You take a long walk with your dog when she sees a squirrel and takes off. Her leash tightens and pulls you to the ground. You fall on your shoulder and have immediate pain and difficulty moving it. Your friend takes you to the emergency room and an X-ray shows that you have broken your shoulder. The doctor places your arm in a sling and tells you to visit an orthopaedic surgeon. This is just one of many scenarios that cause a broken shoulder.
Broken shoulders are very common. Technically, they are called proximal humerus fractures. These account for about 5% of all fractures and are nearly twice as common in women as men. The good news is that more than 85% heal without requiring surgery. Other times there are too many pieces or the pieces are not lying in a good position and surgery is necessary.
Broken shoulders without surgery
If your broken shoulder does not need surgery, then usually 6 weeks in a sling is all that is necessary to allow it to heal. Initially, you should keep the elbow at your side as much as possible and only move it to wash your armpit. If instructed, you may take your arm out of the sling or immobilizer a few times a day to bend your elbow and move your wrist and fingers to prevent them from getting too stiff. You should stay in the sling while you sleep. Try to move slowly and cautiously and avoid any sudden movements. Not only would this hurt, it could cause the fracture to displace or move into a worse position.
After a couple of weeks, a repeat X-ray of your broken shoulder will often be done to make sure that your condition hasn’t worsened. If it is healing well, you may be allowed to use your hand for light activities of daily living as long as you keep your elbow at your side. After another few weeks you will start physical therapy and a therapist will move the shoulder for you. When someone moves your shoulder for you it is called passive range of motion. This is to keep your shoulder from getting too stiff from scar tissue. If you were to move your shoulder yourself, called active range of motion, there is a risk that the muscles could pull the fracture, or break, apart. That is why we typically wait until 6 weeks after the injury to allow you to remove the sling and move it yourself.
After 6 weeks
Another set of X-rays will be performed and if it appears that your broken shoulder is healing well, you may be allowed to remove the sling. You will be allowed to indulge in further activities of daily living. Therapy will continue to improve your range of motion. While it does the strengthening phase of your recovery will begin. The next, and hopefully, final set of x-rays will be done three months after your injury. If the fracture appears to be completely healed you’ll be allowed to resume your activities without restriction. Although the bone may be healed, it will take up to a full year to completely recover.