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fractured shoulder nondisplaced untreated for weeks

Hello,
I fell onto ceramic tile on my outstretched arm and 6 weeks later finally got diagnosed by MRI for "non displaced greater tuberosity fracture" The problem is I have been using arm AND going to PT as if it werent broken. (yes I kept complaining of pain and got naprelan which didnt touch it).

My questions is, did anyone else not have a sling or treatment for that long a period and turn out ok? Im pretty sad about this- well very sad, but trying to remain positive.

thanks!
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replied February 24th, 2013
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anna7777,

Fortunately, you have had what is called a "trial of life". Which means that you have been doing what you have been doing but it did not affect the fracture at all.

After six weeks, you got the MRI, which showed that, yes the greater tuberosity was fractured, but it had not moved at all, it was nondisplaced.

So, there is no need to do anything different now, just because you now have a confirmed diagnosis, you are doing fine which what you are doing. What you were doing in PT did not hurt the fracture in any way.

If you feel better in a sling now, that would be okay, but after six weeks, the fracture should be well on its way to being united. And now, the important thing to do is get your range of motion and strength back.


The greater tuberosity is a bump on the head of the humerus, to which some muscles attach. Because of these muscle attachments and other soft tissues covering the bone, which this bump gets avulsed (pulled off by a muscle), these surrounding soft tissues will hold onto the fragment, so that it can not move very much. So, healing is just a matter of the body "glueing" the tuberosity back down. That usually takes about 6-8 weeks.

Patients with this injury do develop shoulder weakness, which takes a lot of work to regain.


But, since you have a nondisplaced fracture, it is just a matter of letting the fracture unite and then really charge on with PT. So, it sounds like you are on the right track.

Good luck. Wishing the best.
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replied February 24th, 2013
Hey, that is really nice of you to reply. All my dr told me so far was to go out and find myself a sling (wha'?, what kind or how to support?) and keep my appt that is a week after the MRI. I had to call him for the report and only got to speak to the secretary. The drugstore sling makes my arm hurt more but the fact it still hurts and is visible on mri means its still broken. Do you think 2 more weeks might heal it and does immobilizing it at this point speed it up?
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replied February 25th, 2013
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anna7777,

The fracture line is going to be visible on MRI for a long time, even after the fracture is clinically "healed". So, the fact that it is visible is not surprising. It is difficult to see a tuberosity (greater or lesser) fracture on x-rays, especially when it is nondisplaced. Because the tuberosity is just a bump, when it is pulled off, and does not move, the fracture is not readily apparent. Thus, the need for the MRI to see if it is indeed fractured.

At this point, immobilization is a moot point. Again, the only reason to restrict motion is for patient comfort (fractures hurt) or to prevent displacement of the fracture fragment. Since you have gone this long and the fragment did not move, it is no longer necessary to protect it. There is enough "glue" in the fracture to hold the fragment in place. Thus, there is really no need to immobilize the shoulder now.


As to the sling, you have already found out that it is not really comfortable. Usually, for shoulder injuries, a shoulder immobilizer is used. This is an wide elastic band that goes around the chest and has a couple of smaller loops (which open and close with velcro) that go around the upper arm and the forearm (holding the upper arm to the chest and the forearm to the belly). But, again, you probably do not need a lot of immobilization at this point.


If a fracture is in a long bone or other similar position, immobilization is needed to hold the fragments in the proper position so that they heal in an adequate position. Once there is enough callus (new bone formation) around the fracture, external immobilization in no longer needed, the callus is now holding the bone. So, immobilization does not really speed up or slow down healing, it is to hold the bone in the proper position. Since your bone is in the proper position, it does not need to be externally held.


Actually, putting stress across a fracture has been shown to help speed up the healing of fractures. This is known as Wolff’s Law - bone will respond to the stresses applied to it. Bone is living tissue, so it can be built up and it can be reduced. This is why people who lift weights and do a lot of manual labor will have strong, stout bones. While people who do not stress their bones (age, injury, space flight) will develop osteoporosis. This is why PT and rehab are important for healing fractures, to rebuild the bone lost during the reduction in activity right after the injury.


Thus, if you can find a better sling or a shoulder immobilizer, which makes you feel better, then use it. But, after this many weeks, the fracture is well on its way to uniting. So, many patients find that it is better to just tuck a thumb into a belt loop or the top of the trousers, or a pocket around the waist line, to help support the upper extremity (so that it does not just hang down), rather than use a sling.

Doing wrist and elbow exercises should be well on their way to producing “normal” motion, and rebuilding strength in the muscles of the forearm and arm. You should be doing the Codman’s exercises (the shoulder pendulum swings) to regain shoulder motion. The other shoulder exercises will have to wait till you get the okay from the surgeon. The main one that puts a lot of stress on the greater tuberosity is abduction of the shoulder. Abduction is moving the upper extremity away from the body, out to the side; moving the arm straight out and up, away from the side.


Of course, other things which can affect bone healing are: not smoking (nicotine is very detrimental to the health of bone), eating properly, and putting stress across the fracture. You need extra protein, calcium, vitamin D, and magnesium. Again, you are doing PT, which is great.


So, you should actually be at the end of the healing process. The fracture should be well on it way to being united. Just the finishing touches are now needed.

Again, the fracture line is going to be visible on MRI for a long time after the fracture is healed. So, the clinical exam in more important.

Once the surgeon gives you the okay to drive on in PT, do so. The physical activity will help to strengthen the bone and muscles.


Good luck. Hope you are doing well.
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replied June 12th, 2014
I am 74 and a week ago my mobility scooter tipped over and I fell on my shoulder. I have only now decided to see my doctor who sent me for an xray. Well it was found that I had a small fracture and was fitted for a sling. The trouble is that I don't walk and need both hands to use the scooter and also the walker that I use at home. I live on my own, do my cooking and cleaning so the sling is completely impractical for me so what do I do? Any suggestions?
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replied September 16th, 2014
Non displaced fracture of greater tuberosity of the humerous
Sir,

From my MRI Report following impressions are found.These are
1.Non displaced fracture of the greater tuberosity of the humerous with marrow edema.
2.Minimal effusion in the sub-acromial deltoid bursa.
3. Increased Intrasubstance signal intensity in the distal part of the supraspinatous tendon likely post traumatic.
4.Edema in the long head of biceps and deltoid bursa.

I am now wearing siling. I any surgery is required?

Please give suggestion
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replied November 24th, 2014
I am 20 and from last 6 months I am suffering from shoulder pain. I have only now decided to see my doctor who sent me for an xray.
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