Brief Outline of Fracture (Collar Bone, Humerus)
Fractures of the shoulder usually involve a break in either the clavicle (collar bone) or the neck of humerus (arm bone), or both. Impact injuries involving a sudden blow to the shoulder or a fall are usually responsible. Contact sports including football and rugby can result in shoulder fractures following a violent collision of two players.
Anatomy and physiology
The clavicle (collar bone) is a slender, doubly curved bone that attaches to the manubrium of the sternum medially (the sternoclavicular joint) and to the acromion of the scapula laterally (the acromioclavicular joint). The clavicle protects the underlying brachial plexus, pleural cap, and great vessels of the upper extremity. Clavicle fractures are common, often resulting from a fall on the lateral shoulder or on an outstretched arm. The humerus (arm bone) is the longest and largest bone of the upper limb. It articulates proximally with the scapula (at the glenoid fossa). Fractures to the humerus are generally the result of a fall on an outstretched arm.
Cause of Fracture (Collar Bone, Humerus)
Fall on an outstretched arm. Sudden blow to the clavicle. Collision of two athletes in sports, e.g. football.
Signs and symptoms
Severe pain. Redness and bruising around the site of the injury. Inability to raise the arm.
Complications if left unattended
Complications are uncommon, although pneumothorax, haemothorax, and injuries to the brachial plexus or subclavian vessels are possible, requiring medical intervention. Chronic pain due to osteoarthritis may result should the injury be given insufficient time to heal.
- Immobilisation using an arm sling if the fracture is undisplaced
- Surgery if the bones are displaced
Rehabilitation and prevention
Bones of the clavicle and humerus must first be realigned following fracture, so that proper healing may ensue. Healing occurs while the clavicle and arm bones are held in place with a strap or sling. After healing, physical therapy, including range of motion and strengthening exercises should be undertaken to restore full movement and flexibility.
Most shoulder fractures are successfully treated without resort to surgery, although this is occasionally required for fractures of the clavicle. For less severe fractures, full recovery and restoration of mobility may be expected. In the case of more severe fractures and particularly in older patients, some loss of motion and possibility of osteoarthritis exist.
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