Injuries and fractures of the upper limbs

Injuries in the upper limbs (arms) are often seen in the Emergency rooms. This is one of the most common trauma and happens a lot in the elderly and children. Here’s an overview of the most common injuries, safe practices for first aid in case of injury and more information to help.

Injuries in the upper limbs (arms) are often seen in the Emergency rooms. This is one of the most common trauma and happens a lot in the elderly and children. People who play various kind of sports are also prone to injury in the upper limbs – arms and the hands. Here’s an overview of the most common injuries, safe practices for first aid in case of injury and more information to help.

Injuries of the upper limb and shoulder fractures

Bone fractures are also known as simply “broken bones”. They usually result from an impact, trauma or extreme stress to the bone. When a bone cracks or breaks the injury is known as a fracture. In the following material you will often find these two words, and it’s good to know that 'fractured' and 'broken' actually mean the same thing.

A fracture in the arm most often occurs in the long and slender shaft of one of the three arm bones. The three arm bones are known by the names humerus, radius and ulna. Regarding the shoulders, common fracture sites also incl. the clavicle (collar bone), followed closely by the humerus (the long upper arm bone).

Fractures of bones in the shoulder socket usually take place in cases of traumatic dislocation of the shoulder. Arm and shoulder injuries and fractures often occur when a fall causes direct trauma onto the shoulder or the outstretched arm. The collar bone is also a possible site for fractures in many cases. It is very close to the surface of the skin and sometimes the fracture is clearly visible due to visible deformity and possibly protruding bone.

There is considerable amount of pain and visible bruising, as in most fractures. Sometimes the patient will try and hold the injured arm in an attempt to relieve the pain and restrict dislocation.

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Common injuries
Common injuries of the upper extremities

Scapula

The scapula (the large flat bone which forms the rear portion of the shoulder) rarely breaks, but if it does this should act as a red flag to ambulance personnel. High forces are needed to fracture this exact bone and in these cases injuries associated with lung and chest trauma should be excluded in sito.

Humerus

Fractures of the humerus are nearly around 1 in 20 of all fractures. These are commonly caused by direct trauma to the upper arm. Most people can tell right away if their arm has been broken. There could be a snap or a loud cracking. The arm may appear deformed and could be swollen, bruised or bleeding. Fractures of the humerus commonly occur in elderly patients and people with osteoporosis. This fracture is greatly increased by various conditions such as osteoporosis (where the density of the bone has already been compromised and sometimes greatly reduced). This type of fractures are usually occurring when a patient has fallen onto an outstretched arm, but can also be caused by direct trauma on the upper arm.

Possible locations of humerus fractures:

• Proximal
• Mid Shaft
• Supracondylar

Fractures of the humerus often are described by their location:

• Proximal humeral fractures - near the shoulder
• Shaft humeral fractures - in the middle section of the arm bone
• Distal humeral fractures – from injuries near the elbow

Ulna/Radius

Both forearm bones may break when falling onto an outstretched hand. Sometimes it is also possible to fracture one single bone.

Symptoms
Common symptoms of traumatic injuries of the upper limbs

Signs, symptoms and potential problems caused by fractures can include:

• Pain
• Circulatory compromise
• Skin ischaemia and soft tissues necrosis
• Swelling
• Loss of function
• Irregularities on the bone surface – i.e. depressions or lumps
• Deformity
• Unnatural movement
• Crepitus
• Tenderness
• Bruising of the skin in injured area

A person with a broken arm or fracture of the humerus usually experiences:

• Extreme pain at the injured place
• Pain is greatly increased by movement
• Loss of the normal use of the arm
• Pain
• Swelling
• Tenderness and bruising
• Limited motion in the upper arm
• Limited motion in the shoulder
• Deformity of the injured arm
• Visible shortening of the arm compared to the uninjured arm
• Open fracture with parts of fractured bone visible through the skin
• Open wounds

If you have fractured one or both of the bones of your forearm, your symptoms will vary depending on the severity of your fracture.

Treatment
Treatment of injuries and fractures of the upper limbs

When you check in a hospital or at an Intensive care unit, the doctor will check for the pulse, sensation and ability to move the arm and hand. A patient with fracture should undergo X-ray exam of the injured arm. Sometimes additional X-rays of the joints directly above and below the fracture will be ordered to hel with the correct diagnosis. X-rays alone usually confirms the location and severity of the upper limbs fracture. The vast majority of arm fractures can be treated without the need of surgery.

The broken arm usually heals within a month after being immobilized in a cast. Also, a special splint or a functional bracecan be used.

Surgery is needed for severe fractures or open fractures with exposed bone. The humerus can be repaired surgically with plates and screws. Sometimes a metal rod can be used. Patients with opens fracture are given IV antibiotics (intravenously). Antibiotics can help prevent infection in the injured exposed bone and arm tissue.

With fractures of the forearm it is common for the fragile bones placed there to be separated from each other during an injury. In case of forearm injury and fracture only mild fractures that are not displaced are treated without surgery. A typical treatment for a nondisplaced fracture of the forearm includes wearing a cast for at least six weeks. A severe forearm fracture or an open fracture (with exposed bone) will be operated surgically with metal plates and screws. IV antibiotics are used to prevent infections.

When To Call a Medical Professional

A broken arm is a painful and sometimes dangerous injury. If you experience a fracture in the upper limbs call a medical professional right away or check in an Intensive Care Unit to get your arm monitored. Call a doctor if your arm hurts severely and/or the pain lasts after the injury. The help of a health care professional is also needed when the patient experiences numbness or weakness in the hand or the wrist. You should definitely see a doctor in that case, even if the injury itself seems minor.

Prognosis

For most arm fractures, like a humerus injury, the outlook is good. Younger patients and people age 35 and younger tend to heal rapid and fast. Most patients regain full strength and range of motion in the injured arm with little to no problems and complications. The prognosis is also excellent for most fractures of the forearm.

The broken bones usually heal successfully. Even if surgical attention is required in most cases the injured arm regains most of the function and the pain goes away relatively quickly after the arm is immobilized in a cast.

Rehabilitation
Rehabilitation of upper limbs trauma and injury

Once the fractured arm starts to heal, the patient will most likely need physical therapy. This helps restore normal strength in the muscles of the injured arm. Therapy also restores the normal range of motion of the arms. A full course of physical therapy for a fractured bone injury usually takes several months. Sometimes a few simple arm exercises could be more than enough to help return the injured arm to normal. Usually such exercises can be done at home.

Expected Duration

Minor fractures of the forearm can heal in about a month immobilized in a cast. More severe forearm fractures could need surgical attention. Immobilization in severe cases could take up to 3 months. Small fractures of the humerus can heal fully within 2 months in young, healthy persons. Severe fractures of the humerus may take more than 3 months to heal. As a rule – the healing process is longer in the elderly. As for rehabilitation, somewhere p to six months of exercises may be necessary for the muscles to recover after some fractures.

Prevention
Prevention of upper limb trauma

One of the most underrated risk factors for bone injuries is osteoporosis. Take prophylactic test and get consultation with your doctor if you have pain in the arms or wrists. You could find many good strategies to improve bone strength and prevent age-related bone loss.

These strategies may include different sets of exercises, nutrition or medication such as:

• Weight-bearing exercises
• Taking supplements such as Calcium and Vitamin D
• Usage of preventive or other therapeutic medication
• Using protective gear (such as helmets, wrist and elbow guards, and other types of personal protective gear worn by skateboarders and rollerbladers, contact sports players and other) at all times needed to help prevent arm injuries and fractures.

Not all injuries are preventable.

The following simple steps can help greatly reduce the risk of getting injured:

• Always use safety equipment: seat belts, bicycle and motorcycle helmets
• Always follow driving and bicycle safety recommendations
• Do not drink and drive
• Do not allow yourself to be driven by someone under the influence

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