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Proximal humerus fracture

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I dislocated my shoulder last weekend and also fractured/chipped the round end of the humerus.  I've requested copies of the x-ray so I'll put those up in a few days.  How long do I need to stay in a sling and keep my arm immobilized?  Also, is it ok to take my arm out of the sling when I sleep and if I'm sitting at my desk at work typing with my elbow supporting on the arm rest?  I can't raise my arm at all without pain.  I've iced it well and most of the swelling is gone but my range of movement is basically nothing. 

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I dislocated my shoulder last weekend and also fractured/chipped the round end of the humerus.  I've requested copies of the x-ray so I'll put those up in a few days.  How long do I need to stay in a sling and keep my arm immobilized?  Also, is it ok to take my arm out of the sling when I sleep and if I'm sitting at my desk at work typing with my elbow supporting on the arm rest?  I can't raise my arm at all without pain.  I've iced it well and most of the swelling is gone but my range of movement is basically nothing. 

 

Hrrghh, sorry to hear. I snapped my clavicle and screwed up my humerus 2 years ago in a bad crash, make broking collar bone #3 in my life time, and broken bone #12- it NEVER gets easier.

 

Try to keep your arm from "dangling" at all, since it will heal wonky and cause you a lot more pain in the future. Usually the sling helps this, but can suck while sleeping or sitting. You'll find ways to keep yourself out of pain, but make sure you're not stressing the break,

 

I would say it's OK to take your arm out if the positioning is bothering you (I did... work a desk job and I would slouch and rest my wounded arm on the arm rest while i typed), but i would contact your doctor and make sure- no two injuries are exactly alike. I'm not sure of your injury extent but you should be feeling much better around the 3rd week but will still be sensitive to movement, so i stress to take it easy. You'll be in the rough stuff for another week, and once things calm down, you'll get "pain attacks" where your osteoblasts are doing their thing- feels like sharp knives around the wounded area.

 

Try not to immediately run to the pain meds as they'll lose effectiveness, but if you're suffering greatly- don't be afraid to, either. They should have also prescribed or recommended something to keep swelling down.

 

Best thing is to get some rest, find your comfort, and chew through the rough patches. Hope you heal up fast.

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2-3 weeks of staying in the sling will be the best course. Then they will start you on some light range of motion exercise's. Be easy on it and good advice from Cynictis.

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I am a rep for medical devices and I sell the titanium plates/screws/rods. I am in surgeries for this type of stuff every day. First your orthopedic surgeon is who you should be asking these questions too. They are doctors and know all this stuff for a reason. Joe Schmo on here is not who you should be asking. Ice, rest, and then when bones and ligaments and tendons are healed. Then time for rehab. Bones usually take 2 months to heal. Your doctor is usually correct so I would take his advice.

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Here's 2 x-rays taken right after they put the shoulder back in.  In one of them you can see a small fracture or chip.  What do you guys think.   Its been 10 days now and I still have pretty limited mobility.

 

 

 

IMAG1712.jpg
 

 

IMAG1713_BURST002.jpg
 

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When I see a patient with this fracture, I don't get to excited about it.

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When I see a patient with this fracture, I don't get to excited about it.

 

Why is that Dr. Mark?  Here's what they said at the ER. 

"X-ray shows a Hills-Sachs deformity consistent with a fracture but the reduction is good.  The glenohumeral joint is normally located.  A minimally impacted fracture of the humeral head in the vicinity of the greater tuberosity is seen" 

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After a dislocation is it normal for ligaments, muscles or tendons to be out of place or not quite in their normal position?  Can these misplaced ligaments/tendons/muscles severely restrict movement until they go back to their natural alignment?

 

I'm asking this because I've dislocated both my hip and shoulder and both times about 2 weeks after the injury I felt and heard a definitive pop and immediately felt a sense of relief and gained a major amount of mobility without pain.  Both times I was lightly stretching the joint and then suddenly a pop and I gained almost full mobility back.  With my hip I went from walking with a major limp and pain to being able to jog pretty much pain free.  Last night my shoulder popped and now I can lift it to the side and out in front with little to no pain.  I was starting to get discouraged about my shoulder because its been 2 weeks and I haven't really gained any mobility until yesterday.  Its the craziest thing!

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Surgery on the shoulder in these cases are usually done because the greater tuberosity has migrated proximally or for recurrent instability which is not that common in cases with a greater tuberosity fracture and is even more uncommon in those over 30 years. I treat these patients non operatively with rehab after a week or so of immobilization, and can't remember a patient who came to surgery for this exact constellation of injuries.

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Surgery on the shoulder in these cases are usually done because the greater tuberosity has migrated proximally or for recurrent instability which is not that common in cases with a greater tuberosity fracture and is even more uncommon in those over 30 years. I treat these patients non operatively with rehab after a week or so of immobilization, and can't remember a patient who came to surgery for this exact constellation of injuries.

 

Ok so in layman terms, because I'm 30 and had a direct impact type dislocation which fractured my greater tuberosity I'm actually at less of a risk to dislocate again and probably won't need surgery, does that sound about right?

I started physical therapy after 2 weeks and its feeling much better.  My 2 week x-ray showed the fracture has not displaced and is healing.  I"m gonna try and ride this weekend, 3 weeks since dislocation.  I'm a fast healer, when I dislocated my hip 2 years ago I was back running in 3 weeks and racing in 4. 

 

2 week x-ray

 

IMAG1736.jpg

 

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Very simply put: Most of these patients do not suffer from recurrent dislocations that ultimately need surgery. They go back to their sports after a few weeks and never look back.

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UPDATE:

 

Its been 3 months since my dislocation and I have about 90-95% range of motion back but it still hurts when I do most lifting/exercises over my head or out to the side.  It doesn't bother me at all when riding but simple things like reaching back behind my head or out to the side to grab something I'll get some pain.  It also hurts when I sleep on it and it doesn't seem to rotate as much as the other shoulder when I put my arms out to the side and roll my arms forward/backward.   I'm seeing a sports medicine specialist next week and I'm thinking an MRI is in order. I've been doing insanity classes and lifting the last 6 weeks and I've gained some strength in it but I still have a nagging pain just below the joint on the side of the arm that won't go away.  Is that normal?

Edited by maxamillion125

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All these fractures hurt for at least six months.  Its part of the healing process.

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Ya, you were right Dr. Mark.  He said its normal to have slight pain and less mobility in that shoulder because of the fracture it will take longer to heal because some of the tendons attach where the fracture was.  Took another x-ray and its healing fine.  Gonna continue physical therapy and slowly build it back up.  Shoulder injuries suck.

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UPDATE

 

I had an MRI yesterday and the doctors notes said this. 

 

There is a Hill Sachs deformity of the humeral head with residual adjacent marrow edema, related to a prior shoulder dislocation.  Anterior inferior labrum is torn.  The posterior superior portion of the labrum appears degenerated as well.  No definite bony Bankart lesion.  There is some fluid signal along the undersurface of the supraspinatus tendon compatible with fraying and partial tearing as well as increased intrasubstance signal throughout the remainder of the distal supraspinatus tendon suggesting tendinopathy.  Biceps tendon is normally located and bicep anhor is intact.  Acromiocalvicular joint is unremakrable.  No joint effusion. 

 

I haven't heard from the doctor yet but sounds like I tore the labrum and need surgery. 

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If the shoulder is not unstable, I don't recommend surgery.  I treat patients not MRIs.

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If the shoulder is not unstable, I don't recommend surgery.  I treat patients not MRIs.

 

I feel that its very stable I've never had the feeling of it almost popping out or being loose since the accident.  I'm very active, workout at the gym, Insanity, ride at the track twice a week and the shoulder only bugs me on certain lifts over my head or out to the side.  I just don't want to have this nagging shoulder the rest of my life.  If I can get it fixed and be back to normal in 4-6 months then thats what I want.   Will it ever get better if I don't have the surgery?  I feel the last 3 months I've seen 0 improvement. 

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This sounds more like a problem with the long head of the biceps tendon than an unstable shoulder.  MRIs of the shoulder are still a crapshoot.

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This sounds more like a problem with the long head of the biceps tendon than an unstable shoulder.  MRIs of the shoulder are still a crapshoot.

 

My doctor said the same thing.  He doesn't put much stock in an MRI and he thinks the bicep tendon might be in the mix as well.  I'm getting a cortisone shot this Friday and see how it reacts.  The plan is to rehab with physical therapy really hard the next 6 weeks and see how that goes.  Is that what you would recommend too?  Thanks for you input Dr. Mark.

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