Broken Shoulder (Fractured Humerus)
What is a Broken Shoulder?
A fracture is a medical term for a broken bone. A broken shoulder (fractured shoulder) is most commonly a fractured humerus. The humerus is your upper arm bone between your shoulder and elbow.
Common Shoulder Fractures
When your humerus fracture is near or at the ball of your shoulder joint, it is commonly known as a broken shoulder. Your humerus can fracture in many places, and the fracture usually is described by its location, e.g. a fractured neck of the humerus.
The location of these fractures can impact your treatment because of the bone attachment of your essential shoulder muscles. If you use a force attached to a broken section, this can be very painful or cause deformity when your fracture eventually heals.
Below is a list of muscles that attach to different parts of the shoulder. Your physiotherapist or doctor will be able to explain what you should and shouldn’t do if you have a fracture of the following regions:
- Greater tuberosity – supraspinatus, infraspinatus & teres minor
- Lesser tuberosity – subscapularis
- Humeral Head
- A Shaft of Humerus – pec major (displaces shaft medially & internal rotation)
Due to the main reason for shoulder fractures being falls, a second shoulder fracture will often co-occur.
What’s Worse, a Fracture or a Break?
Despite what your friends say, there is no difference in severity between a fractured bone and a broken bone. Fracture is the medical term for a “broken bone”. Fractures have different grading:
- Greenstick (incomplete fracture)
- Transverse (across the bone)
- Spiral (spiral around the bone)
- Oblique (diagonal across the bone)
- Compression (crushed)
- Comminuted (3+ pieces)
- Segmental: the same bone fractured in two places resulting in a “floating” section.
An Orthopaedic Surgeon should assess all shoulder fractures.
Broken Shoulder Treatment
After your broken shoulder diagnosis via an X-ray, a collar and cuff sling will typically support your arm at the wrist. The sling allows the weight of the elbow to pull the humerus downwards. The downward gravity pull helps the broken bones to heal in the correct position.
It would be best if you did not put anything under your elbow in an attempt to support the weight of your arm. This force would push your humerus upwards and move the bones into the wrong position. Hence, this is why a triangular sling is unsuitable. You must not rest your arm on a pillow when sitting or lying. Depending on your surgeon’s recommendations, you will need to wear the collar and cuff for at least six weeks. You may wear it outside your clothes. You may remove it to wash.
Yes! Your shoulder will be pretty painful for the first two weeks. Pain-relieving tablets may help to reduce your pain. Ask your doctor for advice.
Surgery is sometimes required to stabilise your broken shoulder.
Physiotherapy & Exercises for a Broken Shoulder
If you don’t require surgical intervention, your arm will usually be in a collar and cuff for six weeks. It would help to move your fingers and wrist while in the collar and cuff to prevent stiffness and swelling. Your doctor or physiotherapist will advise you when it is safe to recommend range of motion, active-assisted, active and then progressive strengthening exercises. DO NOT attempt to do too much too soon, or you may disturb your shoulder fracture.
While it is essential to move your shoulder to prevent stiffness, your priority is the allow the shoulder fracture to heal. Be guided by your health professionals. They are the experts in getting your broken shoulder repaired and back moving again as soon as possible.
Even with diligent exercising, your broken shoulder may become stiffer than average. Your physiotherapist is the best person to advise you what exercises to do, how often and when? Seek your physiotherapist’s advice within the two weeks after injury or surgery, ideally to attain your best outcome.
Will Your Broken Shoulder Fully Recover?
In most cases, Yes! Your broken shoulder will continue to improve for up to twelve months. However, your best results will occur early.
Broken Shoulder Tips
You may remove the collar and cuff to wash. Wash under your arm using a hanging pendulum position.
You cannot drive while your arm is in a collar and cuff. You will not have free movement of your arm for several weeks after removing the sling. Therefore you will not be able to drive for at least eight weeks.
When your return to work depends on your job, if you can work one-handed, you may be able to return to work two weeks after your injury. Travel requirements are also a consideration. If your job is manual, you will be unable to work for at least three months.
In most cases, you may participate in light non-contact sports about six weeks after your injury. When you start playing, you will not be able to play for as long as usual. Your shoulder will ache at the end of the exercises.
It would be best if you did not smoke while your fracture is healing. Research confirms that smoking slows down bone healing.
Broken Shoulder Complications
Occasionally, your broken shoulder may not heal properly. If this happens, an operation might be necessary. If the fractured shoulder heals in the wrong position, You might require surgery to correct the situation or insert an artificial shoulder joint.
General Advice for Broken Shoulder
After a broken shoulder, you will have dramatic bruising down your arm as far as the elbow. The bruising will take many days to disappear. It is a prevalent injury in older patients. As a result, your shoulder usually ends up stiffer than average following this injury. If you have any problems or queries, please ask your physiotherapist or doctor.
Common Shoulder Pain & Injury Conditions
- Rotator Cuff Syndrome
- Shoulder Tendinopathy
- Rotator Cuff Calcific Tendinopathy
- Rotator Cuff Tear
- Bicep Tendinopathy
- Shoulder Impingement
- Swimmer's Shoulder
- Subacromial Decompression
- Shoulder Arthroscopy
- Rotator Cuff Repair
- SLAP Repair
- Biceps Tenodesis
- Biceps Tenotomy
- Total Shoulder Replacement
Researchers have discovered that managing your shoulder injury with physiotherapy is usually successful. Typically, you have two options: a non-operative or a surgical approach. Your condition will dictate which option is best for you at this time. Non-operative care is conservative rehabilitation.
If shoulder surgery is required, then your physiotherapist may undertake:
Pre-operative rehabilitation - either trial a non-operative/conservative treatment approach or condition and prepare your shoulder and body for a surgical procedure.
Post-operative physiotherapy will safely regain your normal range of movement, strength and function.
PhysioWorks physiotherapists have a particular interest and an excellent working relationship with leading shoulder surgeons. Our physiotherapy team provide you with both conservative and post-operative shoulder rehabilitation options. We aim for you to attain the best possible outcome for your shoulder injury.
For specific information regarding your shoulder, please consult your trusted shoulder physiotherapist.
Acute Injury Signs
Acute Injury Management.
Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.
For detailed information on specific injuries, check out the injury by body part section.
Don't Ignore these Injury Warning Signs
Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.
If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.
Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.
Reduced Range of Motion
If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.
Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.
Immediate Injury Treatment: Step-by-Step Guidelines
- Stop the activity immediately.
- Wrap the injured part in a compression bandage.
- Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
- Elevate the injured part to reduce swelling.
- Consult your health practitioner for a proper diagnosis of any serious injury.
- Rehabilitate your injury under professional guidance.
- Seek a second opinion if you are not improving.
Elite Sports Injury Management
You probably already know that a sports injury can affect not only your performance but also your lifestyle. The latest research continues to change sports injury management considerably. Our challenge is to keep up to date with the latest research and put them to work for you.
How we treated you last year could vary significantly from how we treat you this year. The good news is that you can benefit considerably from our professional knowledge.
What Should You Do When You Suffer a Sports Injury?
Rest from painful exercise or a movement is essential in the early injury stage. "No pain. No gain." does not apply in most cases. The rule of thumb is - don't do anything that reproduces your pain for the initial two or three days. After that, you need to get it moving, or other problems will develop.
Ice or Heat?
We usually recommend avoiding heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early. In traumatic injuries, such as ligament sprains, muscle tears or bruising, ice should help reduce your pain and swelling.
Once the "heat" has come out of your injury, you can use heat packs. We recommend 20-minute applications a few times a day to increase the blood flow and hasten your healing rate. The heat will also help your muscles relax and ease your pain. If you're not sure what to do, please call us to discuss your situation specifically.
Should You Use a Compressive Bandage?
Yes. A compressive bandage will help to control swelling and bleeding in the first few days. In most cases, the compressive dressing will also help support the injury as you lay down the new scar tissue. This early healing should help to reduce your pain. Some injuries will benefit from more rigid support, such as a brace or strapping tape. Would you please ask us if you are uncertain about what to do next?
Gravity will encourage swelling to settle at the lowest point. Elevation of an injury in the first few days is beneficial, especially for ankle or hand injuries. Think where your damage is and where your heart is. Try to rest your injury above your heart.
What Medication Should You Use?
Your Doctor or Pharmacist may recommend pain killers or an anti-inflammatory drug. It is best to seek professional advice as certain medications can interfere with other health conditions, especially asthmatics.
When Should You Commence Physio?
In most cases, "the early bird gets the worm". Researchers have found that the intervention of physiotherapy treatment within a few days has many benefits. These include:
- Relieving your pain quicker via joint mobility techniques, massage and electrotherapy
- Improving your scar tissue using techniques to guide the direction it forms
- Getting you back to sport or work quicker through faster healing rates
- Loosening or strengthening of your injured region with individually prescribed exercises
- Improving your performance when you return to sport - we'll detect and help you correct any biomechanical faults that may affect your technique or predispose you to injury.
What If You Do Nothing?
Research tells us that injuries left untreated take longer to heal and have lingering pain. They are also more likely to recur and leave you with either joint stiffness or muscle weakness. It's important to remember that symptoms lasting longer than three months become habitual and are much harder to solve. The sooner you get on top of your symptoms, the better your outcome.
What About Arthritis?
Previously injured joints can prematurely become arthritic through neglect. Generally, there are four main reasons why you develop arthritis:
- An inappropriately treated previous injury (e.g. old joint or ligament sprains)
- Poor joint positioning (biomechanical faults)
- Stiff joints (lack of movement diminishes joint nutrition)
- Loose joints (excessive sloppiness causes joint damage through poor control)
What About Your Return to Sport?
Your physiotherapist will guide you safely back to the level of sport at which you wish to participate. If you need guidance, ask us.
What If You Need Surgery or X-rays?
Not only will your physio diagnose your sports injury and give you the "peace of mind" associated, but they'll also refer you elsewhere if that's what's best for you. Think about it. You could be suffering needlessly from a sports injury. Would you please use our advice to guide you out of pain quicker? And for a lot longer.
If you have any questions regarding your sports injury (or any other condition), don't hesitate to get in touch with your physiotherapist to discuss. You'll find our friendly staff happy to point you in the right direction.
Arm Pain Causes
Arm pain and injuries are widespread. Arm pain can occur as a result of either sudden, traumatic or repetitive overuse. The causes can be related to sports injuries, work injuries or simply everyday arm use.
Causes of Arm Pain by Region
Causes of Arm Pain by Structure
Neck-Related Arm Pain
Shoulder-Related Arm Pain
- AC Joint Injury
- Biceps Tendinopathy
- Broken Shoulder - Fractured Humerus
- Bursitis Shoulder
- Dislocated Shoulder
- Frozen Shoulder
- Rotator Cuff Calcific Tendinopathy
- Rotator Cuff Syndrome
- Rotator Cuff Tear
- Shoulder Arthritis
- Shoulder Impingement
- Shoulder Tendonitis
- Swimmer's Shoulder
Elbow-Related Arm Pain
Wrist-Related Arm Pain
Hand-Related Arm Pain
Muscle-Related Arm Pain
- DOMS - Delayed Onset Muscle Soreness
- Muscle Strain (Muscle Pain)
- RSI - Repetitive Strain Injury
- Overuse Injuries
Other Sources of Arm Pain
Common Causes of Arm Pain
- Your rotator cuff or frozen shoulder most commonly causes shoulder pain.
- Elbow pain is most commonly caused by tennis elbow or golfers elbow.
- Wrist & hand pain can be related to carpal tunnel, wrist arthritis or even a thumb tendon condition known as de Quervain's tenosynovitis.
Referred Arm Pain
As mentioned earlier, arm pain can be referred to from another source. Cervical radiculopathy is a common source of referred arm pain. Cervical radiculopathy will not respond to treatment where you feel the arm pain. However, it will respond positively to treatment at the source of the injury (e.g. your neck joints).
Professional assessment from a health practitioner skilled in diagnosing both spinal-origin and local-origin (muscle and joint) injuries (e.g. your physiotherapist) is recommended to ensure an accurate diagnosis and prompt treatment directed at the arm pain source.
Arm Pain has Diverse Causes.
The causes of your arm pain can be extensive and varied. Due to this diversity, your arm pain should be assessed by a suitably qualified health practitioner to attain an accurate diagnosis, treatment plan and implementation specific to your arm pain.
What Arm Pain is Associated with a Heart Attack?
Left-arm pain can be an early sign of a life-threatening cardiac issue. Based on this, a professional medical assessment that involves an accurate history, symptom analysis, physical examination and diagnostic tests to exclude a potential heart attack is important to exclude this potentially life-threatening source of arm pain.
For more information, please consult with your health practitioner, call an ambulance on 000, or visit a hospital emergency department to put your mind at ease.
Good News. Most Arm Pain is NOT Life-Threatening.
Luckily, life-threatening arm pain is far less likely than a local musculoskeletal injury. Arm pain caused by a localised arm muscle, tendon or joint injury should be assessed and confirmed by your health practitioner before commencing treatment.
Arm Pain Prognosis
The good news is that arm pain, and injury will normally respond very favourably to medical or physiotherapy intervention when early professional assessment and treatment is sought. Please do not delay in consulting your healthcare practitioner if you experience arm pain.
Common Arm Pain Treatments
With accurate assessment and early treatment, most arm injuries respond extremely quickly to physiotherapy or medical care, allowing you to resume pain-free and normal activities of daily living quickly.
Please ask your physiotherapist for their professional treatment advice.
Common Youth Arm Injuries
Children's Arm Injuries
Children's and Adolescent injuries differ from adult injuries, mainly because the bones are still growing. The growth plates (physis) are cartilaginous (healthy connective tissue) areas of the bones from which the bones elongate or enlarge. Repetitive stress or sudden large forces can cause injury to these areas.
Repetitive overhand throwing can injure a child' elbow. Throwing injuries in the elbow most commonly occur in baseball pitchers, but cricket also has an incidence level. Any child who participates in repetitive overhand throwing can suffer throwers elbow.
The overhand throw creates stress on the growth areas. If repeatedly overloaded, overhand throwing of the immature elbow may result in excessive strain upon the elbow structures, such as ligaments, cartilage, and growth plates.
Medial Apophysitis ("Little Leaguer's Elbow")
Medial apophysitis is a common elbow problem sustained by active children. Medial apophysitis causes pain at the medial epicondyle on the inside of the elbow. The bone prominence, called the medial epicondyle, is at the end of the humerus bone and contains a growth plate called the medial apophysis. Muscles that control wrist motion attach to the medial epicondyle, and excessive overhand throwing can irritate and inflame the growth plate. Young tennis players can also suffer this injury.
Osteochondritis dissecans is a common source of lateral elbow pain. The immature bones of the elbow joint can compress from excessive overhand throwing. Small fragments of bone and cartilage may dislodge and potentially float within the joint. You may require surgery to remove the loose bodies.
The key to pain relief is active resting from the aggravating sport. If left untreated, throwing injuries in the elbow can become severe conditions. Depending upon the severity of a child's injury, they may require surgery. If a child's pain continues after a few days of complete rest, please seek the advice of your physiotherapist or doctor.
More info: Juvenile Osteochondritis Dissecans
Stress Reaction of Growth Plates (Physis)
Repetitive stress on a child's growth plate (physis) in the arms or legs, if ignored, can impair growth. It can also be painful.
Overuse stress reaction may lead to irregularity or widening of the growth plate. If you continue repetitive stress, the growth plate may become permanently damaged and could stop growing prematurely. This premature cessation could lead to a bone deformity.
Sports activities that may cause a stress reaction in growth plates include gymnastics and overhand throwing.
Gymnasts perform repetitive wrist activities that can lead to a stress reaction of the growth plate in the distal radius bone.
Young baseball pitchers apply forces across the upper arm bone in their shoulders during the overhand throw. They can damage their upper humerus (shoulder bone) growth plate. An abnormal growth plate in an X-ray of a child who participates in a high-risk sport requires an Orthopaedic assessment. They may require surgical treatment. Until assessed, they should stop the aggravating activity for at least 2 to 3 months unless your surgeon suggests otherwise.
For specific advice, please seek the professional opinion of your physiotherapist or doctor.