What Happened When I Fell and Broke My Shoulder

By Patricia Salber, MD, MBA | Published 5/25/2020 238

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

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:

  • Absolutely believe in the fear fracture. Though I now almost 72, I can well remember being thrown from a horse and dragged by the stirrup until they could stop him… I was maybe 10? Fast forward to today, when my husband wants to put straps on the pedals of our recumbent bikes. All I can see ifps taking a fall and being unable to get my foot out of the strap. and I’m on a recumbent for fear of falling off a two wheeler.

  • A year ago I had a fall off my bicycle at a young age of 59. Unfortunately fractured my pelvis bottom to top, and a femoral fracture, fortunately with little displacement.
    3 months in a wheel chair no weight bearing, after back to work and doing OK. Have been back out on my bike , but yes there is always that awareness of what another fall could do.

  • Sorry we missed you here in Idaho. I hope you have since made your way to the South Fork.
    Several years ago, while on one of my horses, I took a fall. Broke my radius, ulna and the head of my humerus. I was in the Owyhee Mountains about 60 miles from the nearest hospital. Fortunately I was with a friend who is an ICU nurse ( I am also an RN). Getting down the mountainside with my friend leading both horses and holding onto my belt with one hand was painful, to say the least. I was unable to mount my horse as the movement caused my muscles to spasm and the humerus ends to grind. I knew if I got up there and passed out I would be in a real mess. It was my L arm broken and I needed to use it for balance while getting on my horse, couldn’t do it. All this on the side of a mountain trail.
    We managed to get to the horse trailer. She loaded the horses, I wedged myself in the truck seat so I could brace with my feet on the dash. By now every movement caused spasms in my deltoid and I got very light headed. Until we got to the paved road, I was in 8+ pain.
    Got to the ER, nauseated from pain. Don’t remember what meds I got but I sure did appreciate the pain relief. Demerol and Visteril I think. I was taken to the OR and a general anesthesia for the cast on the forearm. Woke up with a cast and a sling.
    I was 39 y.o. at the time and my deltoids were quite strong, the spasms were terrible for weeks. Ended up with my upper arm terribly swollen and bruised and a cast on my forearm. Arm in a sling for several weeks. Sternoclydomastoid (hope I spelled that right) very painful for weeks.
    I am 69 y.o. now, have about 90% ability to raise my L arm over my head.
    I imagined myself bullet proof up until this injury. When my arm had been in a sling and I had the cast on for about 2 1/2 weeks I couldn’t stand the inactivity and put my leg over my kid’s pony. I could make it up there with some difficulty and rode the 1/4 mile, bareback, to the mail box. That lovely pony made my day. His name was Buckshot and he was so patient and kind. He was humanely put down at age 31, several years later.
    I am still going at 69. I do have some PTSD, I think. It did not bother me for years, but now I have flashbacks of the injury. Now I have RA and Lupus and I know that I would be in a bad place if I were injured again. I still ride. I mostly drive a buggy, but injuries from those accidents are also terrible.
    Thanks for the discussion of the aftermath of these falls and fractures. Life is an interesting trail and an interesting trial.
    I live on a hay ranch in Owyhee County, Idaho. My friend, Margaret Cary comes to visit us here in the wilds of Idaho. Maybe you can come with her some time. Happy healing.
    and I am terrified of getting hurt again.

    • Hi Nancy, thank you for sharing your experience with a fall and fracture. I think fear of falling and PTSD are underreported and underappreciated. Hopefully we can change that by sharing our stories. Maggi has often told me how much fun she has visiting you on the hay ranch. Idaho is also underappreciated, but I selfishly hope it stays that way. Pat

    • Nancy, thank you for your post. As I read your post I found myself nodding in agreement as you were describing the pain and how you got help for your initial injury. I’m only 2 1/2 weeks out from a shattered shoulder but I’m scared witless of another fall! So glad to know there is life after this kind of injury because right now I find myself crying several times a day and struggling not to feel sorry for myself. Seems the only thing I can do well is eat and drink (neither one is an activity I need to do!). Thanks for posting.

  • Thank you for sharing. As a middle-aged runner who falls occasionally on trails (but so far only ever with bruises and irritations), I fully get both why you need to figure out how it happened and how to overcome fear of it happening again.

    And thank you for your kind words about my employer’s SSF team.

    Wishing you a speedy recovery (and hope you get that rafting trip next summer)!

    • Thanks Murray. Please keep your bones strong so your falls only lead to bruises, not fractures!

      Re: the care at SSF. I didn’t have room to write about all of the great care I got including the Medical Assistant who wrapped me in warmed blankets so I wouldn’t get chilly as she irrigated my wound, the expert care of Emergency Physician Dr. Uli Chettipally and kindness of Dr. Sherry Reynolds the radiologist who read my x-rays. Care doesn’t get any better than what I had that night. Thank you Kaiser South San Francisco.

  • Thank you for the wonderful essay, Pat. I’m curious to learn of your analysis of the precipitant for your fall. I concur that serious injury consequent to falling creates a type of PTSD–my tri-malleolar fx-dislocation in early middle-age certainly did.

    I’m glad to learn of your steady improvement/recovery. All good wishes for a rapid return to maximal function and activities. Regards./@sjdmd

    • Thanks, Steve. My recovery is going well. My range of motion back to about 90% and I am still in the early stages of PT. I would love to chat with you about your symptoms of PTSD post-fall. I suspect it may be a common, but perhaps unrecognized symptom. We all know that people with hip fractures often die soon after the event (within a year or two). I wonder, has anyone looked to see how much of that morbidity and mortality is related to self-restricted movement because of FOF (fear of falling) related to some variation of PTSD. Certainly an interesting and perhaps an important question – to me at least.

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