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Upper Arm Fractures

(Proximal Humeral Fractures; Shoulder Fractures)

By Danielle Campagne, MD, Assistant Clinical Professor, Department of Emergency Medicine, University of San Francisco - Fresno

Upper arm fractures occur at the upper end of the upper arm bone (humerus), affecting the shoulder joint.

  • Upper arm fractures usually result from a fall on an outstretched arm.

  • Usually, the broken pieces of bone remain in place or close together and thus tend to heal on their own.

  • These fracture cause pain and swelling in the shoulder and upper arm and limit movement of the arm.

  • Doctors diagnose upper arm fractures based on x-rays and sometimes computed tomography.

  • Usually, only a sling, sometimes with a swathe, is required, but sometimes surgery is needed to realign the broken bones or to replace the joint.

Upper arm fractures usually result from a fall on an outstretched arm. Sometimes they result from a direct blow. Usually, the broken pieces of bone do not move out of place or move only slightly out of place and thus tend to heal on their own.

Upper arm fractures are common among older people.

Fracturing the Upper Arm

Fractures that occur in the upper part of the upper arm bone (humerus) cause pain in the shoulder because the upper arm bone is part of the shoulder joint. The upper arm bone may fracture in different places. One example is shown below.

Symptoms

The shoulder and upper arm are painful and swollen. People cannot easily raise their arm.

Occasionally, a nerve is damaged, causing numbness in the upper arm.

Diagnosis

  • A doctor's evaluation

  • X-rays

  • Sometimes computed tomography

If people think they may have fractured their upper arm, they should see a doctor as soon as possible.

Doctors ask people to describe what happened and what their symptoms are. Doctors also examine the elbow and collarbone (see Overview of Fractures : Diagnosis).

Doctors take x-rays of the shoulder joint from different angles to determine whether it is fractured.

Sometimes, if x-rays are unclear, computed tomography (CT) is done. CT combines x-rays with computer technology to produce a more detailed, three-dimensional image of the injured area.

Treatment

  • Usually a sling

  • Range-of-motion exercises

  • Sometimes surgery to realign the broken bones or to replace the joint

Most upper arm fractures are treated with a sling, sometimes held in place by a piece of cloth or strap (called a swathe—see Figure: Commonly Used Techniques for Immobilizing a Joint).

Exercises to move the shoulder joint through its full range of motion, such as Codman exercises, are started as soon as possible because this joint is prone to becoming permanently stiff, especially in older people.

Codman Exercises

To start, people should

  • Bend at the waist and let the affected arm hang down perpendicular to the floor

  • Relax the arm and shoulder

  • Bend the knees slightly

Then they should

  • Slowly swing the arm from side to side, from back to front, and in circles clockwise and counterclockwise

  • Shift body weight from foot to foot in the same direction that the arm swing

  • Gradually increase the range of the movements as can be tolerated

These exercises should cause only minimal pain. People should do each exercise twice and do them several times a day. These exercises are done even if the arm is in a sling or in a sling and swathe (as it usually is). Moving the bones in the shoulder joint helps prevent the joint from becoming stiff.

Did You Know...

  • Range of motion exercises should be started soon after the upper arm is fractured, even if it is in a sling.

If bone is broken into several pieces, people are referred to an orthopedic surgeon, who aligns the broken pieces and inserts metal plates, screws, and wires to hold the bone together (called open reduction with internal fixation, or ORIF).

Sometimes the shoulder joint must be replaced.

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