What Happened When I Fell and Broke My Shoulder

By Patricia Salber, MD, MBA | Published 5/25/2020 244

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.

You might also enjoy: Dealing with a Rare Eye Disease in the Midst of COVID

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:

  • First of all, thanks Pat for your story and secondly thanks for all the comments from others on their experiences. When you are going through something like this you feel very alone and it helps to read about other peoples experiences. There are so many questions about what to expect and what is normal and this article certainly helped me. Even though everyones experience is unique and everyone heals differently you can usually find something in each story that helps or fits what you are going through. I am a 55 year old healthy female. I fell off a segway and landed on a curb fracturing my proximal humerus in 3 places as well as dislocating it in January/20. I did not break my fall at all as it happened very quickly. I was in a collar and cuff sling for 6 weeks. This was seriously the worse pain of my life. At the initial fall and afterwards as well. Initially,I was taking percocet every four hours and I took this until March weaning down the time span. It was also very humbling as I am a very independent person and was very depended on others for everything including personal care at the beginning. It was also my dominant arm so that didn’t help. I started physio for my lower arm and hand at 3 weeks and on my shoulder at 6 weeks going every week. I was lucky to be seen all through covid every week. In the past I have never found that physio really helped me but for this it has been a God send. She told me all along it would take 4-6 months for the initial healing to be well enough to go back to work and I am two weeks off of 6 months now and feel at about 70%. I am scheduled to go back to work at the beginning of August and I feel that I will be ready. She also said it will take up to a year to get 100%. My pain level now sits between 10-20% depending on what I am doing. I have about 60-70% rom depending on what direction and my strength is slowly coming. 2 months ago I would not have believed that I would be where I am now. It has been very slow and tedious but now I can see the light at the end of the tunnel. My best advice would be listen to your body and your PT. Also, don’t try and rush healing. I tried this at the beginning and it didn’t help. Also, for sleeping I slept in a lounge chair for the first 8 weeks and used an airplane pillow for a pillow. This helped immensely. Also, very important to ice at the initial fall if you have severe swelling and bruising. It helps with the pain and inflammation.

  • Hi Patricia,

    I also suffered a greater tuberosity fracture 2 and a half years ago after a simple fall – I tripped on the kerb and put my arm out to catch my fall. I’ve definitely had a lot of the feelings you mention here; I felt upon reading the literature that greater tuberosity fractures from a simple fall occurred predominantly in much older women (I’m 28) and most incidences in younger women were from more high-impact events. However my concerns about bone density were dismissed when I raised them with my consultant because of my age – frustrating when factors such as oral contraceptives, for example, can effect bone density in younger women.

    I definitely have a much greater fear of falling now, complete with fun ‘walking down a flight of steep, windy stairs and tripping and falling all the way down to the bottom’ dreams, and I had several falls in the year after my fracture (again, dismissed by my GP when I queried if there was an underlying cause). Unfortunately my automatic reaction now when I fall is to snap my arms to my sides instead of trying to catch my fall, which, whilst probably very comedic to watch, resulted in a bit of a bashed up face when I slipped on a wet floor last year…

    As for the actual fracture, I was treated similarly to you – 6 weeks in a ‘collar and cuff’ sling, with follow-up physio. It’s healed well, but I still have niggles – my left arm is noticeably weaker than my left, and I have slight pain at the upper limits of my motion. Occasionally I have problems getting dressed/undressed where my shoulder feels ‘stuck’. I’m much more right-dominant than I used to be. For what was a relatively minor fracture, it certainly has had a big impact and there have been a lot more long-term concerns than I expected.

  • It is June 14, 2020…..January 2019 I fell in my office at work. It was pouring rain outside and I had on a pair of cowboy boots they was soaking wet, muddy and slick on the floor. I was late and quickly bolted into a corner of the room to turn on a lamp I swirled around to go back to my desk and hooked one boot on the other. I flew over a chair and into a wall hitting head first and coming down with my full weight onto my right shoulder. I knocked myself silly when I hit my head, when I could function I managed to crawl to a phone to call our nurses station. Upon examination the nurse insisted a coworker take me to the ER. X-rays showed a comminuted fracture of the humerus. The Doctor later told me he sees injury like I had in high impact situations, not a fall. They did a scan of my head and found no bleed. They did not give me a referral for a neurologist despite the big lump on my head. Big mistake. My pain level was high, I injured my whole arm, wrist and hand. I turned black and blue on the entire right side of my torso. I had spasms in my chest wall. It was the worst pain I have experienced. Their were nights I sat up and whimpered like a wounded animal. I started Physcial therapy and had to go slow. I was finally diagnosed with a concussion which made healing even more complicated. The worst thing and may be the best is the Dr’s told me due to the severity of the fracture with this type of injury I may not get very good movement back in the shoulder. I put 100% into my physical therapy. I cried, I cussed, I wanted to give up, I had arm and hand therapy on top of the shoulder therapy. It was 8 months before I saw what I had accomplished. I completely blew my Doctors away. I have 95% shoulder recovery. My hand is not 100% but I can live with it. I am 70 years old, very active, still working and in very good health. My message is work as hard as you can and never give up. A shoulder injury is not an easy thing especially if it is your dominate hand. I had to go to talk therapy when it was all over. I missed major events, a dream opportunity in my career, and the concussion was hard emotionally. I did EMDR and it helped address my PTSD from the whole event. I am well and glad it is behind me.

  • I read your piece on how you broke your shoulder and are now having fear of falling again as well as questioning why you fell etc.
    I broke my right radial head – elbow last May 6th. I have the same feelings you have had and am very worried about it because I am a 57 year old woman and fear this is only going to get worse. I am still not fully healed and now have pain there as well as some loss of movement and nerve damage in my baby and ring finger on my right hand. I got a bicycle about 3 weeks before I fell (I fell at work, btw) and rode it once before the accident.
    Now, the bike has had a tune up (not really necessary, but made me a little more at ease) and I have ridden it once. I feel very nervous and actually lost my balance (just overthinking) and tumbled when I first tried to mount it…I had to talk to myself – saying “you can do this, don’t be afraid etc” during the short ride home from the bike shop. I almost lost my balance once again – also because I saw myself falling again and just lost confidence….this all on a 2km ride home! I want to try again today, but because of the pandemic, there are so many people riding bikes that it makes me nervous as well….
    Should I just get on and go for it, or stay off the bike and just walk for a couple more months till I feel more comfortable? I have issues sleeping as well, because the arm and hand now go numb if I don’t sleep with it absolutely straight….
    I feel like an old lady and am very upset about this.
    Any advice?

    • Hi Barbara,

      I am your age, and I was also afraid to get back on my bicycle. I advise you do NOT get back on it until you feel happy doing so.
      Like you say, you become too self-conscious, and that’s just not safe. Let it go. Then, from one day to the next (and that might happen in, say, 3 weeks) you suddenly don’t feel worried about it. That’s when you go on your bike again.

  • 6 weeks in, now, and got 100% ROM (though not without a little pain), without physiotherapy.
    I don’t recommend going without physiotherapy, only, I’ve been moving my arm so much (without any weight on it) as of about 1 week in, and then increasing to normal usage since 1 or 2 weeks ago, that PT doesn’t seem necessary. (But who knows, maybe I’m wrong about that.)

    Everything is going so well that I’d like to recommend my regime again, which has been: several grams of vit C daily, about 10,000 IU D3 with K2 (very very important, the K2, to get the calcium which I get from several tbsps of sesame seeds daily, in the right place), magnesium, zinc. And cypress oil and fir needle oil (with some others like helychrisum) on the shoulder to aid in circulation.

    I may be just lucky, with everything going so well, and the surgeon saying, at 1 week in, that it was looking “surprisingly good”, but I think the supplements really helped.

  • Great site. 64 y.o. when I fell 2/24/19 on wet sloped sidewalk. Suffered left arm humerus, ulnar and Colles fractures; nerve and tendon damage. Walked 4 blocks home. ER set/cast my arm, sent me home. Bruised left side from waist to tips of fingers. Took 1 day off work after break and 2 days off with wrist surgery. L hand peeled 3 x post surgery. In sling 3 months. Great PT for 3 months but moved then lousy PT so quit. Painted/prepped house to sell pretty much alone. Bone scan showed osteoporosis so take alendronate, calcium & D3. Currently suffer chronic pain, trigger finger, shoulder ROM ~85%. Was afraid of falling but very careful. Wrist and hand a problem but really hate that I broke my shoulder. It’s the worst!

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