A broken shoulder is a fracture in one of the three bones composing the shoulder joint: the clavicle (collarbone), the scapula (shoulder blade), or the proximal humerus (upper arm bone). Recovery requires precise diagnosis, appropriate initial management, and adherence to a phased rehabilitation program guided by a medical professional. The fracture’s severity and location determine if treatment will be non-surgical or require an operation to restore alignment.
Initial Diagnosis and Fracture Classification
Determining the proper path for healing begins with classifying the injury’s severity and location. While “broken shoulder” often refers to a proximal humerus fracture, clavicle fractures are also common, and scapula fractures are relatively rare. Identifying the exact location is crucial because prognosis and treatment vary significantly among these structures.
Diagnostic imaging, typically X-rays, visualizes the bony architecture and the fracture pattern. A Computed Tomography (CT) scan may also be used to gather more detailed information, especially for complex fractures involving the joint surface. Classification hinges on whether the fracture is non-displaced or displaced, which dictates the subsequent treatment strategy. A non-displaced fracture is stable, meaning the fragments remain in their correct anatomical position. Conversely, a displaced fracture is unstable, with bone pieces separated or significantly misaligned, which often prevents proper healing without intervention.
Non-Surgical Treatment Pathways
The conservative approach is preferred for stable, non-displaced, or minimally displaced fractures, allowing the body’s natural healing mechanisms to bridge the break. The initial and most immediate requirement is immobilization using a sling or specialized shoulder immobilizer to prevent movement at the fracture site and promote bone union. This device is worn continuously for a period that can range from two to six weeks, depending on the fracture’s location and stability.
During this acute phase, pain management is addressed through a combination of methods, including over-the-counter pain relievers or prescription medication for more severe discomfort. Non-steroidal anti-inflammatory drugs (NSAIDs) may be used, though some medical professionals advise caution, as these medications can potentially interfere with the early stages of bone healing. Applying cold therapy, such as ice packs for 15 to 20 minutes several times a day, helps manage swelling and acute pain. Patients must monitor for potential complications during immobilization, such as skin irritation from the sling or signs of nerve issues, which can present as numbness or tingling in the arm or hand. Even during the immobilization period, hand, wrist, and elbow exercises are often encouraged multiple times daily to maintain mobility in the joints not affected by the fracture and to prevent stiffness.
Surgical Intervention and Immediate Post-Op Care
Surgery is necessary when the fracture is severely displaced, involves multiple fragments, or significantly disrupts the joint surface, as these breaks require mechanical support to heal correctly. For complex breaks, surgeons perform Open Reduction and Internal Fixation (ORIF), realigning the fragments and securing them with specialized plates, screws, or wires. In cases of severe trauma to the humeral head, especially in older patients, a shoulder joint replacement (hemiarthroplasty or reverse total shoulder arthroplasty) may be required.
The immediate post-operative period focuses on managing the surgical site and controlling pain. A nerve block offers temporary pain relief, but patients must be prepared for pain levels to increase once the block wears off, typically within 24 to 36 hours. Pain medication is often prescribed, sometimes with a staggered schedule, to maintain consistent relief while minimizing narcotic use. Wound care is required to prevent infection; the surgical dressing must be kept dry and intact until the first post-operative appointment. Strict immobilization in a specialized sling is maintained for a designated period, often four to six weeks, to protect the surgical repair. During this phase, patients must avoid active elevation or muscle contraction of the affected arm, which could stress the newly fixed bone fragments.
Comprehensive Rehabilitation and Recovery Timeline
Restoring full function after a broken shoulder relies on a structured physical therapy program, regardless of the initial treatment. The recovery process is divided into distinct phases to protect the bone while gradually regaining mobility and strength. The overall timeline for healing is extensive; while bone union typically takes six to eight weeks, functional recovery often spans three to six months, with maximum strength potentially requiring up to a year.
Passive Range of Motion (PROM)
The first stage of rehabilitation focuses on PROM, which typically begins around four to six weeks post-injury, once the fracture is stable enough. During this stage, the therapist or the patient’s unaffected arm moves the injured arm without the shoulder muscles contracting. This gentle movement is essential to prevent the joint from becoming stiff. Gentle movements like pendulum exercises continue to be a staple in this phase to improve circulation and mobility without stressing the fracture site.
Active Range of Motion (AROM)
The intermediate phase, starting around six to twelve weeks, transitions to AROM. The patient begins using their own muscles to move the arm. This phase is crucial for regaining muscle control and independent movement, often involving light resistance exercises to prepare the shoulder for greater loads and daily activities.
Progressive Strengthening
The final phase typically commences after three months, once X-rays confirm sufficient bone healing. This stage introduces resistance training with bands, light weights, and advanced exercises to restore the full power and endurance of the shoulder girdle muscles. Consistent adherence to the prescribed exercises is paramount, as the risk of developing joint stiffness, known as adhesive capsulitis or “frozen shoulder,” is a significant concern following any shoulder fracture. Progression is guided by the patient’s pain level and the orthopedic surgeon’s assessment.