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Proximal Humerus (Upper Arm) Fracture

 

A proximal fracture is an injury to the bone of the upper arm. The upper arm bone, the humerus, connects the shoulder to the elbow. Proximal humerus fractures occur near the shoulder joint.

The shoulder joint is a ball-and-socket joint, with the ball being the top of the humerus bone. Fractures of this ball are considered humerus fractures. These fractures may involve the insertion of the important rotator cuff tendons. Because these tendons are important to shoulder motion, treatment may depend on the position of these tendon insertions and their proximity to the fracture.

Etiology

Humerus fractures can occur by many different mechanisms, but are most commonly caused by falls. The proximal humerus fracture is especially common with elderly people due to osteoporosis. Typical history involves a fall on an outstretched abducted arm. Pathologic fractures of the humerus may occur with minimal trauma

Symptoms

  • Pain with palpation or movement of the shoulder or elbow
  • Ecchymosis (blood collecting in the injured area)
  • Edema (accumulation of fluid in the injured area)

Diagnosis

Fractures are usually at the top of the arm bone and can be diagnosed by X-ray. Most often, proximal humerus fractures are not badly displaced and will heal with simple management in a sling. Neurovascular examinations are usually performed to determine if there has been radial nerve damage or damage to the blood supply.

Pathologic fractures of the humerus may occur with minimal trauma and most often with patients who have a history of one of the following:

  • Cancer metastasis to bone
  • Paget's disease
  • Bone cyst
  • Pain
  • Edema
  • Decreased range of motion

Home Treatment

This type of injury requires evaluation by a professional. The good news is that most humerus fractures will heal without surgery. The majority of patients can be treated with a shoulder sling or brace. With time, the fracture will heal.  A cast is not possible with most types of humerus fractures.

Medical Treatment

In more severe or badly displaced fractures, surgery may be necessary. In surgery, either the fracture pieces are put back together and held in position, or the broken bones are removed and a shoulder placement is performed.

One of the commonly associated problems with humerus fractures is injury to the radial nerve. The radial nerve is one of the major nerves of the upper extremity. The nerve travels from the spinal cord, wraps around the humerus bone, and travels all the way down to the hand. When the humerus is injured, this nerve often is damaged, although the damage is almost always temporary.

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