Broken shoulders

If the shoulder came out of joint rather than broke, that has its own page: shoulder dislocation and instability.

Breaks at the top of the arm bone

A fall onto an outstretched hand, or onto the shoulder itself, can break the upper end of the arm bone. This is one of the more common fractures in older adults, and it is also one where doing less is often the right answer.

Many of these breaks heal in a sling, without an operation. What decides it is how far the pieces have moved apart, how many pieces there are, the quality of the bone, and what you need the arm to do. Breaks in several pieces, or ones where the blood supply to the ball is at risk, are the ones that more often need fixing — or, in an older patient, a reverse replacement, which can be the more reliable answer than trying to rebuild a badly broken ball.

A reverse replacement done for a break

From a peer-reviewed publication on which Dr. Routman is a listed author.

Early movement matters in either case. A shoulder that is protected too long gets stiff, and stiffness is its own problem to solve afterward.

How it is sorted out

X-rays first. A CT scan shows the shape of the broken pieces. Whether that is needed depends on what the examination and the first X-ray suggest.

Common questions

Does a broken shoulder always need surgery?

No. Many breaks at the top of the arm bone heal in a sling without an operation. Whether surgery is needed depends on how far the pieces have moved, how many there are, the quality of the bone, and what you need the arm to do.

Why would a broken shoulder be replaced rather than fixed?

When the ball is broken into several pieces, or its blood supply is at risk, trying to rebuild it may not hold. In some patients, particularly older ones, a reverse shoulder replacement is the more reliable answer.