Proximal Humerus Fracture

A proximal humerus fracture is a break in your upper arm bone right where it meets the shoulder. It's one of the most common fractures in adults over 65 — third only to broken hips and broken wrists in older patients. It typically happens from a fall onto an outstretched arm or landing directly on the shoulder. Surgeons grade these fractures by how many pieces have moved out of place: the round ball at the top, two bony bumps where the rotator cuff attaches, and the shaft below — anywhere from 1 to 4 displaced parts (the Neer classification).

The good news: more than 80% of these fractures barely shift at all and heal beautifully in a sling, no surgery needed. The harder cases — multi-part fractures where pieces have pulled apart, especially in younger active patients — are some of the more challenging shoulder reconstructions in orthopedics.

• Immediate shoulder pain after a fall — intense pain right at the top of the arm, starting the moment you hit the ground or catch yourself on an outstretched hand.
• Inability to lift the arm — raising the arm away from your side or overhead is extremely painful or impossible in the first days.
• Rapid swelling — the shoulder balloons quickly, and within a day or two bruising appears and spreads down the upper arm, sometimes reaching the elbow or chest wall.
• A grinding sensation with movement — if pieces have shifted, you may feel or hear crunching (crepitus) when the arm is moved.
• Numbness on the outer shoulder — a patch of numbness or tingling over the deltoid muscle can mean the axillary nerve was stretched by the fracture.

Shoulder pain, swelling, and dramatic-looking bruising that spreads down the arm and chest wall over the next few days after a fall. Your provider checks nerve and pulse function carefully — a nerve that runs around the back of the shoulder (the axillary nerve) sits right next to the fracture and can be stretched or compressed. Two shoulder X-ray views diagnose most fractures. A CT scan with 3D reconstruction is added for the multi-part patterns being considered for surgery.

Significantly displaced multi-part fractures in younger, active patients are the main surgical candidates. The choice between rebuilding the bone with plates and screws versus replacing the shoulder joint with a prosthesis depends on three things: how the fracture broke, how strong the surrounding bone is, and what the patient needs to do with the arm afterward.

External patient-education references and related OSI pages for additional background:

• Britannica — Bone disease (fractures)
• Britannica — Shoulder (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language