Upper Arm and Shoulder Fractures

Distal Humerus Fracture (Upper Arm)

Less common than other upper extremity fractures, distal humerus fractures generally occur when the back of the upper arm receives a direct blow while the elbow is in a flexed position, or when an individual experiences a severe fall. It can also result from a high impact trauma such as an automobile or motorcycle accident.

The humerus is the long arm bone located between the elbow and the shoulder. At the distal end of the humerus, near the elbow, there are two projections called condyles. These are the areas of attachment for the muscles that facilitate forearm movement. The medial epicondyle is the site associated with medial epicondylitis or Golfer’s Elbow. The lateral epicondyle is the site associated with lateral epicondylitis or Tennis Elbow.

Distal humerus fractures often affect both condyles and extend into the elbow joint - as a result soft tissue in the area may also sustain damage, including nerves, tendons, ligaments and blood vessels.

Those suffering from a distal humerus fracture may experience pain, swelling and restricted movement. There may also be skin discoloration if a blood vessel has ruptured, as well as a slight deformity if bone fragments have separated and affected normal arm contour.

Treatment
While uncommon, distal humerus fractures are among the most challenging fractures to treat.

Following a thorough examination and patient history assessment, a treatment plan is established based on the severity and type of the fracture. If the fracture is nondisplaced splinting is indicated for approximately 10 days, combined with anti-inflammatory medication to reduce pain and swelling.

More severe fractures require surgery and internal fixation, followed by a rehabilitative program that includes range of motion exercises.

Shoulder Dislocation

The shoulder dislocates more than any other joint, despite the stabilizing cartilaginous and muscular components that comprise it. Its broad range of motion and involvement in both day to day activities and sports make particularly vulnerable to dislocation.

A partial dislocation is called a subluxation and occurs when the head of the upper arm bone, or humerus, is partially out of the socket, or glenoid. When this happens, there is a feeling of instability in the shoulder, reduced range of motion and pain.

When the humerus slips completely out of the socket, it is referred to as a complete dislocation. Both a partial and complete dislocation can cause muscles to spasm, increasing pain. The shoulder can dislocate in forward, backward or downward positions, though most frequently present as forward or anterior dislocations. Shoulders experiencing recurring dislocations are diagnosed as shoulder instability cases.

Treatment
A thorough physical examination and patient history assessment is part of every diagnosis. Treatment is determined based on the severity of the dislocation and may consist of a closed reduction, which places the ball of the humerus back into the joint socket from the outside of the skin. Pain is immediately relieved when the humerus is placed back into its socket.

A sling or other stabilizing device may also be indicated - accompanied by rest and cold compression to reduce swelling. A rehabilitation exercise program, begins once swelling subsides, in order to improve range of motion.

Those patients diagnosed with shoulder instability may require surgery to repair weakened ligaments in the shoulder joint and prevent degenerative conditions...

Clavicular Fracture

Clavicular fractures are common among athletes and generally occur when there is a forceful blow or fall impacting the outside of the shoulder. These types of fractures can also occur in babies passing through the birth canal, in children who fall onto their shoulder or on outstretched arms and in victims of accidents involving a strong force on the shoulder.

Also known as the collarbone, the clavicle is a common fracture site. Located just over the top of the chest, between the breastbone (sternum) and the shoulder blade (scapula), it rests just beneath the skin and is easy to see and feel.

Those suffering from a clavicular fracture experience pain, swelling, difficulty moving the arm and bruising around the affected area.

Treatment
The treatment option depends on the patient and type of activities in which they are involved. While surgical repair is not necessary to treat the fractured clavicle of the non athlete, particularly if the fracture is simple, or closed, and there is no indication of displacement (malalignment), surgical repair may be indicated for an athlete planning to resume his or her sport.

Conservative treatment generally entails a period of rest, anti-inflammatory medication to help reduce pain and swelling and a sling or clavicle strap to provide immobilization while the bone heals. Surgical repair may entail internal fixation. These types of fractures generally heal within two months.