Your proximal humerus forms the ball of your shoulder’s 'ball and socket'. It also serves as the attachment area for your rotator cuff tendons and tendons of other muscles in your shoulder girdle.
Fractures to your proximal humerus may follow a shoulder dislocation or a fall onto your shoulder or arm. They become more common as we get older as our bones become weaker.
When the proximal humerus breaks, the attached rotator cuff tendons often pull the fracture fragments in different directions to cause displacement.
A broken proximal humerus is generally very painful; patients develop significant bruising and swelling that can go into the chest as well as down the arm.
Sometimes nerves are damaged at the same time and this can cause numbness and weakness in the arm and shoulder region.
Your history and examination findings will be highly suggestive. X-rays taken in the Emergency department will confirm the fracture. Sometimes a CT scan is performed to assess more closely the displacement of the fracture fragments, damage to the articular surface and potential for surgical reconstruction.
Most proximal humerus fractures do not require surgery. For many fracture patterns, the outcome of non-operative management is equivalent to the surgical outcome at two years after injury. Unfortunately, however your injury is treated, proximal humerus fractures take a long time to get over (a year or so) – surgical fixation does not necessarily shorten this period.
Some fractures will however benefit from surgery. Factors that influence the decision to offer surgery include:
Your fracture pattern – (how many parts is it in? how displaced is it? where in the bone is the fracture?)
- Fractures can be described as 2,3 or 4-part depending on the position of the two tuberosities, the humeral head and the shaft.
- In general, the more parts, the worse the injury, but some 2 part fractures also require surgery.
The quality of your bone and your rotator cuff (often age-related)
Your functional expectations (work/hobbies/sports etc) and physical health
Your surgeon will tell you if he thinks you should consider surgery and, if so, what is involved.
What will happen if I don’t have surgery?
You will be given a collar and cuff sling and advised to rest your shoulder. We will give you strong painkillers as your shoulder will be sore for some time. You be able to go home and be seen as an outpatient, typically at a week or two after injury. Repeat x-rays will check your position – sometimes a decision is made at this point to operate. Your worst pain should begin to settle after three weeks, but these first weeks are often very uncomfortable.
At six weeks, you can begin to move your shoulder more and you will be referred to physiotherapy. From three months, you can begin gentle resistance training if your x-rays show healing.
Mr Granville-Chapman was very polite and his examination and explanation of my symptoms and expected treatment was thorough
I found Mr Granville-Chapman to be very knowledgeable and professional. He put me very much at ease and explained all the options that I have thoroughly. He also told me to look for further information on the condition and procedures that I needed on his website, which gave lots of information and detail. It was also easy to understand for those without a medical background. I would highly recommend his services to anyone that has shoulder problems and requires a solution.
I attended for a repair of my right bicep tendon. After a thorough examination, Mr Granville-Chapman arranged an operation to be undertaken within 2 days which was extremely quick; he explained his reasoning which was both thorough and reassuring, explaining both the options of undergoing surgery and deciding to undertake conservative management.On the day of the surgery Mr Granville-Chapman was again very reassuring as although this is minor surgery I was still somewhat apprehensive. He came to fully explain the procedure and afterI woke up was quick to check on how I was doing.Overall I am very happy with the careMr Granville-Chapman
I have been very pleased with my treatment so far. Mr Granville-Chapman combines brisk efficiency with a pleasant, sympathetic manner. My operation, however, is still to come ...
From the initial consultation, through surgery on a fractured wrist, and now post-operative follow up, it has been a very positive and reassuring experience with Mr Granville-Chapman. I would have no hesitation in recommending him to someone else.
A first class clinician. A skilled surgeon with an excellent bedside manner.
A very pleasant Consultant who knows exactly how to make pain go away.
Mr Granville - Chapman has an excellent bedside manner. He engaged with my 12 year old son at an appropriate level and took the time to ensure that he understood the procedure and answer all his questions. He is thoroughly professional and I would not hesitate to recommend him.
I have been very pleased with the attention I have received. Mr. Granville-Chapman has reassured me that my symptoms are normal. It is very easy to make appointments that suit me.
Mr Granville chapman I found be caring informative and professional I would recommend him to all if you have a problem don't hesitate to contact him you won't be disappointed.
I recently broke my right clavicle in a mountain bike accident and it was repaired by Mr Granville-Chapman by adding a plate on top of the bone. Having just finished the last post-op consultation, I can confirm that I have been very happy with the process all along. In particular, Jeremy took time to explain in detail why a plate was needed, what the procedure would entail, and also was very patient answering my questions comprehensively beforehand and after during the recovery phase. Would certainly trust this competent surgeon to fix any future fractures I might sustain.
Mr Granville-Chapman has looked after my 15 year old son brilliantly, explaining the surgery, recovery and best way forward, and Kate has been very supportive helping with logistics etc, thank you so much.
So far my experience with Mr Jeremy Granville-Chapman has been personal and informative with regard to the operation I will be having. I feel confident that my operation will be a success and for this reason I am very happy to have Mr Jeremy Granville-Chapman as my consultant.
Very knowledgeable and helpful. Takes the time to make sure you're getting the treatment you need.
Mr Jeremy Granville -Chapman is not only a highly skilled consultant but is able to put you straight away at ease .My appointments were arranged very swiftly which was great, when you are experiencing severe pain. I am very happy with my treatment so far . many thanks to everyone who was involved in my treatment.
Polite, helpful, professional. Makes an effort to ensure full understanding of issues and procedures to be done. Highly satisfied
Very pleasant. Clear, careful explanations & options/possibilities. I feel well informed, and happy that my concerns are being well addressed, with a plan of review of the symptoms.
Excellent advise with everything explained clearly and a successful treatment which has benefited be greatly.
BMI The Princess Margaret Hospital
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