Shoulder Dislocation with Fracture (Shoulder Dislocation with Broken Bone)

What Is It?

Your shoulder helps you move your arm in many ways. It is made of your upper arm bone (humerus) and your shoulder blade (scapula). The humerus connects to the scapula at a spot called the glenoid. Your shoulder has many muscles around it, like the rotator cuff and deltoid. There are also arteries and nerves that help your arm work.

Figure 1: X-ray of a normal shoulder. The shoulder joint is between the part of the scapula or shoulder blade (blue line) and the proximal humerus (green line).

Figure 2: Skeleton model showing the proximal humerus and other bones of the shoulder.

How It Happens

Because the shoulder can move a lot, it can easily come out of place. This is called dislocation. It can happen when your arm twists, gets pulled, or from a fall or hit. When your shoulder comes out of place, the tissues around it can tear. Sometimes, the humerus or glenoid can break. The most common breaks happen in the humerus or glenoid.

The red arrows denote the most common fractured areas with a dislocation. — Figure 3: The red arrows show the most common parts that might break when you have a dislocation.

First Steps

When your shoulder comes out of place (dislocation), it can hurt and be hard to move. It might feel weak or numb. A doctor will put your shoulder back in place. This is usually done in a hospital with medicines to help with pain. Afterward, they will take an x-ray to check for broken bones. You will be given a sling to hold your arm still and told not to lift anything until you see a bone doctor.

A dislocated shoulder and then put back into place. — Figure 4: A shoulder that was dislocated (left), and then put back into place, or reduced (right). The arrows point to a break in the greater tuberosity of the bone. The greater tuberosity is where the rotator cuff muscles attach. The humeral head moves against the glenoid (part of the shoulder blade) to make up the shoulder joint.

Treatment

Most times, a dislocated shoulder can be treated with a sling. You will work with a therapist to help your shoulder move again and get stronger. Your bone doctor will tell you when you can stop using the sling and use your arm again. If your shoulder also broke when it dislocated, you might need surgery. The type of surgery depends on your injury. It might be done with small cuts or a larger cut with plates, screws, and stitches.

This fracture of the greater tuberosity displaced on a follow-up x-ray. — Figure 5: This fracture of the greater tuberosity moved (middle x-ray) after the first x-ray. Surgery was recommended to put the fractured part back in place to hold it while it healed.

Recovery

If you have surgery, you will need to wear a sling for a while. You will also need to avoid lifting heavy things. A therapist will help you move your shoulder more and get stronger over time. As your bone and tissues heal, moving your shoulder and arm will get easier. It's important to follow your surgeon's instructions about therapy.

Long Term

After a shoulder dislocation, you might have stiffness, weakness, or some pain. Some people feel numb on the outside of their shoulder, which could be permanent. You may not be able to move your shoulder like before. If you have surgery, there can be rare problems like infection or lack of healing, which might need more surgery. If your shoulder came out of place but had no other injuries, it might take four to six weeks to get better. If you have other injuries, it could take much longer to recover, even up to six months. Sometimes, a shoulder can come out of place again. If this happens, your surgeon will talk about your options.

Physical Therapy Videos - Shoulder

More Information

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Sara Putnam, MD
Edited by the OTA Patient Education Committee
X-rays and images from the personal collection of Dr. Putnam and Chris Domes, MD