A proximal humerus fracture is a broken bone (fracture) of the shoulder at the humeral head (ball) of the shoulder. These fractures typically involve the neck and one or both of the greater or lesser tuberosities, the bony attachment points of the rotator cuff muscle.
What Is a Proximal Humerus Fracture?
A proximal humerus fracture is a fracture of the shoulder at the humeral head (ball). These fractures typically involve the neck and one or both of the greater or lesser tuberosities, which are the bony attachment points of the rotator cuff muscle.
With appropriate treatment and normal alignment of the fracture fragments, healing can be expected. Surgery may be necessary to realign fractures that are displaced or to treat fractures that do not heal properly.
Causes and Risk Factors
Causes of proximal humerus fractures include:
- Indirect force from falling on an outstretched hand or bent elbow
- Violent muscle contraction
- Less commonly, a direct blow to the shoulder
Risk factors include:
- Contact sports such as football, soccer, hockey, and rugby
- Sports in which falling is possible, such as snowboarding, volleyball, and basketball
- A history of bone or joint disease or previous immobilization of the arm
- Poor physical conditioning, including strength and flexibility
Symptoms
Signs and symptoms may include:
- Severe arm pain at the time of injury
- Tenderness, swelling, and delayed bruising of the arm or chest
- Swelling and bruising that moves down the arm
- Visible deformity if the fracture is complete and the bone fragments separate enough to distort normal body contours
- Pain with attempted shoulder motion, such as lifting or rotating the arm
Treatment
If the fracture fragments are in appropriate alignment, initial treatment consists of ice and medications to help relieve pain. Immobilization with a sling or shoulder immobilizer for up to six weeks is recommended to allow the bones to heal.
Displaced fractures that are not in appropriate alignment require surgery to restore and maintain the fracture in its normal anatomic position. Surgery usually involves repositioning the fracture fragments and maintaining their position with sutures, wires, rods, plates, screws, or pins.
Fracture stability is necessary to allow early protected motion to help prevent stiffness and functional loss of motion. Following initial healing, moving nearby joints and stretching and strengthening muscles is important. Physical therapists often assist with rehabilitation.
Recovery and Outcomes
With appropriate treatment and normal alignment of the fracture fragments, healing can be expected. Average healing time is six to eight weeks in adults and four to six weeks in children. Full recovery, including rehabilitation, can require four to six months.
Surgery may be necessary to realign fractures that are displaced or to treat fractures that do not heal properly. Rehabilitation following initial healing includes movement of nearby joints and stretching and strengthening of the muscles.
When to See Dr. Chudik
Schedule an evaluation after any shoulder injury that produces immediate pain, inability to lift the arm, significant bruising, or visible deformity, especially after a fall. Call 630-324-0402 or request an appointment online.