Shoulder Fractures and Dislocations

A clavicle, or collarbone, fracture is a common fracture seen in children and adults alike. Located 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.

Clavicle fractures can occur in babies as they pass through the birth canal, children who fall onto their shoulder or outstretched arms, or athletes subjected to a forceful blow or fall at the outside of the shoulder. They can also occur during random accidents involving force to the outside of the shoulder.

Some of the symptoms associated with a clavicle fracture include pain, swelling, difficulty moving the arm and possibly bruising around the affected area.

Treatment
Rarely is surgery required to treat a fractured clavicle, particularly if the fracture is simple, or closed, and there is no indication of displacement (malalignment). Conservative treatment generally entails a period of rest, anti-inflammatory medication to help reduce pain and swelling, as well as a sling or clavicle strap to provide immobilization while the bone heals. A “figure-of-8” splint is a popular splint in treating clavicle fractures. This type of splint wraps around the shoulders to keep them straight and back – a position of perfect posture.

These types of fractures generally heal within two months, without complication.

While the broad range of motion the shoulder can attain makes it one of the most versatile joints in our body, it also makes it one of the most vulnerable to dislocation. And despite the stabilizing components including the cartilaginous glenoid labrum and muscles of the rotator cuff, the shoulder dislocates more than any other joint.

When a shoulder only partially dislocates, it is called a subluxation. The head of the upper arm bone, or humerus, is partially out of the socket, or glenoid. This can feel as unstable as a dislocated shoulder, reducing range of motion and prompting pain.

When the humerus completely slips out of the socket, it is called a complete dislocation. Both a partial and complete dislocation can cause muscles to spasm, increasing pain. While the shoulder can dislocate in a variety of directions – forward, backward or downward, nearly 95 percent of the dislocations seen are forward, or anterior, dislocations.

When a shoulder frequently dislocates, it is called shoulder instability.

Treatment
Following patient history and a physical examination assessment, a closed reduction (realign the bone without open incision) may be performed in order to place the ball of the humerus back into the joint socket. This will immediately relieve pain.

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

Patients who experience chronic, or repeated, dislocations despite conservative treatment may require surgery to repair weakened ligaments in the shoulder joint.