broke shoulder

I was in a hurry to get to the gate for my flight to Tuscon. In the summer of 2016, 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 (I actually 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.

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 a 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? 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 the nausea and foggy head that accompany opioids. It turns out that was all I needed.

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. It included 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.

It also provided 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 the 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 from the UK that I had already read—that 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 and 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 am about 80% of the way to normal shoulder function (Hooray!).

A deep dive into falls and fractures

Because there is so much more to the falls and fracture story, I have decided to divide it up into different posts. Here are some of the issues related that I will be exploring over the next several months:

  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 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 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?

I want to explore all of these aspects of falling with you 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.

Related content: Do You Know Your Risk of Fragility Fractures?

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 info@thedoctorweighsin.com.


I originally posted this on July 24, 2016, shortly after my fracture. I am republishing it today because I am participating in OpenIdeo’s Healthy Bone Challenge.

I am hoping to hear more from readers about their experiences with osteoporotic fractures:

  • Were you asked about 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 were present after the fall/fracture? Did any of your health professionals ask about or offer help with these symptoms? 
  • Would you fine a program, such as the one described in the Challenge description helpful? Would you use it?

You can leave your responses in the comment section below. Or, if you prefer you can leave responses on the OpenIdeo site (link above). Or, send me an email via info@thedoctorweighsin.com

49 COMMENTS

  1. Thank you for the reassurance about travel. I definitely do not want to give it up. We are starting to make plans for our next trip, to Southeast Asia. My husband says we will keep going as long as we can. What did they do for your neuro work up? I too worked for Kaiser and while I was there “hall wall medicine” was practiced a lot. It’s a little more difficult now to get referrals. Does anyone not have trouble with range of motion after these fractures? Thank you again

    • Neuro w/u:

      A neurology consult with detailed neuro exam, nerve conduction study and EMG – all normal.

      Re ROM. The key is physical therapy that focuses on teaching you a home program, not just in office PT. I did my ROM exercises faithfully for well over a year and now have an almost full ROM. I have no functional limitations.

      After my wrist fracture an immobilization I requested a PT referral even though it was suggested that it wasn’t needed. I asked the PT to focus not just wrist ROM (not really too limited by the fracture), but building up the strength of the small muscles in the hands and fingers.

      We loved SEA visiting all of the countries over the course of several visits. Don’t miss Laos (Luang Probang) and the far north and far south of Vietnam.

  2. Six weeks ago I was on a walking tour in Galway Ireland and suddenly found my self on the ground. I think I slipped on the wet cobblestones, but I am not completely sure. I have fallen in the past and always knew what I tripped on. There never was any discussion about why I may have fallen. Fractured surgical head of humerus, mildly displaced. I am 72 and have had osteoporosis for years but also had fear of the treatment side effects. With my fall I had pain in my hip/thigh after a ct scan and mri it was discovered that I had hairline fractures in my hip as well. My care became focused on the thigh pain and my rt arm was left in the Irish immobilizer. Providers just kept saying it was fine. I think someone should have told me to take it off and move my elbow because when it was weaned off my elbow was moderately frozen. I am doing PT now and getting my full range of motion back. Insomnia, I would take norco at night with Ativan and sleep thru the night on the sectional couch. I am interested in FOF, my fall was the 42nd day of a 43 day Europe trip. My husband and I love traveling and have been doing long vacations the past few years. My 36 year old son said we were pushing ourselves too much. I think I was in better shape after walking so much for 42 days. Last night we walked a few blocks downtown, every crack in the side walk was magnified in my mind. I definitely have fear of falling. Also fear of future fractures. I took Reclast 3 days ago and had horrible flu like symptoms afterwards, feeling better now. I am glad to hear the fear of falling will pass. Thank you for your interest in this subject I wish I had found your site sooner.

    • Hi Cathy, I am so sorry about your fractures, but I am glad that you are on the mend now. My adult son said to me a few years ago, why don’t you slow down, quit working, maybe just putter in the garden. Instead, my husband and I amped it up. Last year we had the busiest travel year of our long life of travel – despite having osteoporosis and two fragility fractures (saw Sri Lanka in December wearing a splint for a wrist fracture – definitely doable. Travel is good medicine!

  3. Very informative article especially as it extends into the aftermath of a fall. Thank you. My fall brought on feelings of fragility, inbalance and the FOF. I did not break or fracture any bones when I fell, the fall was due to my right knee not supporting me and needing replacement. I suffered from the knee due to bone-on-bone and arthritis. It was when I fell on two separate occasions that I decided to take my ortho’s advice and have the knee replaced. I thought for sure that once the knee healed I would regain my balance, return to my original gait with no more limping or clumsiness. The surgery wasn’t the success I had hoped for. I still limp slightly – still have some knee pain and an internal clicking every time I bend the knee. The worst consequence is the fear of falling – I go down all stair or curbs planting my foot parallel to the curb. Same thing going up. I did PT and water walking for a while but when forced to stop when another major medical issue put me in the hospital. I am hoping now to resume water walking and some gym workouts soon. My fear of falling was never addressed by with my surgeon or PT during my recoup time. I have that fear today and don’t know as I will ever overcome it. It would seem that information on this possible post-surgery circumstance would be part of an “early pre-surgery” warning” Treating the whole body during any major surgery (or rehabilitation) should be the norm, not the exception.I am a 72 YO female who while not a workout fanatic, but very active. I do travel, love to walk, visit museums, sightseeing and love the outdoors.

  4. Thank you for your article. As a fellow fast walker, I tripped while heading off with my rucksack for a 2-day work trip.
    Greater Tuberosity fracture. Back at work and using sling for protection on public transport, but about to start going out without it.
    I am very active,and several people have asked ‘But how did that happen?’ Now I can say it can happen to the best of us. Thanks to you and your respondents.
    Now doing PT and reassured that I’m not the only one who found it hard to move my arm away from my body.

  5. Pat, thank you so very much for your blog, advice, and encouragement! Tomorrow will be three weeks since I fell, hard, face first while running (literally) to catch the FedEx man at my front door so he’d set a very heavy boxes inside instead of on the porch in the rain. The toe of a sturdy rubber soled German slipper caught firmly on the hardwood and down I went as I reached out for the front door handle. My left shoulder and upper arm, right wrist and forearm took my full weight at a run. I’m 71 and have never broken anything: what an eye-opener! The shoulder pain was excruciating, a wave of nausea came over me, I somehow realized I was alone and needed to try to open the door and ask the delivery man to stay a few minutes. He was a true angel, took off his shoes and said he’d stay as long as I needed him. He took my right forearm and helped me to a sit, when asked, then in a few minutes he mostly lifted me to the nearby couch, got water and naproxen, my glasses and cell phone. He even left his phone number and name, said he’d be in my area all afternoon! Next day I called his supervisor, who has entered him in a national award program for exemplary customer service. So happy for him! I called 911 since I couldn’t move w/o waves of incredible pain in my left shoulder. The hospital took X-rays and put on a firm, wrapped splint. It was a proximal humeral head fracture with three white lines radiating from the neck area, not displaced. Two days later at the ortho, they took off the splint, put on a sling and emphasized it was only for comfort and I did not have to wear it. It wasn’t comfortable after a while so after a couple days, I went without it during the day. The tramadol gave me nausea, so I used naproxen, double dose. Not sure it helped much, though. Lots of zinging pain in the shoulder if any muscles in my body happened to flinch. I’m concerned that I was not told to keep it immobile, as everyone else has been told. At three weeks it still hurts to try to use the left arm for anything. I’ve moved wrist, elbow regularly just in the course of the day, fingers typing. Not sure why ortho didn’t give me the wrist and neck sling support I’ve read is the best for healing. I chose this ortho due to his excellent reputation in our Solano Co. area. Tomorrow I’ll see on the X-ray how it’s healing. A little worried it should be hurting less by now. Thank you again for this wonderful resource you’ve provided!

    • What a story. So glad the UPS man stepped up to the plate. He deserves that award. I learned when I was looking for answers about treatment for my shoulder fracture that treatment recommendations are all over the place.

      Many orthos recommend surgery but my ortho who was willing to spend quite a bit of time with me addressing my concerns. He pointed out that the best studies show that most (but not all) times surgery is not needed. The ortho literature was not that impressive with many just being small studies not well designed. There was one large study from the UK that supported what he said.

      I haven’t heard of people being treated without a sling, but it wouldn’t surprise me at all if the outcomes were the same with and without a sling. It’s primary function may well be comfort.

      I did have a second fracture last year. This time my right wrist (tripped over my big black lab in the dark). Ortho wanted to cast it, but I was going to Sri Lanka for a month a few days later. So I said, just give me a velcro splint instead. I didn’t want to have to deal with showering with a cast when I was in the developing world. When I returned to the states after 4 weeks, the fracture had healed nicely.

      It makes you wonder how much of routine fracture care is science and how much is just the way its always done.

      BTW, I am wondering, did you experience any fear of falling, insomnia, reliving the fall or other types of symptoms after your fall?

      Pat

      • As far as insomnia, I think it was a combination of things that made sleeping not easy. For four nights I stayed on the couch, sitting scrunched on my right side with pillows around me for the first two, then laying mostly down on right side on pile of pillows at head and shoulders. I was terrified to bump shoulder and severe pain with any movement. Night five I made a small space for the right side of my body in bed with a fat pillow behind me, two firm ones under head/rt. shoulder, one to rest left wrist on by my stomach. This allowed several consecutive hours of sleep once shoulder pain subsided. My neck and back hurt constantly from the unusual positions and weight of the sling (wore it to bed 2+ weeks). Still not sleeping a full night, but stay in bed and try to go back to sleep when I wake in the night.

        The fear of falling is strange. Yes, it almost seems I’m less steady due to placing each foot carefully as I go down the few low, wide steps on my deck I’ve zipped up and down w/o thought for 20 years! It feels unnatural, which I think makes one less steady on their feet. I’m a fast walker, tend to run just to feel the good feel of moving vigorously when getting up to tend laundry of go to the kitchen. I walk rapidly on the sidewalk. This is going to be my biggest challenge, I think: changing lifelong behavior to try to ensure I don’t fall again.

        That the fall happened so quickly was unusual for me, as when I trip I’m able to re-place my feet to catch myself. I do tons of heavy yard work, am at a good weight for my 5’7″ frame, and am more active than most of my high school friends on Facebook. But, I was just diagnosed with osteoporosis on the DEXA scan I’d been putting off having. Very frustrating for a 30+ year pescatarian/vegetarian eating a very healthy diet!

        What did your doctors say about driving? Medical advice I read said not for two months. My ortho was rather vague, but I drive a full sized pickup truck and don’t want to take chances. I live alone now, though, and it’s become terribly inconvenient. My in-town kids are already over committed with their careers and children’s activities. I’m always the one helping out to make things work, not the one needing help. One of the wonderful EMTs who came to get me actually volunteered when I worried about my granddaughter that his wife works at gd’s high school and he would ask her to tell my granddaughter I was at the hospital and wouldn’t be there for her that afternoon when she got out of school.

        One more question as far as the pain you experienced. How long would you say it continued to hurt to use the arm with the broken shoulder? Pain is exhausting.

        Chuckled at your comment that maybe ortho care for shoulder fractures (possibly other fractures as well) is done just because it’s always been done that way.

        Your decision on treatment for your wrist before Sri Lanka shows it is a bit of a guess for the docs to know just what each injury needs for treatment. I’m glad it healed well. BTW, what were you doing that broke the wrist?

        Kay

        • So a few things. The pain will go away. I can’t remember exactly how long it took for my shoulder pain. But I can tell you that now I am completely pain-free and have an almost normal range of motion. Be sure to ask your doctor for a PT referral. I saw a PT who only did shoulders. She gave me a home program that consisted of many different range-of-motion exercises. I did them faithfully for a bit more than a year. This, in my opinion, is THE most important thing that you can do to get back to normal.

          The fear of falling thing is weird. And doctors don’t tend to bring it up. I was just like you. Fast walker, going up and down stairs to my office and bedroom with complete ease. During the time I had the FoF, I felt like I was a little old lady – watching every step. It did finally fade away – but it took a fair amount of time – perhaps 12-24 months. My gait is now normal.

          There are a few things I did change in my life. I now wear real shoes instead of the slip-on sandals that contributed to my fall. I also take QiGong which helps with balance. Tai Chi is very good for this as well.

          I am very interested in this complication of falls and have submitted a research idea to IDEO. Take a look. Perhaps you might like to jump in on the conversation. Here’s a link: https://challenges.openideo.com/challenge/healthy-bones/ideas/identify-and-treat-ptsd-like-symptoms-after-the-first-fall-fracture?utm_campaign=healthy-bones_Challenge_ideas_FE&utm_source=contribution-commented&utm_medium=platform-email&utm_content=normal&utm_term=290076#c-b266980e7cc7ed228ea1dce7e463f906

          • I’m a very faithful exerciser too, Pat, so the PT is second nature for me. They have good connections for that here at North Bay or Sutter Health, where I usually go for medical care. About the driving, how long before your drove? Afraid of rebreaking the shoulder if I moved suddenly, etc.. I’ll look at that web site. Thanks!

  6. wow, just discovered this. Great information, only 2 weeks ago I fell of a horse during my lesson, he was bigger than my usual lesson horse. Felt myself falling, tried to tuck and roll, but knew as soon as i had landed something was wrong. Felt like my arm was asleep,taken to ED, given IV morphine. Fractured proximal humerus, and ribs. still very sore, arm in sling. Treating conservatively. So far so good, have had heaps xrays and CT scan.
    I work as a clinical nurse, off work for 10 weeks at least. Frustrating that I cannot ride, run, do all usual things. Shoulder aches heaps, but rib pain is worse I would say. And sleep, manage a few hours before I wake up in pain, both shoulder and back.
    Certainly an experience I dont want to repeat.

    • I forgot to add that I am 63, still very active – or was till this happened.
      I will get back to riding, running, gym but its going to take a while I am a work in progress.

    • I am sorry about your fall and fracture. It is such a shock when something like this happens. I hope you have a smooth recovery. BTW, the most important thing you can do to get back a full range of motion if really good PT (not just a pendulum swing) that you do fully and faithfully. I did mine for more than a year. Good luck!

      • Thank you. yes its 3 weeks tomorrow since accident. I have already linked with PT for assessment next week, and planning to do hydrotherapy, then later back to gym. I need to be able to ride again, as well as back at gym. Running, obedience and agility with my dog.
        I am determined this is going to happen, I know its a long haul. But as they say “üse it or lose it” so I aiming for 100% recovery and giving my self time to do this. :)

        • One of the best range of motion exercises that I did was to hold a long wrapping paper roll in both hands while lying face up on the ground. I then made an arc with my arms each time trying to get the paper roll closer and closer to the ground. I eventually could easily get it all the way down, but continued doing this for more than a year. easy to do at home.

  7. OMG! Thank you so much for addressing this! I’m 59 and 21/2 weeks ago I tripped on a kitchen rug and went down HARD! I have four fractures in my shoulder. The day after my fall I saw an ortho dr who took additional x-rays and said to continue to keep my left arm immobilized and it would heal on its own. A week and a half later he wanted more x-rays and is now referring me to a shoulder specialist for surgery. He told me it would be a decision between a total shoulder replacement or “putting humpty-dumpty back together again.” I don’t understand how it goes from immobilization and rest to a possible shoulder replacement! I’m self employed and haven’t been able to work since my fall. I’m looking at what I can start selling in my house to make ends meet and now I’m facing potential surgery with its lengthy recovery. I have been doing research online but I’m more confused than ever. I don’t even know what I don’t know. Also, I’m scared to death of falling again! I envision myself falling again, I nearly refuse to go up or down a stairway and when I do walk I keep my eyes glued to the ground. Will this go away? What should I ask the surgeon? HELP! I’m in full panic mode!

    • Hi Denise,

      I am so sorry about your broken shoulder. I am sure you are feeling like I did. What a shock? How did this happen? What does it mean? Will I ever get back to normal again?

      I am going to answer these questions based on my experience as someone who also tripped and broke a shoulder. I am not answering as a doctor. I am not qualified to address shoulder fractures and I do not give medical advice on this site.

      So here goes:

      I did a lot of googling after I broke my shoulder. It was disturbing to see the differences of opinion on how to treat different types of shoulder fractures, doctor to doctor, country to country.

      Basically, immobilization (sling) is a good first therapy until you see a specialist who will evaluate the details of your fracture and make recommendations. I thought I needed surgery until I read the medical literature and talked to a trusted orthopedic surgeon. He strongly recommended conservative therapy (immobilization and then PT) for me. My fracture was only 2 part with minimal displacement and no angulation.

      Your fracture sounds more complicated than mine – 4 part fracture. You don’t say anything about whether it is displaced, angulated, where the fractures are, etc. That is really not in my area of expertise to evaluate.

      But I am a big believer in getting as many expert opinions as it takes for you to be comfortable with the recommendations. However, this can be both expensive and confusing. You will have to decide how much advice you need before settling on a doctor that you trust.

      So, let’s talk about your fear of falling. This was the most surprising thing to me. I actually think I developed a mild PTSD and the fear of falling was just one symptom. The other was really bad insomnia.

      Let me reassure you, if you work at it both of these symptoms will go away.

      I spent weeks being afraid of going up and down stairs which was hard as both my bedroom and home office are up a flight of stairs. So I just accepted it as a reasonable defense mechanism on my part. I made it a point to watch my feet wherever I went, particularly up and down stairs.

      Things you can do to help yourself include
      -seeing a good PT for balance exercises,
      -taking balance classes (including Tai Chi or what I am doing now, QiGong).

      IT WILL TAKE TIME.

      Be patient and be good to yourself.

      You didn’t describe insomnia, but for me, it was a huge issue. I actually moved my bed into another room and cried at night when I couldn’t sleep. I tried melatonin – didn’t work. I went to a local meditation center – it helped a bit. I finally tried prescription sleeping pills which worked beautifully but were not a viable long-term solution. Little by little almost all of my symptoms (fear and insomnia) went away. Yours will too.

      I ended up tripping on my dog and fracturing my wrist a few months ago. It was interesting that although my fear of falling again reappeared – I think mainly because my wrist was in a splint instead of a cast because I was traveling. But that went away once I was out of the splint.

      Bottom line: After your shoulder is treated (sling or surgery), work really hard at the recommended physical therapy. Aim for a full range of motion. Keep on doing the PT for month and months after you are pain-free. I did my range of motion exercises for almost a year.

      Work on your balance. Keep on moving (swimming great). Get enough sleep.

      You will get back to normal.

      • Thank you so much for your thorough, articulate and kind response. I actually gasped out loud and my heart started racing when I read you had tripped and broken your wrist. I wish you a speedy recoery!

  8. Thank you for your stories. I’m on week 4 of a broken humorous right at the ball. The pain seems to be getting worse, which makes my fear of falling overwhelming. I’m 52 and like many of you having terrible insomnia. Just reading your stories made me feel better.

    • You are welcome, Pamela. I am glad all of the stories have helped you feel better. Two thoughts offered as a person who has been there (not as medical advice): 1. Keep on walking, watch where you put your feet do balance exercises (yoga or Tai Chi) and take a deep breath, the fear of falling will fade over time. 2. The insomnia was harder for me to conquer. I tried meditation (helped a bit), melatonin, benadryl, sleep tapes, etc. But for me what really helped was a short course of a medium acting (~5 hours) prescription sleeping pill. It let me experience what it felt like to wake up fully refreshed after weeks and weeks of fitful sleep and long days of feeling horrible. I am not advocating sleeping pills for anyone else. They certainly have their side effects (dependence being one of the most serious), but they helped me over a rough patch.

  9. After caring for my sick husband for over 15 months, I had lost 40 pounds when he died. After 6 months of changing names on titles and other stressful tasks. I was headed to bed when I hit my toe on some object and was thrusted forward into the corner of a wall. I hit right side of face and shoulder and then totally spun around landing on hardwood floor. I hurt and was dazed. I just laid there trying to comprehend what happened. My right arm hurt but I could move fingers. I used my left arm to move my right arm over my chest. I searched around in near darkness and found a wide ribbon I had saved from Christmas. I used it to tie right arm to my neck. I was in food physical condition and scooted down hall to staircase and used rails to stand up. I called my daughter. It took her over an hour to get to me and I decided to just sleep. I thought may it was fractured but thought I would wait. Next day decided to go to ER. Yep, 3 fractures. A spiral fracture to upper humerous and fractures on both sides of humerus head. After 5 miserable weeks in sling I started using arm. No, I started to move it but I could hardly lift it. I had home therapy. BTW 80 years old and l live alone. I could lift 20 pounds and drag 30 pounds but now I couldn’t even reach a lightswitch. The worse part was not being able to cook decent meals. Now over a year and a half later I can do much more but I am always in pain. Sometimes a 2 level and sometimes an 8. Using a vacuum cleaner is torture. Even using a computer mouse is painful. So I am concerned that the pain will never stop. As for fear of falling, I was an ice skater and never feared falling and usually went with the fall. This made me fearful of falling. I was walking sort of fast when I fell. Now I walk slower. We use our arms to balance when we walk. So having an arm in sling changes our balance. While in sling we are less active and leg muscles get weaker as do other body muscles. I think PT should be a whole body activity. I had always done PT exercises for legs when I cared for my husband. I have resumed them. I also thing possibly being less mobile might do something to our inner ear balancing. My arm was black and blue from shoulder to my hand. My age and diabetes definitely had negative effect on my recovery.

  10. Thanks for your reply – 95% range of movement sounds like a great result. I’m definitely focusing on one day at a time & avoiding the worst case scenario/catastrophising, which would be terribly unhelpful. I’m expecting to begin physio in the next fortnight, so that’ll be a real positive step.
    Again, thanks for putting your story & analysis on the web.

  11. So interesting to come across this blog post. I fell a week ago running downhill on cobblestones, wearing hiking boots, something I’d done several times previously. Landed heavily on outstretched right (dominant) arm. Fractured humeral head, not displaced, in sling, expecting to begin physio in a fortnight assuming next xray is satisfactory. Painful & extremely inconvenient. I live with my parents in their 70s, dad v fit, mum quite advanced with Parkinson’s. So my inability to drive will impact seriously on all 3 of us. Dad & I usually share the care/ driving, so next few months is going to be tough.
    Also, I’m a keen outdoor hiker & gym fiend, at my best fitness level since childhood (I’m 46), so serious restrictions on my activity levels is already freaking me out. I can see my OCD has worsened considerably since the accident. I have a long history of depression & eating disorders too, so all those factors are cause for concern. But I do have some excellent longstanding friends, great neighbours & a close family, so I’m hoping to take this thing one day at a time.

    • Hi Kate, I am sorry to hear about your fall and fracture and definitely agree it is very inconvenient to have your arm in a sling. Once you are out of the sling, you will probably be recommended to have physical therapy to get back your range of motion – this is very important. I had a 2-part fracture of my humeral head/neck. I went to PT for a while and did all my home exercises, some of which I still do today – several years later. I have about 95% of my prior range of motion – a very good result. I also had a mild PTSD and terrible insomnia after the fall which is not uncommon. I went to our local zen center to get help meditating which helped with stress and with sleep. Glad to say, all’s back to normal now – except I do watch where I put my feet much more closely than I did before. Be patient with yourself. Recovery takes time. But I am confident that you will get there with the help of your health professionals, family, and friends. Best wishes.Pat

  12. It was interesting to read your report and I thought I’d explain what happened to me. 3 weeks ago I was out running with my husband when I tripped over a root sticking out of a concrete footpath unfortunately I fell forward on to my hands and have broken both shoulders the Dr’s felt sorry for me and have opperated on my right but left the other in a sling gradually I am regaining strength in both. I think I’m a bt of an experiment to see if the final outcome on both shoulders is the same!
    With regards
    Charlotte

  13. Hi Patricia, I appreciate you for sharing and I hope you are doing well.
    On November 28th 2015 while shopping at a local grocery store I fell into the the dairy case (cooler) and came within inches of hitting my face.
    It all happened because I am short and the chip dip was on the top rack and was not fronted so I knew that this was going to be challenging. I put my body as close to the rack as possible stood up on my tip toes and flung my right arm up to reach for the dip only to realize the rack was not locked in place! Everything happened so fast as I reached to the right to prevent my face from injury I grabbed the metal rack and felt something give way in my arm/shoulder. There was a man behind me trying to help, he grabbed my shirt combined with his help and me using every muscle in my right hand and arm saved me from a serious face plant. I felt my embarrassed afterwards and just wanted to leave the area. As I walked away my whole right arm, shoulder and hand felt like it was on fire. I did not know the extent of my injury for about 6 weeks. My doctor wanted to give it time to heal because he thought I had sprained my arm. I was in incredible pain for weeks, finally I had enough and went to see a two different surgeons. After a CT-scan I was diagnosed with a torn rotator cuff. The hand surgeon diagnosed me with carpal tunnel and trigger finger. After all the test were in I was scheduled for hand surgery to fix my problems. He made two incisions on my hand and the shoulder surgeon repaired my arm and shoulder. When the shoulder surgeon opened up my arm he found that I had ripped 80% of my bicep off the bone. It’s been a year since the surgery and my shoulder seems better after the cortisone shot. I wish I had not gone through with the hand surgery.
    Ten days after my shoulder surgery I had a mini stroke. Also I lost three teeth from the tubing they put in my mouth. When woke up from surgery my partial plate was already back in my mouth. I’ve had several surgeries and not once did they put my partial plate in my mouth. I always put it in myself when they bring it to me.
    Thank you for letting me share. I don’t know what to make of all this!

  14. Your photo of the bruising and the x-ray of the fracture look just like mine now. I don’t have your knowledge, so, I am going in for the surgery tomorrow morning. The displacement is well over 5mm and that was the magic number for me to say plate and pin it. My neck popped and has ached since the fall, but, I didn’t mention it, since my shoulder was my main concern. I wonder what the treatment was for your neck.
    My fall was from misjudging my steps coming off a ladder. I was too eager to get cleaned up after successfully repairing a garage door opener. Age 51 years & 51 weeks.
    Hope you had a full recovery.
    I’m not sure how the PT will go on my arm, I tore the bicep many years ago, so, range of motion was already impaired, some.

  15. Thank you so much for this. I’m 11 days out from a shoulder fx incurred while ice skating. The fear of morbidity is far harder to cope with than the pain (I’m 60.) It’s my dominant arm and I fear being unable to draw or to swim, since like you The injury is to the tuberolosity area. I will see the orthopod tomorrow so I will hope get more info then.

    I’m going down stairs with my feet parallel to the tread instead of at right angles. in other words, I am turned so that I face the rail. I don’t advance to the next stair until both feet are on the ‘current’ stair, i.e I play ‘catch up.” If I cone out of this with reasonable ability I’m not givingup cycling but I have thought carefully and I can’t risk ice skating again, even thogh I love it – too easy for ice to be damaged (which caused my stumble and fall) or to be knocked down by overexcited youngsters, etc. Risk assessment is hard – where is the ‘sweet spot” between paranoia and carelessness. The stress is very real and I struggle to get enough sleep. I find sleeping in recliner awkward as it puts a lot of stress on the back for example.

    Nancy your story sent chills down my spine. I wish you and the author the best.

    • Thanks for sharing your story. I think reactions like these are much more common than we have thought and are, I think, by and large, ignored by physicians. I know I didn’t pay much attention to these issues when I was in practice. I would love to hear from others, what is your experience with getting help with emotional issues after a significant health event?

      • Fell hiking in New Mexico 6 weeks ago. Fell on top of shoulder and crushed everything. Fear of falling is a real issue now. Out of sling, will have to have some surgery for impingement. Driving & using arm a bit, but the memory of the fall is a real nightmare. I won’t look at the X-rays. No one discussed anything about the fear. 3 days after my break I tripped on the concrete lip at the end of my garage where it meets the driveway. It was a miracle I didn’t fall. I came so close. Every night I dream about falling: off a bridge, off a mountain trail, off a ledge, out of a tree, off a bike, off a roof, off a cliff. I hate to go to bed.

        • I am sorry to hear about your fall and the fear of falling. The latter is quite common after falls. I had it. Every time I walked down the stairs from my office I could feel myself falling to the bottom. And whenever we went to the airport, I had to avoid the place where I fell.I also had terrible insomnia.It was a mild form of PTSD. It did eventually go away completely, and yours should too. One of the things I did that I think helped me was going group meditation once a week. I also saw a neurologist to be sure I didn’t have any gait issues that could have contributed to the fall, then I saw a PT who helped me both with shoulder mobility and balance. I also have a great massage therapist who has been working on my shoulder to keep it mobile. You will get better, it just takes time and a bit of work on your part. Let me know how it goes. Pat

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

LEAVE A REPLY

Please enter your comment!
Please enter your name here

This site uses Akismet to reduce spam. Learn how your comment data is processed.