Anatomy of the Shoulder

The shoulder is one of the most mobile joints in the human body. Its wide range of motion allows you to lift, rotate and reach in many directions.

Three bones form the shoulder structure:

• Clavicle (collarbone) – connects the shoulder to the chest and stabilizes the shoulder girdle
• Scapula (shoulder blade) – forms the socket of the shoulder joint
• Humerus (upper arm bone) – the top portion forms the ball of the shoulder joint

The acromioclavicular joint connects the clavicle to the acromion of the scapula, while the sternoclavicular joint connects the clavicle to the sternum. Both joints play important roles in shoulder stability and movement and may be affected during shoulder trauma.

The head of the humerus fits into a shallow socket in the scapula called the glenoid, forming the ball-and-socket joint known as the glenohumeral joint.

Fractures affecting the clavicle or proximal humerus can disrupt this structure and limit shoulder movement.

Types of Shoulder Fractures

The type of shoulder fracture depends on which bone is involved and the nature of the break.

While several bones can fracture in the shoulder region, the two most common injuries treated by orthopedic specialists are:

• Clavicle fractures
• Proximal humerus fractures

Other types of shoulder fracture include distal humerus fractures, which occur near the elbow and open fractures, where the broken bone pierces the skin and requires urgent medical attention.

Non-displaced shoulder fractures are the most common type, accounting for approximately 80 percent of cases.

Both injuries frequently occur after falls, sports injuries or trauma to the shoulder.

Clavicle (Collarbone) Fractures

A clavicle fracture, also known as a broken collarbone, is one of the most common shoulder injuries. The clavicle acts as a rigid support that helps hold the shoulder away from the body and allows full arm movement.

Clavicle fractures may involve areas near the acromioclavicular joint or sternoclavicular joint, both of which contribute to shoulder stability.

Because of its position near the surface of the skin, the clavicle can break when a person falls directly onto the shoulder or lands on an outstretched arm.

Causes of Clavicle Fractures

Clavicle fractures commonly occur from:

• Falls onto the shoulder
• Sports injuries or collisions
• Bicycle or motorcycle accidents
• Car accidents or other high-energy trauma
• Direct trauma to the collarbone

Athletes and active individuals are particularly susceptible due to contact sports and high-impact activities.

Symptoms of a Clavicle Fracture

Common symptoms include:

• Sudden shoulder or collarbone pain
• Intense pain in the shoulder area
• Swelling or bruising around the shoulder
• Tenderness along the collarbone
• Difficulty lifting or moving the arm
• A visible bump or deformity along the collarbone
• Grinding or clicking sensation with movement

Medical evaluation is important after a suspected injury because these fractures can significantly limit arm motion.

Types of Clavicle Fractures

Clavicle fractures may be classified based on location and fracture pattern.

Common fracture locations include:

• Midshaft fractures (most common)
• Distal clavicle fractures near the shoulder joint
• Proximal fractures near the sternum

Fracture patterns may include:

• Transverse fractures
• Oblique fractures
• Spiral fractures
• Comminuted fractures (bone broken into multiple pieces)
• Displaced fractures (bone fragments are separated and not aligned)
• Open fractures (bone breaks through the skin)

Some fractures, especially displaced, comminuted or open fractures, may require surgery to properly realign and stabilize the bone.

Treatment for Clavicle Fractures

Treatment depends on whether the bone fragments remain aligned.

Most non-displaced shoulder fractures heal with conservative treatment such as immobilization and physical therapy.

Non-Surgical Treatment

Conservative treatment may include:

• Arm sling for immobilization
• Ice and anti-inflammatory medications
• Activity restriction
• Gradual physical therapy

Many non-displaced fractures heal within six to eight weeks.

Physical therapy is commonly recommended after both non-surgical and surgical treatment to restore shoulder mobility and strength.

Surgical Treatment

Surgery may be recommended when the fracture is:

• Significantly displaced
• Shortened or overlapping
• Broken into multiple fragments
• Associated with nerve or vascular injury

Surgical repair typically involves open reduction and internal fixation (ORIF) using plates and screws to stabilize the bone during healing.

Follow-up imaging may be used to monitor the healing process.

Potential surgical risks may include infection, nerve injury, stiffness or delayed bone healing.

Proximal Humerus Fractures

A proximal humerus fracture occurs when the upper portion of the arm bone breaks near the shoulder joint. This injury affects the “ball” portion of the ball-and-socket joint and may impact shoulder stability.

These fractures are particularly common in older adults with decreased bone density.

Causes of Proximal Humerus Fractures

Common causes include:

• Falls onto an outstretched arm
• Direct trauma to the shoulder
• Sports injuries
• High-energy trauma such as car accidents

Older adults with osteoporosis are at increased risk because weakened bones fracture more easily.

Symptoms of a Proximal Humerus Fracture

Symptoms may include:

• Severe shoulder pain
• Swelling or bruising around the shoulder
• Limited ability to move the arm
• Tenderness at the top of the arm
• Visible deformity in severe cases

Because the fracture involves the shoulder joint, it can significantly limit arm movement.

Treatment for Proximal Humerus Fractures

Most proximal humerus fractures are non-displaced, meaning the bone fragments remain aligned and can heal without surgery.

Non-Surgical Treatment

Conservative treatment often includes:

• Arm sling for comfort
• Pain management
• Early physical therapy to maintain mobility
• Gradual strengthening exercises

Early supervised movement helps prevent stiffness and frozen shoulder.

Surgical Treatment

Surgery may be required when the fracture is displaced, unstable or complex.

Possible procedures include:

• Open reduction and internal fixation (ORIF)
• Intramedullary nailing
• Shoulder replacement surgery for severe fractures
• Reverse shoulder replacement when rotator cuff damage is present

The goal of surgery is to restore normal alignment and function of the shoulder joint.

Diagnosis of Shoulder Fractures

If a shoulder fracture is suspected, a physician will perform a physical examination and imaging tests.

Diagnostic evaluation may include:

• Medical history and injury assessment
• Physical examination of shoulder movement
• X-rays to confirm the fracture
• CT scans or MRI for more detailed imaging

Advanced imaging may be used for complex fractures such as scapula fractures.

These tests help determine whether the fracture is displaced or non-displaced, which guides treatment decisions.

Complications of Shoulder Fractures

Shoulder fractures can sometimes lead to complications affecting long-term shoulder function.

Potential complications include:

• Shoulder instability
• Limited range of motion
• Persistent shoulder pain
• Rotator cuff injury
• Nerve or blood vessel injury

In some cases, the bone may not heal properly, resulting in nonunion or malunion, which may require additional treatment.

Early diagnosis and proper management help reduce these risks.

Recovery and Rehabilitation

Recovery time depends on the severity of the fracture and whether surgery is required.

Recovery may include:

• Immobilization in a sling for several weeks
• Gradual range-of-motion exercises
• Physical therapy to rebuild strength
• Progressive return to daily activities

Healing times vary with fracture severity: many fractures heal within six to 12 weeks, while more complex or surgically treated fractures take longer and full recovery may take several months.

Following your physician’s rehabilitation plan is essential to restore shoulder function.

Prevention of Shoulder Fractures

While not all shoulder fractures can be prevented, several steps may help reduce risk.

Helpful prevention strategies include:

• Maintaining strong shoulder muscles and bone health
• Performing regular exercise and strength training
• Removing tripping hazards at home
• Using protective equipment during sports
• Managing osteoporosis or bone density loss
• Wearing a seatbelt during vehicle travel

These steps can help reduce the risk of falls and shoulder trauma.

Managing Pain and Discomfort

Pain management is an important part of recovering from a shoulder fracture.

Treatment may include:

• Over-the-counter pain medications
• Ice packs to reduce swelling
• Use of a sling or immobilizer
• Physical therapy to restore movement

Following your physician’s instructions and attending follow-up visits helps ensure proper healing.

When to See a Shoulder Specialist

Seek medical evaluation if you experience:

• Severe shoulder pain after a fall or injury
• Inability to lift or move the arm
• Swelling or bruising around the shoulder
• Visible deformity of the shoulder or collarbone
• Persistent pain that worsens with movement
• Possible shoulder dislocation

Prompt evaluation can help ensure proper healing and prevent long-term complications.

Schedule an Appointment

If you have shoulder pain after an injury or suspect a fracture, the orthopedic specialists at OrthoTexas can help. Our team provides comprehensive evaluation, advanced imaging and personalized treatment plans to restore shoulder function and mobility.