The shoulder consists of three bones (scapula, clavicle, and the humerus) attached by ligaments, tendons, and joint capsules that enable arm function. It has essentially three joints: glenohumeral, acromioclavicular and sternoclavicular. The main one is glenohumeral and consists of a "ball" (humeral head) on a golf tee shaped articular facet (glenoid of the scapula).
Fractures (broken bone) can occur in the clavicle or humerus after direct trauma due to fall, collision or road accident; fractures of the scapula are more rare and usually occur due to high energy trauma, such as violent road accidents, and may occur with other associated injuries.
What are the symptoms?
Signs and symptoms depend on the nature of the trauma and severity of the injury and range from local pain and hematoma to deformity and total functional disability of the shoulder.
How is the diagnosis made?
The diagnosis is usually made by radiography, but other complementary diagnostic means such as computed tomography may be necessary.
What therapeutic options are available?
Most clavicle fractures can be treated conservatively, ie, without surgery, only with antebrachial suspension and analgesic or anti-inflammatory medication. Surgery is only necessary if the fracture is complex, if the deviation is large and / or if the skin is at risk, and includes fixing with plates and screws.
Many of the fractures of the proximal humerus can be treated if the bony extremities are not significantly diverted or out of position. Otherwise, surgery is usually necessary and may include fixation with plates and screws, metal wires or even arthroplasty (prosthesis) of the shoulder in more severe situations.
Fractures of the scapula can be treated without surgery. Includes immobilization with antebrachial suspension (arm), ice and analgesics. About 10 to 20% of these fractures require surgery, particularly if there are other associated fractures of the shoulder.
What to expect after a fracture?
A fracture can impair activities of daily living for weeks and often months. Most patients treated conservatively or surgically require a period of immobilization and rehabilitation assumes a primary role in recovery.