Proximal Humerus and Glenoid Fractures
Fractures near the shoulder joint can involve the upper arm bone (humerus) or the shoulder socket (glenoid). Below is detailed guidance on both types of fractures, including causes, symptoms, diagnosis, treatment, and recovery.
Proximal Humerus Fractures
What Is a Proximal Humerus Fracture?
A proximal humerus fracture is a break in the upper portion of the humerus (upper arm bone), just below the shoulder joint. This area includes the ball of the shoulder joint and the attachment sites for the rotator cuff muscles that help lift and rotate the arm.
Proximal humerus fractures are among the most common shoulder fractures. They may occur after a fall onto an outstretched arm or directly onto the shoulder. In younger patients, these fractures are usually the result of high-energy injuries such as sports injuries or motor vehicle accidents. In older adults, especially those with osteoporosis, they often occur after a simple fall from standing height.
Causes and Risk Factors
Common causes include:
- Falls, particularly in older adults
- Sports injuries, including skiing, cycling, football, hockey, and contact sports
- Motor vehicle or motorcycle accidents
- Direct trauma to the shoulder
Risk factors include:
- Osteoporosis or weakened bone
- Increasing age
- Balance problems or frequent falls
- Participation in contact or high-impact sports
Symptoms
A proximal humerus fracture may cause:
- Immediate pain around the shoulder
- Swelling and bruising that may spread into the upper arm or chest
- Difficulty or inability to lift the arm
- Tenderness to touch
- A feeling that the shoulder is unstable
- Occasionally numbness or tingling if nearby nerves are affected
Diagnosis
Your orthopedic specialist will perform a thorough examination and review how the injury occurred.
Imaging studies may include:
- X-rays to determine the location and severity of the fracture
- CT scan for more complex fractures to better understand the fracture pattern and assist with surgical planning
- MRI in selected cases if there is concern for associated rotator cuff or soft tissue injuries
Non-Surgical Treatment
Many proximal humerus fractures heal well without surgery, especially when the broken bones remain well aligned.
Treatment may include:
- Sling immobilization for comfort
- Ice and pain medication
- Early gentle range-of-motion exercises
- Physical therapy to gradually restore motion and strength
Most patients begin supervised rehabilitation within the first few weeks after injury.
Surgical Treatment
Surgery may be recommended when:
- The fracture pieces are significantly displaced
- The fracture involves multiple parts of the bone
- The fracture extends into the shoulder joint
- The blood supply to the humeral head is at risk
- The injury is unlikely to heal in a good position without surgery
Surgical options include:
Open Reduction and Internal Fixation (ORIF)
The fractured bone is repositioned into its normal alignment and stabilized with plates, screws, or pins. This allows the bone to heal while maintaining proper alignment.
Intramedullary Nail Fixation
In selected fracture patterns, a rod placed inside the humerus may be used to stabilize the fracture through smaller incisions.
Shoulder Replacement Surgery
In severe fractures, particularly in older adults with poor bone quality or fractures that cannot be reconstructed, shoulder replacement may provide the best outcome.
Types include:
- Hemiarthroplasty (replacement of the ball portion of the shoulder)
- Reverse total shoulder replacement, which is commonly used for complex fractures in older adults and often provides the most reliable pain relief and functional recovery
Recovery
Recovery depends on the severity of the fracture and the treatment performed.
Typical recovery includes:
- Sling for approximately 2-4 weeks
- Physical therapy beginning with gentle motion exercises
- Most fractures heal within 8-12 weeks
- Strength and function continue improving for 6-12 months
After Surgery
- Sling for approximately 4-6 weeks
- Guided physical therapy beginning soon after surgery
- Gradual strengthening over several months
- Full recovery commonly takes 6-12 months
Most patients can return to normal daily activities, although recovery of strength and motion varies depending on the severity of the injury.
Glenoid (Shoulder Socket) Fractures
What Is a Glenoid Fracture?
The glenoid is the shallow socket portion of the shoulder blade (scapula) that forms the shoulder joint with the ball of the upper arm bone. A glenoid fracture is a break involving this socket or the surrounding portion of the shoulder blade.
These injuries are much less common than proximal humerus fractures and usually occur after significant trauma.
Causes
Glenoid fractures are commonly caused by:
- High-speed motor vehicle accidents
- Motorcycle accidents
- Falls from significant heights
- Contact sports
- Shoulder dislocations with associated bone injury
Symptoms
Patients with a glenoid fracture may experience:
- Severe shoulder pain
- Swelling and bruising
- Inability to move the shoulder comfortably
- Pain with any attempted arm movement
- A sensation that the shoulder is unstable or “slips”
- Occasionally numbness or tingling if nearby nerves are injured
Diagnosis
Evaluation includes:
- Physical examination
- Standard shoulder X-rays
- CT scan, which is often essential for defining the fracture and planning treatment
- MRI when additional soft tissue injuries are suspected
Non-Surgical Treatment
Small fractures that remain well aligned and do not make the shoulder unstable may be treated without surgery.
Treatment includes:
- Sling immobilization
- Pain control
- Gradual physical therapy
- Follow-up imaging to ensure the fracture heals properly
Surgical Treatment
Surgery may be recommended when:
- The joint surface is significantly displaced
- A large portion of the socket is fractured
- The shoulder is unstable
- The fracture prevents normal shoulder alignment
Surgical treatment usually involves:
Open Reduction and Internal Fixation (ORIF)
The fractured pieces are carefully repositioned and secured using specialized plates and screws to restore the normal shape of the shoulder socket.
In rare situations involving severe arthritis or fractures that cannot be reconstructed, shoulder replacement surgery may also be considered.
Recovery
Recovery following a glenoid fracture depends on the severity of the injury and whether surgery is required.
- Sling for several weeks
- Gradual physical therapy
- Bone healing typically occurs within 8-12 weeks
- Return to most activities over 3-6 months
After Surgery
- Sling for approximately 4-6 weeks
- Early guided motion exercises
- Progressive strengthening beginning after fracture healing
- Most patients recover over 6-12 months
Athletes and individuals performing heavy labor may require additional rehabilitation before safely returning to sports or physically demanding work.
When Should You See an Orthopedic Specialist?
Seek prompt medical evaluation if you experience:
- Severe shoulder pain after a fall or injury
- Inability to lift or move your arm
- Significant swelling or bruising around the shoulder
- A visible deformity
- Numbness, tingling, or weakness in the arm or hand
Early diagnosis and treatment by an orthopedic specialist can improve healing, reduce complications, and help restore shoulder function.
Why Choose Midwest Orthopedic and Musculoskeletal Alliance?
At Midwest Orthopedic and Musculoskeletal Alliance, our fellowship-trained shoulder and trauma specialists provide comprehensive care for simple and complex shoulder fractures. We offer advanced imaging, state-of-the-art surgical techniques, individualized rehabilitation programs, and coordinated follow-up care to help every patient return safely to work, sports, and the activities they enjoy.
Schedule Your Shoulder Fracture Consultation
If you have experienced a shoulder fracture or significant shoulder injury, contact Midwest Orthopedic and Musculoskeletal Alliance today at 414-384-6700. Our team in Southeastern Wisconsin is here to help.