Scott Webb (Host): Welcome to BayCare HealthChat. I'm Scott Webb.

And today we're talking about broken shoulders with Dr. Christopher Donaldson. He's an orthopedic surgeon with BayCare.

Doctor, thanks so much for your time today. We're going to talk about broken shoulders, when we know a shoulder is broken, and what we, and you, can help us do when something is broken, when the shoulder is broken. So, let's just start here. What exactly is a broken shoulder?

Christopher Donaldson, MD: Yeah, I think that's an important part to clarify. I think many people will say that when their shoulder is non-functional, it's broken. I guess that's simplified terminology, but essentially, what we're terming broken shoulders would be things of the nature, like fractures, breaks, cracks of the bone. Those are all synonymous with what we would consider a broken shoulder, so independently something like a rotator cuff tear or a tendon tear around the shoulder, we're going to exclude from that conversation for today and focus mainly on those things that are fractures, breaks, or cracks to define a broken shoulder.

Host: Sure. So how does one know, I mean, I know how you would know, but how do we know and maybe what should prompt us to go see you, basically?

Christopher Donaldson, MD: Yeah, so typically there's a mechanism of injury, a fall or a trip, something of that sort, a significant trauma to the shoulder, that can be an indicator of a break or a fracture. Bruising, ecchymosis. Most people know that as having black and blue on the skin can be another indicator. Swelling, persistent pain, weakness with attempts to use the shoulder. All of these can be indications that the shoulder has been traumatized and broken.

Host: Yeah, traumatized for sure. So how serious is a broken shoulder?

Christopher Donaldson, MD: Thankfully these serious injuries, major injuries are relatively rare. I think a major injury, that would impair life or limb is infrequent. Thankful for that. But functionally speaking, you know, shoulder injuries can have major impacts to a person's lifestyle, their life, their employment, their ability to have leisurely activities. All those are major effects on a person's life. So, as much as we'd like to think that they aren't life threatening, they can be life impacting pretty significantly.

Host: Yeah. Impacting, no doubt. So then let's talk about the surgical and non-surgical options. Hopefully most of the time it's non-surgical but tell us about both.

Christopher Donaldson, MD: Yeah, so many times we can treat breaks or fractures around the shoulder non-surgically. We really drive that indication or the decision for treatment anatomically. So breaks of the ball side versus the socket side. The shoulder blade can have breaks or fractures in it, as well as the top part of the shoulder called the clavicle.

Many of these can be treated nonsurgically. We use the characteristics of the break or fracture on x-ray to help us drive those decisions. Additionally, the patient's needs in regards to lifestyle, their overall general health, demands from employment and personal demands are all important components to tailoring treatment for the patient's needs.

Treatment options surgically, if that is the case, can be supported through either plate and screw configurations or replacement surgery, at times, if the ball is broken and needs that to get back to lifestyle. But it's extremely important to make sure that correctable risk factors when we consider surgical care such as diabetes, malnutrition, smoking cessation, all of those things need to be considered and planned for so that safe and successful surgical intervention can be completed and good functional outcomes can be achieved.

Host: Yeah. And Doctor, is it wishful thinking or can broken shoulders just kind of heal on their own? If we essentially do nothing, will many of these injuries, will they heal just by sort of, you know, not using your shoulder for a while basically?

Christopher Donaldson, MD: Yeah, so self-limitation, nonsurgical treatment. Many studies will support nonsurgical treatment for many types of shoulder breaks and fractures. The most important guiding treatment is that the appropriate expert opinion such as an orthopedic surgeon be able to evaluate and assess, you know, the nature of the break.

And that can essentially help to drive the treatment. So, many times plain x-rays in the office, or from the emergency department can be reviewed and decisions around that can be made. Other times, more advanced imaging studies like MRIs or CAT scans can be needed to help make those decisions.

But in fact, many times, non-surgical treatment can occur successfully. I'd say the majority of times, successfully without needing any surgery on the shoulder. It is important though, to understand that, you know, guiding the care following, or through that healing process is just as important.

So understanding that at the appropriate time points, shoulder motion can be started so that you know, convalescence can be shortened, hopefully, and stiffness can be avoided, but you don't want to do that too soon and create displacements or movement of the breaks, of the fracture that would require surgical intervention when nonsurgical care could have been carried out.

So, in addition to that range of motion, when to strengthen the shoulder and how to, you know, get back the conditioning on the shoulder are all important considerations, but in fact, yes, many times a broken shoulder can heal on its own. A supportive sling or some directed, limited range of motion exercises can be prescribed.

And that in combination with working with our therapists and other partners can help to drive successful nonsurgical treatment of the shoulder.

Host: Sure, and as we've sort of established here, there's a range of things that one might do to the shoulder and where we might do those things in our shoulder. But generally speaking, when we think about the recovery time, as you said, we can maybe speed up the convalescence and whether that's passive or actively or strengthening in the right schedule and all that good stuff. But generally, how long does it take to recover?

Christopher Donaldson, MD: So standard orthopedic timeline for a shoulder fracture would entail about six weeks of healing time. That's where the bone begins to mend itself. It's typically around two to three weeks before we'd see significant signs of healing on x-rays. So in the first early periods of non-surgical treatment, we're watching for the alignment of the bone before that healing process starts.

But six weeks of healing time before we see that occur on x-rays, and then another six weeks of building back some of that range of motion. And then, when we start to drive some strength into the recipe, it starts at about six weeks following that. And then, so it really is about three to six months of healing time total when you get through that process for nonsurgical treatments of shoulder breaks.

Host: Yeah, it's been good stuff today. Doctor, just want to ask you about physical therapy and is that something you recommend as a part of the recovery process?

Christopher Donaldson, MD: Yeah, I think physical therapy is important. Physical and occupational therapy can be helpful in guiding a patient through the recovery process. I think the communication between a health care provider, the therapist and the surgeon is critically important. That's a three-way triangle, including the patient there so that we can understand, you know, the needs of the patients, the expertise in regards to building back that strength and motion, sort of boots on the ground with the therapist, and then having the surgeon's input in regards to understanding the mechanic's, biology, and fracture characteristics, so that everyone can understand the expectations, the treatment plan and moving forward, so that efficient and proficient prescription of motion and strength and getting back to lifestyle and activities can be efficiently achieved.

Host: Yeah, that's the goal for sure. And does sound like a multidisciplinary approach, and I'm sure patients appreciate, you know, as much knowledge, information, education as transparent as possible, as you say, to just sort of set their expectations. Here's how long it's going to take before you're doing stuff again, playing golf, whatever it might be. So, Doctor, thanks so much. You stay well.

Christopher Donaldson, MD: I appreciate your time. Thank you so much.

Host: And for more information go to BayCare.org. And that wraps up this episode of BayCare HealthChat. Always remember to subscribe, rate and review this podcast and all of the other BayCare podcasts, so we can share the wealth of information from our experts together. I'm Scott Webb. Stay well.