Shoulder Fractures

A broken bone is called a fracture. If the bone breaks through the skin it is called a compound fracture.

This is normally caused by trauma but can be caused by osteoporosis. It will need to be diagnosed by X-ray.

If you are unable to see your GP or the pain is severe, there is deformity or the bone is poking out of the skin then go straight to A&E or dial 999/111.

Whilst you are waiting you may find benefit in supporting the area with a pillow/cushion so that your arm is supported on top of your tummy, with your elbow bent up.

You may also want to make a splint using a towel to stabilise the area. You should try to move the area as little as possible until it has been medically checked.

Follow the PRICE M&M 

Normally broken arms and collar bones heal over time: Recovery is different for everybody, however the rule of thumb is that for the first 48-72 hours you will be in the inflammation phase. Your shoulder will be swollen and bruised and very sore.

Following this you will enter the Repair phase which can last up to 6 weeks. In this phase your body is laying down the new tissue to repair the damaged area, initially this tissue will be weak and will have to strengthen over time. Initially they will not be same shape or orientation as the tissue that is there, but with gentle movement and by following the PRICE regime this tissue will start to repaire.

The remodelling phase follows the repair phase.  Your body is always regenerating throughout your life. Unfortunately after the age of 30 this does slow down somewhat! By 6 weeks this new tissue will be stronger  and the fractured area becomes more reliable and functional once more. This period can last for up to 12 weeks from the initial injury. Your bone may take up to 12 months to completely repair, however after 12 weeks then there is very little chance that you will re- damage or fracture (in a healthy person).

 

How to Treat

It is unlikely that you will receive any early treatment from your Physiotherapist. Most people will start to receive Physiotherapy around 6 weeks after the Fracture is stabilised. This will normally be checked by X-ray.

It is vitally important that you keep your elbow and wrist moving whilst you are in the sling to avoid problems with these joints once out of the sling.

Once you are able to wean off the sling, you may benefit from Physiotherapy or by doing exercises to restore your Range of Motion and strength. As well as reduce any residual pain and aid your bodies’ ability to know where you are in time and space (proprioception).

PRICE M&M

  • Protect- Try not to further damage the area by wearing a support/sling, which covers the area.

  • Rest - Try not to do any activity that may put the area at risk. Aim to rest the area from Sport or too much activity for 48-72 hours.

  • Ice - (after 48-72 hours Heat may also be beneficial). A bag of frozen peas/ ice packs etc. Wrap in a damp tea towel and compress it (use cling film or tie around the other side of the shoulder). Do either 10 minutes on 10 minutes off 10 minutes on. Or no more than 20 minutes on in one sitting. Aim to do this regularly throughout the day in the initial phase. Do not fall asleep with the Ice Pack on and always check the area to avoid skin irritation/ice burns.

  • Compress- bandage or compress the area to reduce the swelling and to avoid painful movements. Elasticated bandage is effective but it should not be so tight that it restricts blood flow as this could be dangerous. For the same region please do not sleep with the bandage on.

  • Elevate- Keep the affected area raised and supported on a pillow to try and limit the swelling/ place it in a sling.  Try to avoid long periods where your arm is raised above the level of your heart as it is harder for your body to return blood to the heart and you may experience numbness.

  • Medication - Always check with a Pharmacist/ GP about what you can and cannot take safely, always follow the instructions on the packet. As a rule Ibuprofen (anti- inflammatory) is generally more effective at night and first thing in the morning to reduce the swelling. Paracetamol is used to reduce the pain. You may also wish to try Ibuprofen gels etc.

  • Management- Every shoulder is different but in the initial phase of injury, it is always best to be cautious, so where possible try to avoid direct Heat (for 48-72 hours).

  • Alcohol consumption should be reduced to limit further injury

  • Running or exercise should be limited until the swelling starts to subside

  • It is good to still move the joint (within a pain free range), as much as your body will allow. Try not to keep it still for long periods as it will only become more difficult to move once you have to!

 

Some GP’s or A&E departments may issue you with a sling/collar and cuff crutches, to help immobilise the joint. Try to not become over reliant on these, as it can limit your recovery.

More useful reading

http://www.nhs.uk/conditions/broken-arm/Pages/Introduction.aspx

http://www.nhs.uk/conditions/broken-collarbone/Pages/Introduction.aspx

http://www.ouh.nhs.uk/patient-guide/leaflets/files/10920Psling.pdf

https://www.youtube.com/watch?v=9Cifk_ohsDo

Water Lane Clinic Physio Team