A proximal humerus fracture is a type of broken shoulder. The anatomy of your shoulder comprises the humerus (upper arm bone), scapula (shoulder blade) and clavicle (collarbone). The humeral head at the top of the humerus is the ball part of your shoulder joint, which rests inside the shoulder socket.
A proximal fracture is a break at the top of the humerus, either at or just below the humeral head. The bones of your shoulder are held in place by groups of muscles, including the rotator cuff, deltoid and pectorals.
Causes of proximal humerus fractures
A proximal humerus fracture is one of the most common broken bones in older people and normally occurs as the result of a trip or fall onto an outstretched arm. Ageing can cause the bones to weaken so this type of injury in an older person may result in the bone breaking in several places. In younger people, it normally requires a greater force to break the proximal humerus. Such injuries can happen if there is a fall from a height (such as horse riding or rock climbing), a heavy impact during contact sports like rugby or football, or a vehicle collision.
Symptoms of proximal humerus fractures
A broken shoulder is a painful and debilitating injury. You will experience pain when you try to move your arm and even small movements like breathing can be painful. Swelling and bruising can occur in your armpit, down your arm, across your chest and into your hand.
Who is at risk?
Proximal humerus fractures can occur at any age, but older people can be particularly at risk, especially those with osteoporosis or who fall frequently. Women are twice as likely than men to experience this type of injury and the older the patient is, the more complex the fracture is likely to be. A proximal humerus fracture can also occur in sportsmen and women who compete in contact sports, like rugby, or those at risk of falls, such as rock climbers.
Diagnosing proximal humerus fractures
If you suspect a fractured shoulder, you should seek urgent medical treatment and an accurate diagnosis. Proximal humerus fractures can cause the bone to break in multiple places so you will need an X-ray to determine the type and extent of the fracture.
The doctor will examine your shoulder and chest area. If they suspect you may have split the humeral head or you might require surgery, you may also be given a CT scan.
Treating proximal humerus fractures
Most proximal humerus fractures can be treated without surgery. You will need to wear a sling to immobilise your arm while the bones start to heal (normally three to four weeks) and avoid lifting anything heavier than a couple of pounds with your damaged shoulder until the bone is fully healed. It is important to perform exercises recommended by a physiotherapist during this time to help restore strength and mobility to your shoulder joint and prevent stiffness. Your surgeon may also recommend avoiding certain movements. Even so, it can take around 18 months to regain full function in your shoulder and some people never do, even with surgery.
For some proximal humerus fractures, you will need to undergo a surgical repair. These are normally badly displaced fractures, where the bone fragments are too far apart to heal well or fractures where the shoulder is also dislocated. If you do need surgery, an incision will be made over your shoulder. The bones will be realigned and fixed in place with metal plates and screws.
Complications associated with proximal humerus fractures
With some proximal humerus fractures there can be long-term issues, including stiffness and loss of strength. For some people, the shoulder never regains its pre-injury mobility and in some cases it may not heal completely. There can be an increased risk of arthritis in the damaged shoulder joint. If this becomes severe, you may require a shoulder replacement at a later date.
Related Reading
SPOTLIGHT ON 3 COMMON SHOULDER & ELBOW FRACTURES
We specialise in all types of diagnosis and treatment of shoulder injuries, from the simplest to the most complex. Contact us to discuss your proximal humerus fracture.
Orthopaedic Consultant & Surgeon | London
Thames Shoulder & Elbow are able to provide advice and support to anyone experiencing symptoms affecting the upper limbs (shoulder, upper arm, elbow, forearm and wrist).
Telephone: 020 376 15987
Email: admin@thamesshoulderandelbow.co.uk
Our Locations
Hospital of St John and St Elizabeth, St John’s Wood – Directions
BMI The Syon Clinic, Brentford – Directions
HCA Chiswick Medical Centre, Chiswick – Directions
West Middlesex University Hospital, Chelsea and Westminster Foundation Trust, Isleworth – Directions
