Have you ever wondered what type of injuries can occur from falling off a horse? A scapular, clavicle, and humerus fractures are all examples. Read below for information about these types of injury.


Fractures can occur by falling directly onto the shoulder with the arm either tucked or restrained to the body.
● This type of injury usually occurs in male athletes who play contact sports such as football, rugby, wrestling, and mixed martial arts.
● Tears develop in the ligaments surrounding the AC joint, which is located between the acromion process and collar bone.
o When someone falls with his or her arm outstretched, the distal clavicle and acromion process may be fractured.
o Injury to the AC Joint can damage the cartilage within the joint, which can later cause arthritis in the AC joint.

There are three types of shoulder fractures: scapular, clavicle, and humerus.

1) Scapular Fracture

● The scapula is the triangular bone located in the upper portion of the back.
● It connects the arm to the chest.
● Scapula fractures occur from severe direct trauma to the upper thoracic and scapular area.
● Scapula fractures are very uncommon.


● Symptoms include posterior shoulder and thoracic area swelling, tenderness, and bruising.
● Most of the time, when patients have a scapula fracture, they will have a severe life-threatening injury to their lungs, ribs, and nerves that will result in the scapular fracture treatment being delayed until the patient is stabilized.
o When the scapula injury is severe, surgery will be needed.
● Most scapula fractures do not require surgery due to minimal displacement and strong muscle support.


● Patients will wear a sling for short-term immobilization.
● Once out of the sling and pain has improved, patients will be referred to physical therapy for progressive range-of-motion exercises until they have achieved full recovery.
● Most scapula fractures heal in 6 weeks.

2) Clavicle (Collar bone) Fracture

● The clavicle is the long bone that begins at the base of the neck and extends to the shoulder.
● Clavicle fractures are common.


● This injury occurs from trauma caused by falling on an outstretched arm or direct impact to the shoulder.
● Common causes include vehicle accidents and sports injuries.


● Hearing a snapping or cracking sound when the collar bone breaks.
● Front upper shoulder pain, swelling, deformity over the clavicle observed, one shoulder appears shorter than the other (one side drooping).
● Difficulty breathing or shallow breath sounds (indications of a lung injury).
● Vascular injuries such as a diminished pulse, swelling, decreased blood flow (venous stasis), possible blood clots (venous thrombosis).


● If anyone exhibits any of these symptoms, please go directly to the ER for medical treatment.
o Labs (blood work) to assess arterial blood gases.
o X-rays of the clavicle, shoulder, chest (to assess pneumothorax or hemothorax), ribs.
o CTs to evaluate fractures and neurovascular injuries.
● Depending on the severity of vascular and pulmonary (lung) injuries, patients will be referred to either a vascular surgeon or a general/thoracic surgeon.
● Treatment for a clavicle fracture depends on the imaging results.
● Most clavicle fractures will heal without surgery.
● Wearing a shoulder sling may be necessary; however, not all clavicle fractures are the same.
● Fractures can occur in various parts of the bone.

o For example, if a fracture occurs in the middle of the clavicle, surgery is typically not required.
o If the fracture is medial, then surgery is possible, but may not be likely.
o If the fracture occurs laterally (near the acromion), then surgery may or may not be required.
o Patients will be referred to an orthopedic surgeon for a consultation for a possible surgical fixation.

3) Humerus Fracture

● There are two types of humerus fractures: proximal and distal.
● Proximal humeral fractures occur in older patients with osteoporosis.
o These fractures are often caused by falling while standing, falling down the stairs, or motor vehicle accidents.
o Patients with possible proximal fractures often complain of pain while moving their shoulder and elbow.
o Bruising and swelling of the affected shoulder and arm will be present.
o Most proximal fractures are nondisplaced and typically will not require surgery.
● Distal humerus fractures are associated with ipsilateral proximal forearm fractures.

▪ This type of fracture occurs in younger patients.
▪ Treatment plan
▪ Minimizing movement
▪ NSAIDS for pain management
▪ Ice compresses for pain relief and swelling reduction
▪ ER for evaluation
▪ Surgery based on the severity of the displacement

Figure 1: (Anterior Right Shoulder) Shoulder bursa, bursitis


Alila Medical Media. (2019). Shoulder bursa, bursitis. [Illustration]. https://www.shutterstock.com/image-illustration/shoulder-bursa-bursitis-122298685?src=LgujqAxYpFEk2V8pW5kcBw-1-8

Frankle, M. (2019). Proximal Humerus Fractures. https://emedicine.medscape.com/article/1261320-overview

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