Upper Arm Bone Fractures (Proximal Humerus Fractures): Overview

Upper Arm Bone Fractures (Proximal Humerus Fractures): Overview

An upper arm bone fracture, also referred to as a proximal humerus fracture, is a break in the bone close to the shoulder joint. Upper arm bone fractures are the third most common fracture type. They are more common in women compared to men, and the incidence increases with age. This type of injury is also more common to occur in the winter months, compared to other times of the year.

An upper arm bone fracture is sustained from an acute injury to the shoulder. In the older population, this injury commonly occurs after a ground-level fall, when a patient tries to brace themselves with an outstretched hand or lands directly onto their elbow. Specifically in older patients, they are more susceptible to sustain an upper arm bone fracture in this way because our bones can weaken with age.

Upper arm bone fractures can occur in younger patients, too, but it takes a significant force, like a motor vehicle accident or a fall from heights to do so. Although it is not possible to prevent all accidental falls, there are some steps to help lower the risk. Ensuring areas in the home are well-lit and clear of clutter when walking, installing handrails in stairwells and bathrooms, and keeping items within arm's reach are just a few measures that can help reduce the risk of falling.

As mentioned, weakening bones also make patients more susceptible to sustain a fracture. Loss of bone strength over time is called osteoporosis or low bone mass. Weight bearing exercises like walking or lifting weights, quitting smoking, reducing alcohol consumption, and use of certain medications as recommended by your primary care physician can all play a role in slowing down bone loss with age.

As we look at the anatomy of the shoulder joint, it is made up of three different bones. The upper arm bone, known as the humerus, the shoulder blade, known as the scapula, and the collarbone, known as the clavicle. Looking more closely at the upper arm bone, the humerus, the fracture occurs closer to the ball, the humeral head. This is referred to as the proximal portion of the humerus bone, hence the term used by health care providers: proximal humerus fracture.

Within this area, there can be one break in the bone, or there may be multiple breaks. These bony pieces may also be home to attachments of the rotator cuff tendons. Depending on where the bone breaks, these tendons may pull the bony pieces in certain directions, causing them to separate from one another. This will be one consideration in determining how to treat the fracture.

After sustaining a fall or acute injury to the upper arm that results in an upper arm bone fracture, there will be an immediate onset of pain. Patients will also notice swelling and have limited use of the injured arm. They may even notice extensive bruising around the shoulder joint that can travel down the arm and into the hand.

An orthopedic specialist will be on the lookout for all of these signs and symptoms during their evaluation. They will also ask questions about how the injury occurred and take into factors like the patient's age, activity level, and hand dominance. On physical exam, testing the range of motion of the shoulder will be difficult due to pain. Often, the provider will try to move the arm gently or let the patient move it as much as they can.

The orthopedic specialist will also ensure all the nerves in the shoulder are functioning properly. To confirm the diagnosis, x-rays will be obtained. As previously mentioned, an upper arm bone fracture can look very different from patient to patient. The x-ray will help the orthopedic specialist to see this and will play a part in the decision on how to treat the fracture.

Sometimes, they will need to obtain a CT scan in addition to an x-ray, which allows for a better understanding of the fracture in 3 dimensions. Once all the necessary information has been gathered, the health care provider will review their findings with the patient, along with explaining which treatment options are best suited to their needs.