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A Guide to Proximal Humerus Shoulder Fractures

If you experience a significant fall or other shoulder trauma any part of your humerus is susceptible to injury

proximal humerus fracture

Your shoulder joints are some of the most important and most-used joints in your body, so it’s only natural that any injury or problem with the joints should be taken particularly seriously.

One of the most common injuries shoulder injuries is a proximal humerus at the top of the bone, which may be accompanied by a partial or complete bicep tear.

Humerus fractures are typically the result of an acute traumatic injury like a fall or collision.

Surgical treatment may be required depending on the location or type of fracture, but more mild cases may respond to nonsurgical treatment as well.

Either way, physiotherapy, rest, and anti-inflammatories are generally considered standard practice no matter what the severity of your humerus fracture or bicep tear.

What is a proximal humerus fracture?

The proximal humerus is one of the most commonly broken bones in the shoulder.

The humerus bone itself is one of the long bones in the upper arm; the bottom part is called the distal humerus and it’s part of the elbow joint, while the top end is referred to as the distal humerus and it’s a major component of the shoulder joint.

If you experience a traumatic event like a significant fall, a car accident, or other injury to the shoulder, any part of your humerus is especially susceptible to injury, especially if other associated bones like your scapula, shoulder blade or clavicle are affected.

While all of these injuries can be serious, it’s important to understand that humerus fractures are especially important to monitor due to the location of the bone and its proximity to the rotator cuff, the brachial plexus or the web of nerves extending from your neck to support your arm, and other essential tissues within your shoulder joint capsule.

Fractures of this particular shoulder joint often occur during a traumatic injury, e.g. a fall where you land directly on your shoulder, a forceful collision while you’re playing a sport, or a car accident.

The type of fracture and it’s severity depend on the position of the arm and the rest of your body during the accident, along with other risk factors like age, osteoporosis, or brittle bones.

proximal humerus

What causes proximal humerus fractures?

There are several key risk factors for these types of shoulder injuries, but the most significant one is age.

Proximal humerus fractures often happen to elderly individuals due to osteoporosis and weakened bones; in fact, the proximal humerus bone in the shoulder is the third most frequently broken bone (after hip fractures and wrist fractures) in patients over 65 years old.

The combination of age, potential osteoporosis or weakened bones, and significant trauma or accidents can all result in a proximal humerus fracture.

Why are bicep tears associated with a proximal humerus fracture?

One of the injuries that is most commonly associated with a proximal shoulder fracture is a completely or partially torn bicep.

A bicep tear or rupture occurs when one of the tendons connecting the bicep to the humerus bone becomes frayed or damaged, and eventually ends up tearing.

Torn biceps usually happen either as a result of constant and consistent overuse (which is unlikely to result in a humerus fracture) or a serious and traumatic injury.

The latter being the most common cause when a bicep tear happens at the same time as a proximal humerus fracture.

humerus fracture

Complete bicep tears vs partial bicep tears

There are two types of bicep tears.

Proximal biceps tears occur when one of the two tendons that connects the biceps muscle to the shoulder – either the “long head” tendon that attaches the bicep to the top of the scapula or the “short head” that attaches the biceps muscle to the front of the shoulder socket is fully or partially torn (note that most biceps tendon tears occur in the long head tendon).

If you experience a tear in the long head tendon or a nondisplaced humerus fracture, there’s a decent likelihood that the short head tendon will help you to continue using your biceps muscle without surgical intervention.

However, if you’re also dealing with a shoulder fracture due to acute injury, there’s a greater likelihood that you’ll need surgery.

A distal biceps tendon tear happens to the single tendon – the “distal tendon” that connects the biceps to the elbow; these types of tears are rare and typically are caused by an injury or trying to lift an overly heavy object.

Distal biceps tendon tears tend to be complete tears where the muscle is fully separated from the bone, and may be accompanied by a humerus fracture in the case of acute injury.

humerus bone

What are the signs and symptoms of a humerus fracture?

If you experience a sudden, severe pain in the upper region of your arm or shoulder, or near the elbow, then you may have torn your bicep tendon and you may or may not hear or feel a popping sensation when you tear a tendon.

You may also experience sharp pain in your shoulder or elbow and a feeling of weakness at those joints.

proximal fracture

Other symptoms of a torn bicep or shoulder fracture include bruising on your upper arm or forearm.

There may also be a “Popeye” appearance to your bicep, or a shift in the shape or contour of the bicep muscle at the front of your arm.

You may also have problems turning rotating your arm into different positions – things like moving your arm up from a palm down to a palm up position may be difficult.

How are proximal humerus fractures and biceps tears diagnosed?

If you’ve recently experienced an injury to your shoulder and are experiencing symptoms like significant pain, immediate swelling and bruising, numbness, tingling, and restricted movement of the shoulder joint, or an unusual change in the muscle contour of your upper arm (the “Popeye” muscle), then you may have recently fractured your proximal humerus, torn your bicep, or both.

The next step should be heading to your doctor or orthopaedic surgeon for a thorough exam and imaging in order to diagnose your injury and create a treatment plan. X-rays, magnetic resonance images (MRIs) and computed tomography (CT) scans may be required.

There are two types of proximal humerus fractures, displaced and non-displaced.

In a nondisplaced fracture, the bones at the site of the fracture are separated but haven’t moved out of their normal positions, which means this type of shoulder might not require surgical intervention.

On the other hand, in a displaced proximal humerus fracture the bones at the site of the fracture have separated and moved out of position, and it generally does require surgery.

Approximately 85% of proximal humerus fractures are nondisplaced, and while the nonsurgical treatments for both types are fairly similar, whether or not surgery is recommended depends upon the age and activity level of the individual, as well as their hand dominance (it’s generally considered more important to fix or improve range of motion and strength on the dominant arm), and the degree of displacement.

biceps tendon tear

What are some similar shoulder issues or injuries?

Scapula or shoulder blade injuries as well as clavicle or collarbone injuries often occur in conjunction with proximal humerus fractures.

If you have suffered from a traumatic injury that resulted in a proximal humerus fracture or a bicep tear (or both), then you may have additional injuries to these areas.

Nonsurgical treatment for proximal humerus fractures

For minor fractures and biceps tears, nonsurgical treatment may be possible, especially for more elderly patients.

Physiotherapy, icing and heat treatment, and anti-inflammatory medications may all be advised, even if surgery is required.

Either way, if you’ve experienced a traumatic injury to your shoulder that includes a proximal humerus fracture, you should work with your orthopaedic surgeon to determine a physiotherapy plan to help you heal and avoid losing any further strength or range of motion in your shoulder, and prevent you from developing altered patterns of movement caused by the pain and limitations of your injury.

The physiotherapy process after a proximal humerus fracture is essentially similar whether or not surgery is required.

Range of motion exercises, strengthening exercises, manual therapy (where the therapist gently moves your shoulder joint and the surrounding muscles in order to work on the range of motion, strength, and flexibility), and functional training (meant to improve movement quality and help you avoid improper movement patterns you may have developed due to the limitations of your injuries.

Surgical treatment for humerus fractures

If you’ve experienced a major traumatic injury to your shoulder like a proximal humerus fracture, then you may be a candidate for shoulder surgery.

This generally involves re-aligning and repairing the fractured bones using metal screws, rods, wires, large sutures, or plates (or some combination of the above).

Even if surgery takes care of most of your issues with your shoulder joint, you will likely be required to participate in physiotherapy and other follow-up treatments meant to help you regain flexibility and strength in your damaged shoulder after you’ve suffered a proximal humerus fracture.

torn bicep tendon

Recovery from proximal humerus fractures and bicep tears

The post-operative process for recovering from these types of shoulder surgeries and treatments doesn’t vary much – physiotherapy, anti-inflammatory medications, and rest are the standard.

If you’ve had surgery for a proximal humerus fracture or a bicep tear, you will probably also leave the hospital with a sling for your affected arm.

If you think you’ve fractured a bone or torn a muscle or tendon in your shoulder joint, then you should consult with your orthopaedic surgeon as soon as possible to determine the best course of treatment.

Preventing proximal humerus fractures

While injuries are not always preventable, older individuals with balance problems will benefit from removing any falling hazards or other risky objects from their home (things like loose rugs or slippery flooring can be problematic) and adding handrails is helpful.

Slippers or house shoes with grippy rubber soles are also a good idea. Adding calcium and vitamin D to maximize healthy bone composition is helpful as well.

For athletes, using the recommended protective equipment is always recommended as well as seeking medical help immediately after a shoulder injury even if it doesn’t initially seem that problematic.

One of the biggest problems with proximal humerus fractures is that the result of the treatment is not always desirable, in the sense that the patient may not regain full mobility or strength even with proper treatment.

This is why it is particularly important to work with your orthopaedic surgeon immediately following a shoulder injury of any kind in order to achieve the best possible outcome.

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