons and ligaments around the shoulder joint provide strength and stability to the joint.

What is a Shoulder Fracture?

A break in a bone that makes up the shoulder joint is called a shoulder fracture.

Types of Fractures

The clavicle and end of the humerus closest to the shoulder are the bones that usually get fractured. The scapula, on the other hand, is not easily fractured because of its protective cover by the surrounding muscles and chest tissue.

Causes of Shoulder Fracture

Clavicle and humerus fractures can occur by a direct hit from a motor vehicle accident, collision or fall. A fracture of the scapula can occur by high-energy trauma during an accident from a high-speed motor vehicle.

Fractures of the proximal humerus are common in elderly individuals suffering from osteoporosis. In younger individuals, a severe trauma such as a fall from a height on an outstretched hand or motor vehicle accident can cause these fractures.

The break or fracture of the clavicle (collarbone) is a common sports injury associated with contact sports such as football and martial arts, as well as impact sports such as motor racing. A direct blow over the shoulder that may occur during a fall on an outstretched arm or a motor vehicle accident may cause the clavicle bone to break.

Signs and Symptoms of Shoulder Fracture

The common signs and symptoms of a shoulder fracture may include:

  • Pain
  • Swelling
  • Bruising
  • Difficulty in lifting your arm
  • Numbness, tingling or coldness of the hand and forearm
  • The popping sound also referred to as crepitus, heard or felt at the time of the fracture

Diagnosis of Shoulder Fracture

A shoulder fracture is usually diagnosed based on a thorough physical examination, and imaging studies such as X-rays and CT scans.

Treatments for Shoulder Fractures

The treatment for a shoulder fracture is based on the type of fracture. Treatment can include non-surgical and surgical methods.

A broken clavicle bone usually heals without surgery. Non-surgical treatments for shoulder fractures may include immobilization by placing your arm in a sling, pain medication and physical therapy. If the fracture has led to the displacement of the bones, then surgery may be required to correct and fix them with pins, plates or screws.

Post-surgery, physical therapy may be recommended to aid in the recovery and improve range-of-motion and strength of the arm.

Elbow Anatomy

The arm in the human body is made up of three bones that join to form a hinge joint called the elbow. The upper arm bone or humerus connects from the shoulder to the elbow to form the top of the hinge joint. The lower arm or forearm consists of two bones, the radius and the ulna. These bones connect the wrist to the elbow forming the bottom portion of the hinge joint.

What are Elbow Fractures?

Elbow fractures may occur from trauma, resulting from various reasons: A fall on an outstretched arm, a direct blow to the elbow or an abnormal twist to the joint beyond its functional limit.

What are the Types of Elbow Fractures?

The types of elbow fractures include:

  • Radial head and neck fractures: Fractures in the head portion of the radius bone are referred to as radial head and neck fractures.
  • Olecranon fractures: These are the most common elbow fractures, occurring at the bony prominence of the ulna.
  • Distal humerus fractures: These fractures are common in children and the elderly. Nerves and arteries in the joint may sometimes be injured in these fractures.

Symptoms of Elbow Fractures

The symptoms of an elbow fracture may include pain, bruising, stiffness, swelling in and around the elbow, popping or cracking sound, numbness or weakness in the arm, wrist, and hand, and deformity of the elbow bones.

Diagnosis of Elbow Fractures

To diagnose an elbow fracture, your doctor will review your history, perform a thorough physical examination and order X-rays of the joint. In some cases, a CT scan may be needed to view the details of the joint surface.

Treatment Options for Elbow Fractures

The aim of treatment is to maximize early motion and reduce the risk of stiffness. Non-surgical treatment options include pain medication, ice application, the use of a splint or a sling to immobilize the elbow during the healing process, and physical therapy.

Surgery is indicated in displaced and open fractures to realign the bones and stabilize the joint with screws, plates, pins and wires. Strengthening exercises are recommended to improve the range of motion.

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