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.

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:

  • I’m not exactly the demographic you’re targeting, but about 2 months ago I was in a motorcycle – SUV accident. A driver failed to yield right of way and turned left into me – almost T-boning me, but at perhaps 75 degrees, not 90. I’m male, 53. I was thrown from my bike and landed on my left side. I’m not sure which part hit the pavement first, but I suffered a broken foot from vehicle impact, a broken hip, and a compound fracture to the proximal humerus. The last injury was treated by placing a plate and 8 fasteners. When the accident happened, I could feel my hand and move my fingers, but it hurt like hell to move my arm. After surgery, when I was just coming around, I awoke to several OR personnel wrestling me to put my shoulder back into socket. Apparently it popped out twice. Since then, I have been able to extend my range of motion, but try as I might I am not able to lift the humerus. I can lift the forearm from the elbow. I can perform some shoulder movement, bit it hurts in the center of the outside of my left humerus whenever I make these movements. I’m being sent for an MRI after explaining this to the orthopedist. He is floating two possibilities: 1. a rotator cuff issue that was missed when he was fixing the arm, or 2. a brachial plexus injury. I’m worried about the 2nd possibility as it may be permanent and I’d love to return to my activity of riding motorcycles (I am safe and wear a helmet). My OT doesn’t think it is a serious injury as I have function of the hand and lower limb still. The doctor says it is really early and I’m not behind the curve in rehabilitation. Of course all of this possibility gives me a little downer, as I like to stay active. Even simple activities like rolling over in bed just to snuggle next to my wife come with pain….Is there hope for normality again? Are there measures for mild brachial plexus injuries?

    • I can’t speak to the brachial plexus injuries, but I can tell you that in my experience and in the experience of many writing comments here, you will improve with time.It may take longer than you like so be patient with yourself as you continue to follow the instructions of your OT including any home program recommended to you. I did my range of motion exercises for well over a year. I have 100% function even though my ROM is still a bit limited. Good luck.

    • I fell while jogging a little over 5 weeks ago. I landed with my left (dominate )arm straight out in front of me. Luckily I was with friends. They helped me to a sitting position. One of my friends went to get her car and drove me to urgent care. You could clearly see that my shoulder was dislocated. At urgent care, the NP ordered X-rays of my left forearm. I asked the tech about X-ray for the shoulder. She said it wasn’t ordered. Back to the exam room to wait for results. The np came in and said nothing was broken. They were going to give me a sling and send me home. I asked about X-ray for the shoulder. NP says she saw no need to X-ray. My friend said you can see that the left shoulder is misshapen. So the np says if it will give you peace of mind we can X-ray it. All of this happening while I am in the most excruciating pain ever. After shoulder X-ray no comes back in and says you have a dislocated shoulder and we are getting your paperwork ready for the ER. While being driven to ER by family, I read that I also have a fracture of the humerus head. I got to ER at 10am and finally had shoulder popped in around 4pm. I had to ask the nurse to clean off the lacerations on my hand and knee. No one had looked at that. They did a CT and said that the fracture had fit back in place and I didn’t need surgery. This was on a Saturday, saw the orthopedist on Tuesday. I started PT about 2 1/2 weeks after my fall. I am now 5 weeks post fall. I am taking much less pain medicine, but still have pain waking me up at night. No one asked about osteoporosis or osteopenia. I have osteopenia of the hip and spine. I noticed a pothole right before I fell. No one asked about dizziness. The PT told me that I can start jogging again after I pass the 6 week date. I am 68 y.o.
      I usually have a high pain tolerance, but this has been the most painful experience I’ve had

  • I am one of the April 2020 non-displaced club, though in my late 50’s, rather than the 2 I saw in their 30’s. I posted on here before and thought I would provide an update. I finally had an MRI a couple of weeks ago, after my physical therapist said she thought I probably partially tore my rotator cuff. The physician assistant I had been assigned in Orthopedics said he didn’t think I needed an MRI, however most of our appointments were by phone and I think my range of motion and strength was only tested in Ortho toward the beginning of my injury.

    The x-ray showed that I partially tore several tendons in the rotator cuff area and that my shoulder is still fractured. I have an appointment with a shoulder specialist in a couple of weeks.

    My physical therapist said that it is not uncommon for older/middle aged women who fracture their shoulder to also partially tear their rotator cuff. If you are middle aged or older, are struggling to heal from your broken shoulder, and have not recently had your range of motion and strength assessed, you might want to check with your physical therapist for their view.

  • I am a 33 year old woman living in Brooklyn. I made a stupid decision to run down subway stairs to catch a train, resulting in a fall down approximately 8 concrete steps…fully aware with my purse in one hand and my phone in the other (yes, certain phone cases are worth the extra $).

    I’ve fallen down stairs before and generally I am admittedly somewhat clumsy but never broken a bone until this incident. A woman who had seen me fall rushed over asking if I needed an ambulance, yet I said no and asked her help in handing me my phone about ten feet away. Yes, this is pretty silly, yet the areas of injury, my attire, and even that phone likely prevented more serious injury.

    So, of course, I do the RICE method and take NSAIDS for a day or so – it was obvious something was wrong beyond my ability to treat at home.

    We currently have an unprecedented situation and I rarely leave the confines of my room. If I do go anywhere, I always wear a mask. It’s not just for me, but a way of respecting others and also….mandatory in basically all establishments. While much news focuses on the difficulties of doctors in this crisis, it’s also eerily disturbing to find so few of a patient.

    I have free health insurance due to unemployment which almost no one accepts. It’s an ordeal I’ve experienced whilst previously unemployed with paid insurance at a low cost for the u.s.

    I go to cityMD, after utilizing their online services to video chat with a doctor who says I need to go and receive x-rays – I am told the good news…you haven’t broken anything, though a tendon etc. May have been torn, so just keep on keepin on. If it still is unimproved in a week, come on down! And your question about pain management? What you’ve been doing.

    Two days later I do actually return, as the doctor also neglected to treat a scrape that was showing those telltale signs of inflammation and possible infection. I was so focused on my foot I did not realize he did nothing to do with my scraped up bloody knee which I even showed him. Cmon man….at least anoint and bandage! Redness, warm to touch vs. uninjured knee, pain moving it…..along with my increasingly painful and more swollen foot/ankle.

    I request something I had in that state of mind and injury not realized I was given. My discharge paperwork overall write up which is something you always receive at a cityMD. I also request to see my xrays and are told my doctor on duty would be able to do, so I just firmly state I must have my prior paperwork before I see them.

    Per the paperwork I had been given it. I’m called in to the room, disturbed by this, and read no apparent fracture and specialist will further review in a few days.

    I tell the “doctor” (not meant in offense) about the knee and increase in pain and swelling and I ask for – god forbid – something stronger for my pain. I am told NO. my medical history is accessible to them, and there isn’t a history of asking for nor receiving something such as Vicodin, etc. I tell them my current prescriptions and usage of them. I’m also asked by who I thought was the PA my Xanax prescription info and my alprazolam info. I tell her that Xanax is a brand name, and I have one prescription. She still writes I have a script for Xanax and generic which is downright silly as I shouldn’t be more knowledgeable as a health care worker on health care.

    I’m told by the “doctor” – who was actually a physicians assistant that I must proceed to an ER for a CT scan, though they could re X-ray it first. I declined as….why go to the ER for said scan when they could X-ray it as well? So, I get my paperwork (showing I never saw a physician) and hobble on over to a conveniently located ER a block away fully equipped with an N95 and admittedly expecting chaos and basically the likelihood of Covid in a Brooklyn ER.

    Oddly, it was very quiet and never containing over 5 individuals (family included) in the waiting room. Many staff were not covering their noses with mandatory masks, and I was and still am worried of this. Particularly an ER primary physician who – at a desk with zero barrier whatsoever- didn’t even have one on. I told him he should be wearing one, knew they had my results as I had overheard, and went back to my room.

    I also heard the nurses and doctors unprofessionally discuss patients, ignore my begging for help, rudely seeing me afraid of a needle if I was in pain did I want it or not? Well…I guess I have no choice? Given shot of a powerful NSAID oft given to professional athletes as I had been denied at the ER a painkiller as well….New York needs to figure this out and quit assuming we all are drug seekers.

    Finally, I’m given crutches and practice with nurse. After, the primary physician tells me I’m doing it wrong. Heck, I don’t know what’s what in the crutches game but okay!

    Enter the disturbing verbiage of this physician. I am “suspicious” of a fracture. He not once after several attempts told me what does suspicious mean? A dark spot a light spot? What? Nothing but I must go to podiatry wing during his hand written hours of operation following business day. They actually close at 4P EST, not 5P.

    I had to tell this individual to NOT WRITE ME A SCRIPT FOR IBUPROFEN- I HAVE IT. I also later read my discharge papers, and the findings are not suspicious and factually stated. I broke a bone and have some bony fragments. I call my mother in another state to interpret the findings in layman’s speak as she is in a field of medicine.

    I couldn’t afford to uber there until my unemployment came tuesday, when I discovered mister Friday has zero clue about the LAW but also none of podiatrists hours of operation. However, they thankfully see me.

    I am then told I will need a cast for three months and my bone density needs improvement. I buy calcium plus vitamin d as is needed for absorption. I am an unemployed single woman making ends meet and confronted with the harsh reality that I’ve had a broken bone requiring 3 months of a cast when it is near impossible to find non-manual labor work and need to figure out what the heck I’m going to do.

    While I cry again as he puts a cast on me which is too large to accommodate 90% of my leg wear (what am I going to do when I can’t budget new baggy pants….don’t want to offend anyone nor humiliate myself) – I’m told I also should not put weight on it…..my original nurse approval of crutch usage was deemed proper. Doctor was VERY wrong per specialist.

    I am told I am being prescribed something for the pain, though of course, welcome to NSAID only, as well as prescriptions for vitamin D, aspirin, other things I ALREADY HAVE. To boot, the podiatrist assistant (he was asking someone a question re: how to prescribe Toradol whilst prescribing ibuprofen). And….the guy wrote them incorrectly resulting in a very hungry, in pain, dehydrated and jaded woman having to get it resolved wondering why in the world am I receiving scripts for things I don’t need nor told prescribed? Why is my severe penicillin allergy I ALWAYS MENTION not listed? Allergies: None.

    Whoa. Not true, and if you ever give me a strain of it I might die. I stated my reaction to it which caused my eyes to completely swell shut and break out in hives. I have an allergy, and it’s serious.

    I’m utterly sick of all the stories of how stressful life is for ER doctors. If I wasn’t afraid of needles and queasy about blood I’d love to do the good one is able to in such a position, but I acknowledge I am not fit for it. When you pursue such a career, you must know the possibilities in your line of duty. I work in customer support (pre unemployment) and I’ve never met a soul who dreamt of that job, but I wound up doing it and I enjoyed it. I also know that territory includes extremely rude problematic frustrated individuals and maintaining professionalism.

    Why the heck wasn’t I told that I DEFINITELY broke something? Treated like crap? I’m not sure, but I wouldn’t behave like that, and after some calls am glad common ER security footage is kept for 30 days, as I am reporting the physician for endangering myself and others. I unfortunately followed the rules on that day and didn’t even hobble with phone in hand like much of my generation.

    I also have a tolerable amount of pain so….l will not ask for help from those able to provide between snacks and openly talking s-word about patients.

    • I am so sorry this happened to you. I was an Emergency Physician in my prior life. On behalf of the profession, let me apologize to you.

      And, with regard to the pain med issue. First, doctors were told that we were underprescribing narcotic medications. I once had to take a course before I could renew my license. It essentially taught me that these drugs were not as dangerous as we used to think. But of course, the opioid crisis has proved that wrong. Now, I am hearing many stories, like yours, where people are made to feel like they are “drug-seekers,” just because they have pain.

      That being said, I refused narcotics in the ER after I broke my shoulder. I asked for IV acetaminophen instead (aka Tylenol). It worked like a charm. I used NSAIDS for a few days after the fracture and then found pain relief from immobilization in a sling.

      I wish you a full and speedy recovery.

      Pat

  • Hi
    I fractured my proximal humerus back in May and posted a comment. I was gutted as everyone is!
    Just wanted to let you know how I am getting on now – 3+ months later. It was very painful at the beginning as everyone knows! To just move my right arm slightly away from my body made me scream and I experienced all the difficulties of washing under my arms too! I re-discovered the delights of talc and had to wash twice a day in the bath/shower. But you can do the pendulum thing by moving your whole body to one side and letting your arm hang and then washing underarm.
    I attended A&E but was given no info initially but also looked up immediately online for advice. I found this https://www.esht.nhs.uk/leaflet/proximal-humerus-fracture/ which was very useful.
    So right away I was doing my own little bit of physio. I attended hospital again very quickly at the clinic and was given another x-ray and then two weeks later was told I could discontinue the collar and cuff and start moving my arm more. This was a relief and also terrifying. Physio commenced about 3 weeks after the accident and I was lucky enough to receive NHS face-to-face physio every two weeks or so until 3 months. I have been diligent with my physio – doing it 3 times a day at home until recently when I now do it twice a day. I think doing yoga before has helped because I am pretty aware of how my posture should be (but isn’t!) and about keeping my shoulders down and back. Pretty soon I could see how much I was compensating with other muscle groups to lift my shoulder, sometimes it felt I was using my whole body to lift one arm…..
    But I wanted to say too that I am now doing OK, I think. The pain and bruising continued for 6 weeks and also my arm ached a lot. The aching has gone mostly and the pain has too. I met my osteopath early on by chance whilst out on a gentle walk and she advised me to take ibuprofen for 6 weeks at least to help with the inflammation (not sure whether this interferes with healing though?) I took maybe 400mg a day after that, and, most importantly, to put ice on after the physio which I still do. She told me it would take me 18 months to get back to normal whatever that is. Of course, this all depressed the hell out of me as did the doctor telling me my shoulder would never be the same again and their aim is to get me back to my normal activities etc. But that has been like a red rag to a bull! I am 64 and thought I was doing OK. I am pretty determined to do my best. I also had the horrendous fear of falling for the first 8 weeks but that is slowly wearing off though I am so much more careful than I used to be.
    So I am still doing my physio and trying to be aware of compensating for my shoulder in the exercises and I am going to go to private physio soon to get as much help and advice as possible in these early stages. I start swimming next week too and I can do downward dog in yoga.
    I just wanted to say to everyone who has just gone and done this to themselves – don’t despair! It is absolutely horrendous at the beginning but it does get better! I got so depressed thinking this was it, I am finished but I am fighting back! Shoulders are notoriously difficult and need extra care. I talk to mine and apologise and say we will get better! I want to learn how to kayak and go out on the sea……
    Just a word of warning. I fell with arms outstretched. My wrist was stiff and sore but that was camoflaged by the pain in my shoulder. So, eventually when my shoulder pain had subsided my physio noticed how I was still sore and stiff in my wrist. She referred me for an x-ray which didn’t show a scaphoid (common) fracture but weeks later with no improvement I had to return to the shoulder consultant who proposed an MRI (which I still haven’t had). BUT my wrist is now much better so it took at least 3 months for the damage there to settle. Scaphoid fractures get missed a lot apparently and I will go for the MRI eventually to see if there was any damage. So do the hand physio too and keep an eye on your hand if you fell with arms outstretched.
    In the meantime I am following Dr Salber’s advice about doing physio at home. I use a resistance band now, lying down and trying to get my arm over my shoulder behind me. Still got a way to go but I do see improvement every week with the physio and believe that is the key to getting back ROM so thank you Dr Salber!
    I also unbelievably got a phone call a few weeks ago from my GP who discussed a bone scan with me. I just told her no because I wouldn’t like to go on the drugs they give you (I too am a nurse). We discussed diet etc and exercise and I was happy with that. To be honest I fell with such force that I would have been surprised if I hadn’t broken something. So that is why too I am determined to get back with my exercise, yoga and everything.
    I read avidly everything everyone has put on here and found it enormously helpful if a bit scary at times. I really feel for people who don’t have anyone to help them at the beginning because oh boy I really needed it and I think I have been lucky with the NHS and how covid has been. And as for having to go back to work! Well that would have been impossible for me, I just couldn’t believe how painful this injury proved to be – it didn’t look that bad on x-ray. Good luck to everyone and thank you.

    • Thank you for this. I just fractured my shoulder October 4th,
      Same age as you and arm outstretched and I hyper extended it. I have an orthopaedic appointment Oct 16 ( yes that is our excellent canadian healthcare😳- having to wait 12 days…)
      Thank you for your tips and reassurance in improvement and normal function.

    • Hi Lesley, thank you for sharing your story, I’ve found it very useful. I came off my bike three weeks ago and have a spiral fracture of the humerus.. I was advised to not take ibrufen as it can interfere with bo e growth but I have swelling in my forearm and hand. So I’m interested to know whether I should be taking it to help. I’ve printed off your attachment too, thank you. Michelle

    • Hi Michelle,
      So sorry this has happened to you. Just tried to look for spiral fracture of the humerus and oh that looks painful and also more complicated that a proximal fracture? I honestly can’t advise wisely on ibuprofen use. I did use it but only for about 2 weeks as my osteopath told me that it helps with inflammation but I’m not sure if you have been told otherwise. As mentioned, I did use ice packs a lot which definitely helped especially after physio. I also had pain and bruising in my forearm and pain in my wrist (the latter finally settled after 3 months). You are very early days if you are just 3 weeks. I can’t remember exactly but I know the bruising took ages to settle and I used arnica and comfrey, probably it was gone only after 6 weeks.
      I am now exactly 9 months post accident. I can only say it is very true what everyone says about slowly slowly with this type of injury. I thought I could beat it all by doing physio but I have discovered I can’t! I have function back and go to work etc. but went a bit crazy after Christmas with resistance bands thinking I needed to build up strength. Then I wondered if I was doing more harm than good. I am now back having private physio and being much much gentler with myself. My physio told me my muscles were fatigued. She is doing ultrasound on my shoulder and my home exercises are different and gentler. Still under her care for the time being. It is amazing just how quickly your muscles lose their strength after just a few weeks really of non use and how long it takes to get them right again.
      I also went for my DEXA scan but was unprepared for the result which said I had thinning bones. The “specialist” advised alendronic acid for me without really knowing the full history of my fall or my family history. I am not taking it and am now researching about bones, diet and exercise. It would appear that prescribing that drug with all its nasty side effects is the default setting for doctors and it is advisable to be fully armed with knowledge and research before going for the scan.
      So, all in all, my recovery from the shoulder fracture is ongoing. These fractures are not easy and I do think it is wise to keep an eye on yourself and if not happy with anything return to the physio or keep asking questions of your doctor. I am trying now to limit any arthritis I may get in that shoulder. The NHS in the UK aim to get you functioning and don’t really look beyond that for anything else.
      Good luck with your recovery and yes, it does get better! I can get through the day without really being aware of anything now. I have one range of motion that my shoulder just won’t let me do but hopefully, fingers crossed, that will resolve.

  • I slipped on an incline while hiking, put my arm forward to steady myself, and heard a loud crack. My shoulder dislocated, the ball broke off the humerus, and a small piece of the socket also fractured. My initial surgery repaired the ball/bone with a “bird cage” titanium mesh (I apologize for not knowing the exact terminology), along with a plate, pins, etc. I had a second surgery 6 weeks later after it re-dislocated, repairing the socket again and tightening everything up. Initially I made a lot of progress in PT, felt little pain, and had good movement, but then it regressed. My therapist basically said I was getting worse and he couldn’t help me any more, and encouraged me to be more assertive with my surgeon. After a year, the regrowth was not successful, and the ball was flattening out and no longer fitting in the socket, so I had a reverse shoulder replacement 2 weeks ago (at age 52).

    No one talked to me about bone density. I specifically asked about the possibility, and was told it was probably not a problem (despite strong history of osteoporosis in my family, AND I had shattered my elbow 2 years before in a bike fall). I requested a bone density test and was diagnosed with osteopenia.

    My emotions have mostly been manageable, although I have had a few quiet pity parties for myself. I did experience unexpected fear when I took a non-strenuous walk through the woods on very flat terrain — I heard the crunch of gravel under my feet and it triggered a small panic. As I recover for the third time, I divide my timeline as before/after the break, as my quality of life has noticeably decreased and the chronic pain is disruptive to my mood and my ability to participate in activities and work (teaching). No one on my medical team has asked about this or offered any help.

    • Unfortunately, your experience with not being tested for osteoporosis or being asked about adverse psychological side effects of the fall/fracture is all too common. These injuries cannot continue to be addressed as “broken bone, stabilization, end-of-story.”

  • This post and comments section has been super enlightening and helpful! I (32 yr old woman) came off my bike at the end of April this year, landed hard on my left shoulder. X-rays confirmed an un-displaced greater tuberosity fracture. I’d cracked the bone in a couple of places, right where the rotator muscles attach. Because of the location of the breaks I was told to be super careful to avoid any displacement, otherwise surgery would be needed. Had some follow-up x-rays a week later which showed that nothing had moved, so was allowed to continue healing up in the sling.

    Fast-forward to this point, where I’m nearing the 4-month anniversary of my accident. What I’ll say is it’s been a constant process of readjusting my expectations, as the healing process has been slower than I expected. Honestly, I thought I’d be nearly back to normal by now! I was given a pamphlet of standard physio exercises at the outset, and then only spoke to an NHS physiotherapist (over the phone, due to Covid) at around week 8. I was pretty frustrated at that point, so I started having private regular in-person physio sessions from week 10, which has been a HUGE help. The range of impacts from the injury seem to be so varied (based on this comment thread alone), and it’s made such a difference having somebody working with me specifically and assessing my movements and personal progress – from a physical point for sure, but also from a peace of mind point of view!

    Right now my ROM is still significantly limited. I can only raise my arm just above shoulder level, and there’s a bit of compensation going on so the movement isn’t completely normal. But I don’t have too much pain or trouble sleeping, and I can see tiny baby steps of improvement week to week. I’ve been told healing is slow because of the location of the breaks, and how they disrupted the rotator cuff muscles. Also my muscles atrophied quite badly while immobilized, so I have a good deal of weakness. It is hard to constantly bat off the negative thoughts about the slow progress, and worries that maybe I won’t get full ROM back. I’m trying to stay positive and focus on those silver linings. I wanted to share this for any of you out there in a similar position (still battling to get back to normal, months down the line, after what seemed like quite a minor fracture!) I really think the mental challenges which come with injuries like this are as significant as the physical aspects.

    • Thank you for your comment. I know the slow progress can be discouraging and think it would be helpful if our doctors laid out the expected time course for a return to normal. That being said, PT is the key to getting back your range of motion and strength….keep it up. I did my ROM exercises for more than a year and still to strength training 3-4 times/week. Keep on working at it. Pat

    • You’re doing well! I had the same injury with some displacement following slipping on the ice on 18th December. Struggled pain wise and I was given no movement advice in ED just told to wear the sling. I’m a nurse so googled and found a fabulous exercise sheet for the injury from a different NHS trust which I did from day 2 so when I finally got physio 8 weeks post injury she was thrilled with my movement but pain was still a problem. Covid then hit and I had to return to work and physio stopped. My movement started to go backwards and the pain increased and I really became quite distressed about my limited movement having worked so hard to help myself. Fortunately for me I work in a fabulous team and one of our physios became my knight in shining armour! My pain is still a big problem as I also have supraspinatus calcification, but my movement has dramatically improved which I am so relieved about. It seems hopeless at times but all of a sudden you will notice you’re able to do more things if you carry on with the physio, but I’ve been warned it will take 12 months to achieve the best ROM, but I am definitely more optimistic now and hopefully you will find this too! Good luck!

    • This is SO helpful! I’m an almost identical case – 35 yr old woman, fell mountain biking, hit my left shoulder, and have a non-displaced greater tuberosity fracture. I didn’t realize it was broken at first (I thought I had torn my rotator cuff) and didn’t go for an x-ray until 2 weeks after the fall. I started wearing a sling at 2.5 weeks and I’m now at 5 weeks. Luckily it’s healing as it should for week 5 despite not wearing a sling the first 2.5 weeks. I’m starting physiotherapy next week (week 6). I’m really surprised by how much it still hurts, and I’m finding most of the pain isn’t actually where the break is. It’s around the middle of my upper arm and the front of my shoulder. It seems to be the strain/atrophy of my muscles that are causing me pain vs the actual break. Thanks for sharing your story. It’s really encouraging to find the exact same case to mine!

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