Shoulder & upper-arm fractures

This page covers the three fractures seen most often around the shoulder and upper arm:

• The collarbone (clavicle) — the bone that runs from the base of the neck to the point of the shoulder
• The proximal humerus — the top of the upper arm bone, at the shoulder end, near the ball of the shoulder joint
• The humeral shaft — the long, straight middle portion of the upper arm bone

A helpful starting point is that many fractures in this region — including many clavicle, proximal-humerus, and humeral-shaft fractures — heal well with nonsurgical care. Surgery is not automatic, and a broken bone does not by itself mean an operation is needed.

At the same time, selected fractures do better with surgery. Which path fits depends on where and how the bone is broken, on findings from the examination, and on the person — their health, activity, and goals. The rest of this page walks through what goes into that decision, region by region and then overall.

The collarbone is one of the most commonly broken bones. It usually breaks after a fall onto the shoulder or an outstretched arm, or from a direct blow — often in sports, cycling, or a fall. Pain, swelling, and a bump or deformity over the collarbone are typical.

Most collarbone fractures are treated without surgery, with a period of support (a sling) followed by a gradual return of motion and strength as the bone heals. Surgery is considered in selected situations — for example when the bone ends are substantially out of place or shortened, when the skin over the fracture is at risk, when the fracture is open (through the skin), or when there are other associated injuries. Because there is a distinct set of considerations and a specific operation involved, the collarbone treatment page covers nonsurgical care and surgery (open reduction and internal fixation) in more detail.

A proximal humerus fracture is a break at the top of the upper arm bone, near the shoulder. It is common in older adults — often after a fall from standing, when bone is more fragile — and can also occur in younger people from higher-energy injuries. Pain, swelling, bruising down the arm, and difficulty moving the shoulder are typical.

Many proximal humerus fractures are treated without surgery, particularly when the pieces of bone are in a reasonable position. A period of support is followed by an early, guided return of motion. Some fractures — for instance those where the bone is markedly displaced or broken into several pieces, or where the blood supply to the ball of the shoulder is a concern — may be better treated with surgery to fix the fracture, or in some situations with a shoulder replacement. Which approach fits is an individual decision.

A humeral shaft fracture is a break in the middle portion of the upper arm bone, between the shoulder and the elbow. It can happen from a fall, a direct blow, a twisting injury, or a higher-energy accident. Pain, swelling, and difficulty using the arm are typical.

Many humeral shaft fractures heal well without surgery. Nonsurgical care often uses a functional brace that supports the arm while allowing the bone to align and heal, followed by a gradual return of motion and strength. A nerve that runs close to this bone — the radial nerve — helps power the muscles that lift the wrist and fingers, so part of the assessment is checking that this nerve is working. Surgery is considered for selected fractures, such as certain patterns or positions of the break, some open fractures, particular nerve or blood-vessel findings, or when nonsurgical care is not leading to healing.

These fractures usually follow one of a few patterns: a fall onto the shoulder or an outstretched arm, a direct blow, a sports collision, or a higher-energy injury such as a motor-vehicle crash. In older adults, a fall from standing height is a common cause because bone can be more fragile with age.

Higher-energy injuries are more likely to involve displacement, several fragments, or associated injuries, and they prompt a closer look for other problems. Lower-energy fractures in older adults raise the separate question of bone health over the longer term.

Common symptoms include pain, swelling, bruising, tenderness over the injured bone, difficulty moving the arm or shoulder, and sometimes a visible bump or deformity. The assessment begins with how the injury happened and a physical examination.

Part of that examination, when relevant, is a neurovascular check — confirming that blood is reaching the hand and that the nerves to the arm and hand are working, by checking sensation, movement, and circulation. This matters especially for humeral shaft fractures (because of the nearby radial nerve) and for higher-energy or markedly displaced injuries. Any concern here is taken seriously and can change what happens next.

X-rays are the primary imaging test for these fractures. They usually show where the bone is broken, how the pieces are positioned, and whether more than one bone is involved, and they guide the initial plan.

More detailed imaging, such as a CT scan, is used selectively — for example to understand a complex proximal humerus fracture or to help plan an operation. Not every fracture needs advanced imaging; whether it is done depends on the specific injury and whether the extra detail would change the plan.

There is no single rule that decides surgery. Instead, a number of factors are weighed together for your specific injury:

• The fracture's location and pattern
• How far the bone is displaced and how well the pieces are aligned
• The condition of the skin, and whether the fracture is open (through the skin)
• The neurovascular findings — nerve and blood-supply function
• Any associated injuries
• Your age, general health, bone quality, activity level, functional needs, and goals
• Whether the injured arm is your dominant arm, when that is relevant
• Your ability to follow the restrictions and rehabilitation a given plan requires
• How the fracture looks on follow-up imaging over time

A plan set at the first visit is not necessarily fixed. Follow-up examinations and X-rays show how the alignment is holding and whether the bone is healing, and the plan can be adjusted based on that, on your symptoms, and on your circumstances. For example, a fracture being treated without surgery that shifts position or is not healing as expected may prompt a conversation about other options, and a plan may equally be reassured and continued when healing is on track.

Whether a fracture is treated with or without surgery, recovery is usually staged. An early period focuses on protecting the injury and controlling pain, often with a sling or brace, while keeping nearby joints — such as the hand, wrist, and elbow — moving when that is allowed. As healing progresses, motion is restored and then strength is rebuilt, with the pace guided by how the bone is healing on examination and X-ray rather than by the calendar alone.

Each of these fractures has a rehabilitation protocol that lays out that staged progression. Those protocols are linked below. They describe the general path; the specific restrictions and timing are set for you by your care team, and the operative note takes precedence when surgery was performed.

Seek prompt medical attention — including emergency care when appropriate — if you have:

• An open wound over the fracture, or bone visible through the skin
• Skin over the fracture that is tented, pale, or looks like it may break down
• New or worsening numbness, tingling, or weakness in the arm or hand
• A hand or arm that becomes cold, pale, or dusky
• Severe pain that is not controlled
• Trouble breathing or chest pain — particularly with a collarbone injury