What Happened When I Fell and Broke My Shoulder

By | Published 5/25/2020 236

broke shoulder

What I learned when I fell and broke my shoulder is that a fall is not just a fall and a fracture is not just a fracture. (Photo source: Adobe Stock Photos)

Who knew that a trip to the airport, one that I had done many times, would end up so badly. Here is what happened in August 2016 when I fell and broke my shoulder.

I was in a hurry to get to the gate for my flight to Tuscon. I was flying to an important meeting where I was going to have the chance to interview a former Surgeon General. The traffic from Marin to SFO was obnoxious, and the TSA line very slow.

I was wearing a heavy backpack. Optimistic about getting some work done on the plane, I had filled it with medical journals and my laptop. I was also pulling my wheelie.

I was walking my usual fast pace when the ball of my left foot struck the floor first—it had been happening a lot lately—and I stumbled. As I tried to get my balance, the backpack slid up towards my head and propelled me forward and down—hard.

I took the brunt of the fall on my right shoulder, but the worst pain was in the middle of my upper arm. I couldn’t use it to help me get up off the floor.

After the fall

A kind passerby got down on the floor next to me and said, with confidence, “I am certified in first aid. Can I help?” Grateful, I directed her to take my left arm and gently pull me into a sitting position.

By now, I am the center of attention, surrounded by airport police, passengers, and a United Airlines representative who told me, in no uncertain terms, that I would not be getting on my flight to Tucson. This was after I asked him to please take me to the gate in a wheelchair. Although he kindly booked me on a later flight, just in case the injury turned out to be something minor, he had already called for an ambulance.

So that was how I ended up as a patient in the ER I used to work in. The emergency physician on duty was one of the few people I still knew at Kaiser South San Francisco.

He sewed up a small laceration in my right eyebrow and arranged for the x-ray. The radiologist, an old friend from my running days, gave me the bad news. I had a displaced fracture of the greater tuberosity of the humerus plus a non-displaced surgical neck fracture.

I was definitely not going to Tucson.

broke my shoulder

My Xrays showed a proximal humerus 2-part fracture. I am definitely not going to Tucson. (Photo source: author)

Why a fall is not just a fall

There are so many interesting and important questions raised by my fall that I want to share with you because I learned that a fall is not just a fall and a broken shoulder is not just a broken shoulder. Bear with me as I take you through some of my thinking.

First of all, there’s the question: Why did I fall? The folks at the airport and the clinicians in the ER asked all the right questions to make sure it wasn’t something that needed an urgent evaluation. Did I have chest pain, dizziness, palpitations? No. Did I trip on something—an uneven tile or an object on the floor? No.

I am very clear about why I fell. I tripped over my own left foot. Once I explained that people lost interest in why I fell and concentrated on the result of my fall—the proximal humeral fractures. But, we will come back to the why later on because it is one of the most important questions that can be asked about a fall.

Managing the pain of my broken shoulder

The next question was, what did I need for pain? I opted for 1 gram of IV acetaminophen. It worked like a charm and left my head clear, so I could sort out the other issues.

One of the most urgent was notifying my client that I would not be at their meeting in Tucson the next morning. I also had to figure out the best way to get home without having my husband schlepp an hour to retrieve me.

An obviously important issue to address: What’s the treatment? After all, you can’t put a shoulder in a cast.

I was given a sling and a follow-up appointment in Orthopedics for a week hence. I opted for NSAIDs for pain because I don’t like nausea and foggy head that accompany opioids. It turns out that was all I needed.

Getting discharged from the ER was smooth and easy

The discharge from the ER was amazing. My friend, the ER doc, gave me a white and blue pocket folder filled with all the information I would need until I could see the bone doc. In it were several sheets of paper that described upper extremity fractures. It also outlined the home care and follow-up instructions and explained when to seek urgent medical advice.

I also found instructions on how to take the pain medication together with a note telling me that I could pick up my prescription at any pharmacy. It was already entered into the system-wide EHR. (Eat your hearts out, all you people getting care outside of an integrated delivery system.)

I tucked the paper copies of my X-rays in the folder and paid my $5 (no kidding) copay. And then I said my thank yous to the staff who had treated me so kindly and professionally.

ADD_THIS_TEXT
 

I took a Lyft home, whining to the driver about how I was missing a great meeting in Tucson. Even more important, I complained, I was going to miss the upcoming family trip rafting the Middle Fork of the Salmon that I had been looking forward to for months.

Follow-up for my broken shoulder

broken shoulder

My bruised arm looked like something from another world. Who knew a trip and fall could end up looking like this?

I got plugged into Kaiser’s orthopedic department and had regular x-rays to ensure healing was going ok. Of course, I spent hours on PubMed and other sites on the internet trying to determine what was the best treatment for my particular fractures.

My fellow internists won’t be surprised to hear that the Orthopedic literature is a mess. Most of the papers I read insisted surgery was the treatment of choice, but I was being treated conservatively with a sling and physical therapy (PT).

So, I made an appointment with the shoulder specialist at my Kaiser medical center to review the literature—yes, you can do that. He described several studies. One was from the UK that I had already read. The researchers found that outcomes were the same for people treated with surgery and those treated with a sling. 

This was the case even if there was displacement of the greater tuberosity like I had. Further, he pointed out, the top of my humeral head had a good shape. Also, there was plenty of room between it and the acromion, so impingement syndrome was unlikely.

I was lucky. Even before I started PT, my shoulder range of motion started to improve. With PT, I went to 80% of the way to normal shoulder function within 2-3 months. I continued doing my PT exercises at home for about a year and a half. My functional range of motion is now about 95 to 100% normal.

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Many questions about my fall and fracture remain

I have only scratched the surface of issues related to falls and fractures in this post. Many questions remain:

  1. The humerus is a big bone. Why did mine break after a simple fall from a standing position? Had my long-standing osteopenia progressed to osteoporosis? If I have osteoporosis, what is the best treatment? And what are its side effects?
  2. Why did I trip? Did I have a foot drop or some other gait abnormality? Or was it just a problem with my shoes, my clumsiness, or my inattention? Equally important, what can I do to prevent falling in the future—a huge source of morbidity for women (and men) “of a certain age.”
  3. How can I get back the full and normal function of my right arm? Believe it or not, I was so good at holding it still by my side that I had to consciously remember to use it once it was freed from the sling.
  4. How do I overcome my newly acquired fear of falling and mental images of falling when I go up and down stairs or walk with my big old black lab? Is this a form of PTSD? What’s the best way to renormalize my disturbed sleep?

It is important to explore all of these aspects of falls and fractures because I think all too often clinicians, friends, and family members,—and even patients—think that a fall is just a fall. But in many cases, as I have learned, a fall may be so much more.

If you would like to add to this list of issues to explore, please pass them along either as a comment on this post or as an email to [email protected]

Learning and supporting each other

I am also hoping to hear more from readers about their experiences with osteoporotic fractures. I am pleased that the comment section of this post has become an important resource for people (mostly women) who have fallen and broken their shoulders.

In addition to telling their fracture stories, women have been offering answers to the following questions:

  • Did anyone ask if you had low bone density (osteopenia or osteoporosis)? Were you offered screening for the condition?
  • Were you evaluated for underlying or contributing reasons for the fall (e.g., balance problems, vision problems, safety issues in the home)?
  • Did you experience significant emotional sequelae (e.g., fear of falling, depression, insomnia) after the fall/fracture? Did any of your health professionals ask about or offer help with these symptoms? 

Please join in by leaving your responses in the comment section below. Or, send me an email via [email protected]

Related content:
Do You Know Your Risk of Fragility Fractures?
Why are So Many People Taking Their Chances with Osteoporosis?
Drugs, Falls, and Fractures: Missed Opportunities in Osteoporosis
Early Testing for Osteoporosis Gives Voice to a Silent Disease


Originally published in August 2016, it was updated by the author for republication today.

Patricia Salber, MD, MBA

Patricia Salber, MD, MBA

Website: https://thedoctorweighsin.com

Patricia Salber, MD, MBA is the Founder. CEO, and Editor-in-Chief of The Doctor Weighs In (TDWI). Founded in 2005 as a single-author blog, it has evolved into a multi-authored, multi-media health information site with a global audience. She has worked hard to ensure that TDWI is a trusted resource for health information on a wide variety of health topics. Moreover, Dr. Salber is widely acknowledged as an important contributor to the health information space, including having been honored by LinkedIn as one of ten Top Voices in Healthcare in both 2017 and 2018.

Dr. Salber has a long list of peer-reviewed publications as well as publications in trade and popular press. She has published two books, the latest being “Connected Health: Improving Care, Safety, and Efficiency with Wearables and IoT solutions. She has hosted podcasts and video interviews with many well-known healthcare experts and innovators. Spreading the word about health and healthcare innovation is her passion.

She attended the University of California Berkeley for her undergraduate and graduate studies and UC San Francisco for medical school, internal medicine residency, and endocrine fellowship. She also completed a Pew Fellowship in Health Policy at the affiliated Institute for Health Policy Studies. She earned an MBA with a health focus at the University of California Irvine.

She joined Kaiser Permanente (KP)where she practiced emergency medicine as a board-certified internist and emergency physician before moving into administration. She served as the first Physician Director for National Accounts at the Permanente Federation. And, also served as the lead on a dedicated Kaiser Permanente-General Motors team to help GM with its managed care strategy. GM was the largest private purchaser of healthcare in the world at that time. After leaving KP, she worked as a physician executive in a number of health plans, including serving as EVP and Chief Medical Officer at Universal American.

She consults and/or advises a wide variety of organizations including digital start-ups such as CliniOps, My Safety Nest, and Doctor Base (acquired). She currently consults with Duty First Consulting as well as Faegre, Drinker, Biddle, and Reath, LLP.

Pat serves on the Board of Trustees of MedShare, a global humanitarian organization. She chairs the organization’s Development Committee and she also chairs MedShare's Western Regional Council.

Dr. Salber is married and lives with her husband and dog in beautiful Marin County in California. She has three grown children and two granddaughters with whom she loves to travel.

Comments:

  • I found this discussion not long after my fall in September 2020. I had a dislocated left .shoulder and mon displaced upper humerus fracture. I am left handed! I was fortunate that the orthopedist on call for the ER was excellent and had a CT done after my should was back in place. That showed that the humerus fracture was also back in place. They scheduled a follow up orthopedist appointment for 3 days after the fall. I couldn’t lift my left arm for quite some time. My doctor ordered PT about 3 1/2 weeks after my injury, once he saw enough bone healing that he was not worried about the fracture displacing. I just completed PT at the beginning of April. My range of motion is almost back and my strength is improving. It may not seem like it in the beginning , but your arm will heal and you will get better. While it didn’t seem like PT was doing much at first, it has been a great success .

  • I was happy to stumble onto this. It has some helpful information and it’s nice to read the perspectives of others dealing with an injury similar to mine.

    My accident was a combination of bad luck and hubris. I was, and hope to be again, a serious distance runner, competing well in my age group (I’m currently 62) at distances from 5K to the marathon. About 4 weeks ago I pulled a muscle in my hip and had to stop running for a while, and I tried switching to fast walking to maintain fitness. But I’m not used to walking fast for long distances, and my hip was stiff from the pulled muscle. I started scuffing my foot against the ground as I got tired, and I should have recognized the warning signs and backed off, but I couldn’t believe that someone who regularly ran 10+ miles at a time could possibly get hurt walking. Shortly thereafter I tripped on a rough spot in the road and fell hard. I couldn’t use my left arm at all to push myself up, and once I got up my whole left arm was numb and tingly, I couldn’t move it, and it felt like it was in the wrong place. I walked very carefully the remaining 1.5 miles home and my husband drove me to the ER. By the time we got there the pain was severe and the x-rays were really scary. A piece of the head of the humerus had broken off and was still in the socket, but the rest of the humeral head was about 3 inches away from the socket. I was sedated and the ER doc did an excellent job of getting the head of the humerus back into the socket aligned with the broken-off piece. I was sent home with a sling, a prescription for narcotics, and directions to follow up with an orthopedist.

    That was 11 days ago. Once the joint was reassembled there was surprisingly little pain and I’ve taken no drugs for it. My biggest problem is remembering not to use that arm, although I imagine if I tried to move it very far or put any load on it, it would complain loudly. I saw the orthopedist 3 days ago and she concluded from the x-rays that the tendons of the rotator cuff stayed attached to the head of the humerus as the humerus fractured and the rest of it moved. She does not think surgery will be required and just prescribed another 3 weeks in the sling followed by another x-ray to see how healing is proceeding. Four weeks in a sling is a major inconvenience but it sure beats surgery.

    As I wait to heal and hope for no setbacks, I’m also encountering some of the same confidence issues others have mentioned. This certainly isn’t the first time I’ve tripped and fallen while hiking or running, but always before the result was just scrapes and bruises. I’ve always thought of myself as a healthy, athletic runner, not some elderly person who has to worry about getting hurt in a fall! I’m trying not to let it mess with my head too much. I’ve resumed walking, 3-4 miles per day, but at a strolling pace (fast walking seems like a bad idea with one arm strapped to my side) and you can bet I’m looking very carefully at where I’m putting my feet. I’m also pedaling a stationary bike trainer, which seems safe, about an hour a day to try to maintain some aerobic conditioning. But I don’t know whether I’ll ever recover my old confidence. In years past I did a lot of hiking and backpacking in wilderness areas over the summer. Now I think about what would happen if I had an accident like that in the backcountry, 15 miles of rugged trails from the nearest road. I hope that time will heal this stab to my confidence.

    • So sorry to hear about your fall and what sounds like a subsequent fear of falling. It is actually very common after an event like this. I had it. Every time I had to go down the stairs from my home office, I could visualize myself tumbling to the bottom. So, like you, I was very careful. Now (~4 years later), I am back to normal, although I still watch where I put my feet. Hang in there – things will get a whole lot better.

  • I am a 59 year old female. I tripped and fell face first 12 days ago. I fractured my upper humerus, with no displacement. No one told me how long to wear the sling, and no one asked me any of the questions you listed above. It’s a small rural hospital. I was given an appointment to see an orthopedic surgeon, and I traveled an hour to see her. I should have stayed home. She didn’t even ask to look at my arm. All she asked was if I had any tingling in my forearm or fingers, which I don’t. Then she gave me a card to call her office and make an appointment for 3 weeks time, and that they’d take another x-ray then. I’m not going back. I told them to send everything to my personal doctor, and I can get an x-ray at our local hospital. It was ridiculous! I’m seeing new bruising in the last few days. Is that normal? And I’ve also got swelling in my legs – water retention, I believe. It stays dented when I press on them. I’m not sure if this is related or not, but I always have my legs elevated, and they never swelled like this before – it feels like my skin is going to crack. Any help would be appreciated.

    • Hi Joanne, it is hard to say if the swelling in your legs is related to the fracture. I suggest you check in with your PCP to be on the safe side. Yes, bruising (sometimes dramatic – see the photo of my arm in the story). But it will fade with time and if you are diligent about physical therapy, including a home program, you may have a remarkable return of function. I’m so sorry to hear about the lack of interest on the part of your orthopedist. Although it may have seemed like a routine case to her, for the person with the fracture, it can be life-changing – as you can read in some of the comments below. Best wishes for a speedy recovery.

    • Thanks for your reply. I did see your photo, though mine actually looks a bit worse. What I was concerned about was new bruising. It’s been almost two weeks, and I have bruises now, that weren’t there in the first week. I’m sure it will be ok. I called to try an make an appointment, but they’re now booking for the end of April. I’ll see how how it looks next week, and maybe go to the outpatient department at the local hospital instead.

  • 30, had a scooty accident 2 weeks ago, fractured right shoulder. Doctor gave me a temporary plaster and a sling which need to be in place for at least 6 weeks. I think I am going through a state of disbelief. As I am typing this with my non-dominant hand, I am constantly worrying that it’s putting pressure on my right shoulder and it’s never going to heal.( I have anxiety, depression and severe trust issues.) This has been my constant dillemma, how much of the other good hand I should use. Using the good left hand to do little mundane things gives me courage and confidence that I am going to fight this and I’ll be okay. But at the same time, I am constantly panicked about overdoing it and messing up the bone setting and the healing process all together. I don’t know how to figure it out. My doctor was not specific about it (or anything apart from being careful to not move the right shoulder and sleep on my back). In fact he was pretty chilled and told me to not worry about anything (probably he sensed the anxiety bit and wanted to assure me).
    I’m really glad I found this blog and the discussion board.

    • Your Dr is right Bree. Try not to worry about it too much! I broke both my shoulders on a scooter 12 weeks ago. My left one more or less healed in six weeks (got pretty much full movement there now) and my right one is just about healed now (got about 80% movement back so far with possibility for more to come). My main advice is to just do the physio as much as you can stand (listen to your body – it’ll tell you when it’s tired). Don’t worry about using your non dominant hand. That sounds like a life saver to me! It’s also hard emotionally not being able to do things that were easy just a few weeks ago. Be kind to yourself about that.

      It gets better. I promise. You’ve definitely been through the low part now.

      Simon

    • I wrote a month ago and no response. I have suffered some kind of nerve damage where my forearm hurts, my hand is swollen and it looks like a craw. I can hardly write. I broke my shoulder and have nine pins in it

    • Hi Karen, we don’t diagnose or treat conditions on this website (it’s not legal!) Rather, we provide information that may be useful in understanding your problem. That being said, I found this article on “claw hand” that may be helpful: https://www.healthline.com/health/claw-hand#diagnosis I believe that you should see a knowledgeable physician (neurologist, orthopedist) soon for a proper evaluation, testing, and treatment. Let us know how it goes. Pat

    • Thank you. Seeing an orthopedic surgeon and next scheduled to see neologist.

    • Hi Bree
      I’m 10 months on now. I was also petrified of upsetting the healing bone but short of falling and doing the same thing again, I think it’d be difficult to upset. I know I jarred myself a few times and was worried but it healed OK. Now on with strengthening the muscles still. Yes do the physio but try not to rush yourself – it doesn’t work! The shoulder takes time but you’ll get there. I too worried myself silly but there’s nothing you can do but wait, eat well and rest. I’m 65 and you are younger so you’ll heal well I’m sure!

    • Bree, I am considerably older than you. I was a couple of months shy of 69 when I fell -dislocated my dominant shoulder and had a fracture of the humerus. Luckily once they put my shoulder back in place the orthopedist had a CT done which showed the bone back in place. Thankfully I did not need surgery. The first 6-8 weeks were awful. I have a high pain tolerance, but this was the worst ever. I started physical therapy about 4 weeks after the injury. It is slow progress but I am almost back to 100% movement. I think regaining the strength will be a bit longer. Be patient with yourself. I was using the sling for a few months. My physical therapist is great and they are the best ones to ask about specific activities. You will get better!

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