The shoulder joint is made up of three bones: the arm bone (humerus), the shoulder blade (scapula) and the collarbone (clavicle). Fractures can occur in any of these bones, but those of the upper arm and collarbone are most common.

The collarbone joins the scapula at the acromioclavicular (AC) joint. This joint is situated at the top of the shoulder and may separate or dislocate after a fall.

Signs and Symptoms
Fractures of the clavicle are common sporting injuries seen in young people. Pain is felt immediately over the clavicle and a lump may be obvious.
Fractures of the upper humerus tend to occur in older people who have thinner bones. Typically the patient will have fallen onto an outstretched arm. Severe pain in the shoulder is experienced which is worse when the shoulder is moved.
A similar fall onto the elbow or outstretched hand may result in a dislocation of the AC joint. Pain in the shoulder is again felt immediately and a bony lump at the top of the shoulder may be seen.

Diagnosis
The diagnosis of all these injuries is often obvious from the history and examination but is confirmed with an X-ray. In complex fractures of the humerus, a CT scan may be organised to help the planning of your treatment. If a dislocation of the AC joint is suspected, you may be asked to hold a weight during the X-ray. This will demonstrate how ‘open’ the joint can become.

Initial Treatment
The aim of treatment is to fix the bones in the correct position as healing takes place.
Minor fractures of the clavicle where there is no displacement of the bone are successfully managed with painkillers and a sling for 4-6 weeks. Similar treatment is also recommended for simple fractures of the upper arm.
A sling is worn only for a couple of days in minor injuries of the AC joint before physiotherapy exercises are encouraged to maximise mobilisation.

More Complex Treatments
Shoulder Fractures
If any fracture has led to piercing of the skin, or if the pieces of bone are multiple or out of alignment, an open operation may be required to fix them back into the correct position. The exact procedure necessary to correct your injury will be discussed carefully with you, and it may involve the use of plates, wires, nails and screws.

AC Joint Dislocations
A number of operations are available to repair the AC joint and include:

• Open Surgery – An open operation performed very soon after the injury may
• Arthroscopic Repair – performed very soon after the injury to repair torn ligaments
• Arthroscopic Repair – performed if the original injury did not heal as expected following conservative treatment
• Arthroscopic removal of the AC joint
• Open Surgery

Any proposed operation will be discussed in detail.

In all cases, rehabilitative physiotherapy or further necessary operations will also be discussed, but please do ask questions at any time. It is important that you understand the nature of your injury, the operation proposed and what you can expect during your rehabilitation.