Diagnosing Shoulder & Elbow Fractures

NYU Langone orthopedic surgeons diagnose shoulder and elbow fractures using a physical exam and imaging tests that reveal the location of a fracture and how many bones are affected. These tests also let our doctors know whether an injury has caused damage to the surrounding soft tissue structures such as muscles, ligaments, or tendons. 

Most fractures require immediate medical care. If you have been injured, feel pain in the arm or shoulder, and have trouble moving or extending the arm, our doctors recommend going to a nearby emergency room.

A fracture, or broken bone, may occur in one or more of the bones in the shoulder and elbow. Most fractures in these joints occur because of a fall, car accident, or sports injury, such as a hard tackle in football or hockey. 

Most of the time, the severity of a fracture varies depending on how much force was applied to the bone. A fracture may be a thin crack in a bone, called a hairline fracture. This type of fracture may not cause a visible injury or limit arm or shoulder motion, but can cause aching pain and redness or swelling around the site of the injury. 

More serious fractures may break a bone completely and prevent you from using the affected arm. Other symptoms include sharp pain, swelling, bruising, and tenderness. Some fractures may cause a visible protrusion beneath the skin such as a bump. If a broken bone breaks through the skin, it is called an open fracture. In most shoulder and elbow injuries, open fractures are rare.

Sometimes, a shoulder or elbow fracture injures nerves or blood vessels. This can occur if the fractured bone is displaced—moved out of its normal position—and presses against nerves or blood vessels that are nearby. An injured nerve may cause weakness, tingling, or numbness in the arm or hand. An injured blood vessel may cause internal bleeding. 

People with osteoporosis, a condition that causes bones to become weak and fragile, are at an increased risk of fractures. They may sustain an injury after a minor accident, such as tripping on a stair and putting out a hand to break the fall.

Orthopedic specialists at NYU Langone evaluate the affected shoulder or elbow during a physical exam and confirm the diagnosis using imaging tests.

Physical Exam

Your doctor examines the shoulder and elbow, assessing the amount of swelling, bruising, and disfigurement, and asks about the type and severity of pain you’re experiencing. 

An open fracture is visible immediately because the bone protrudes through the skin. These injuries should be treated in the emergency room. 

With closed fractures, in which the bone fragments remain beneath the skin, the doctor asks questions about how the injury occurred, how much pain you feel, and exactly where the pain is located. You may be asked to extend or flex your arm as much as possible, so the doctor can evaluate whether other bones, tendons, or ligaments are injured as well. 

During an exam, the doctor also asks questions about your medical and family history. Information about other medical conditions or previous shoulder or elbow injuries helps our doctors to make an accurate diagnosis and recommend appropriate treatment. 

Diagnostic Imaging 

NYU Langone radiologists, who specialize in administering and interpreting diagnostic imaging tests, work closely with orthopedic doctors to take detailed images of the shoulder or elbow. 

X-ray

X-ray images can reveal the location of a fractured bone in the shoulder or elbow. They also help your doctor to determine whether the break goes all the way through the bone or just affects the surface. 

CT Scan

During a CT scan, a series of X-rays is taken to create two- or three-dimensional computer images of the shoulder or elbow, letting doctors examine a fracture from many different angles. Your doctor may recommend a CT scan if an X-ray reveals that a fracture has occurred in more than one place in the bone, or if pieces of bone have separated from each other.

NYU Langone specialists use new techniques to ensure that CT scans use the lowest possible dose of radiation. 

MRI Scan

If a shoulder or elbow fracture is severe and doctors suspect the injury has affected nearby ligaments, tendons, or nerves, they may recommend MRI. An MRI scan uses magnetic fields to take detailed images of the soft tissue surrounding the joint, and can reveal whether there are torn or strained ligaments or tendons. The scan also indicates whether a bone fragment is pressing on a nearby nerve.

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