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.
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.
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
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:
- 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?
- 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.”
- 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.
- 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]
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 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.
I am currently recovering from open reduction and internal fixation surgery which I had two weeks ago. Three weeks ago I was out on my mountain bike and hit a tree root going downhill at 20mph, I came flying off and landed on left arm and shoulder which took the majority of the impact. Owing to the level of pain I was sure before the ambulance arrived that I had broken my shoulder.
On arrival to casualty I was x-rayed and given the news that the humerus had broken in 5 places – proximal fracture and that this would most likely require surgery. After appointments with an orthopedic consultant and CT scans it was confirmed that there was displaced bone that would require ORIF to ensure proper bone alignment and recovery.
For others who are facing potential surgery please be aware that pain for the first couple of days after the procedure is pretty horrendous, especially after any nerve blocks wear off.
However two weeks later I have a good level of movement back in arm and hand- shoulder is still very stiff but hoping that physio will help with further rehabilitation,
64 yr old female, I was babysitting my son’s full grown German Shepard that they had provided a very long training leash for. Being simple minded, I wrapped the leash around my left arm a couple times and proceeded to throw a stick for the dog. Next thing I was flying face and shoulder first for the ground. Immediate intense pain and I knew something was broken. My arm was dangling useless. I have a proximal humerus (head) fracture in 3 places with a large section of bone broke free with tendons, nerves and muscle still attached. Surgery resulted in over 10 plates, screws, pins and wires. 8 days post op and the pain has subsided enough that I can manage it without opioids. Surgical follow up next week so will hear first hand if a cadaver bone was used in the repair. Without doubt, this has surpassed any pain I’ve ever experienced.
Thankful to have found this site!
I tripped when walking at speed on the pavement and went down heavily. I knew I couldn’t take weight on my arm to get up and a passer-by helped me. My husband then took me to A&E. Cause of covid he had to leave me there. After triage, I went to x-ray ten to urgent care where a nurse told me the registrar had seen my x-ray and confirmed # head of the humerus. I was given a collar and cuff and a leaflet and left the hospital with an appointment for the virtual fractured clinic.
I saw live doctors at weeks 2 and 6 and all is healing normally. Also, the physio at 6 weeks, who said if I wanted I could try pottering in a quiet place in the car. I didn’t. Now coming up to 8 weeks and feeling ready to start driving.
I am anxious about falls. I watch the ground surface carefully and am very aware of balance issues. I’m hoping that the anxiety will fade with time.
No one has asked about bone density, or about the emotional side of it all.
I fractured my proximal humerous on 30/12/2020,my arm was put in a sling,I was in terrible pain my orthopaedic surgeon didn’t tell me what I should do and how long to keep it in a sling,just make appointment for 2 weeks,I’d go back same again xray and then consultant, this happened again go back xray and see him. I told him I was in a lot of pain but all he could say was it will stop hurting ! I’ve had 4 sessions of hydrotherapy and another 5 weeks of pt and then referred back to physio only to be told its not healed right, I’ve got limited movement still in a lot of pain and I don’t go back to the consultant for another 5 weeks.im absolutely frightened of falling, it’s been 6 months and I’m 66 years old.
Your story is very helpful to me. Eleven days ago, I sprinted to cross a street and tripped, falling. My right arm couldn’t move right after, and my husband helped me get up and I cradled my right arm in a 90 degree angle, like a sling. We didn’t go to the ER because I found the pain bearable. I slept in the same clothing, keeping the arm by my side. The next day we went to urgent care and an xray showed a proximal humerus fracture. I scheduled a visit with a surgeon for the next week. Those xrays showed a severed numeral head and some additional fractures that needed repair. The surgeon said I would have permanent arthritic pain without surgery and a reverse shoulder replacement. So I agreed to surgery. Later they called and scheduled surgery for the next day. After the surgery, the doctor said it was worse than he thought. The rotator cuff was messed up, more bone had to be discarded, and the humeral ball was severed with part of it smashed into shoulder cup. The surgeon said I would never have had use of my arm again without the surgery. So I’m recovering from surgery and am grateful to be the beneficiary of modern medicine. However, I anticipate being anxious about future falls. I’m 60, not ready to stop long walks.
I’m so grateful to have found this website. 5 hours ago, I tripped over a root while walking in woodland and fell headlong, with my left shoulder taking all the impact. My daughter and a kind passing couple looked after me then we walked very slowly to arias so my husband could pick us up. It was excruciating and I felt very faint. I was popped in a wheelchair immediately at A&E and seen very quickly. Penthanol helped me through the x-ray and I’m now on codeine and gasping every time I have to move. I have a simple fracture of the humeral head. Reading all the comments on here is very comforting. I’m watching people looking for homes in Spain and thanking heaven that I didn’t fall heavily on my face. Tomorrow, I’ll binge watch the Great British Sewing Bee.
Did anyone get relief from cold packs early on?
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