Nonsurgical Treatment for Shoulder & Elbow Fractures

Many people with shoulder or elbow fractures don’t need surgery. Orthopedic doctors at NYU Langone recommend immobilizing the affected arm and joint while the fractured bone or bones heal. As you recover, physical therapy prevents the arm and shoulder muscles from becoming weak and helps preserve range of motion in the affected joint.

Immobilization Devices

A fracture cannot heal unless it is prevented from moving. Immobilization also helps the bone fragments fuse together by keeping them in the correct position. Your doctor may recommend wearing an immobilization device, such as a sling, splint, or cast, for a few weeks or longer, depending on the location and severity of a fracture.

Slings

A sling is a device made of flexible fabric that loops around the neck or back and holds your arm in a bent position in front of your chest. Many slings have adjustable Velcro® straps so you can customize the positioning of your arm, helping it to remain both immobile and comfortable.

Slings are more commonly prescribed for people with a shoulder fracture. For a fractured clavicle, a sling may be worn for four to six weeks. For a fractured proximal humerus, a sling may be needed for up to two weeks. For a fractured scapula, doctors usually recommend wearing a sling until you can move the shoulder without significant pain—anywhere from two to four weeks.

For elbow fractures, a doctor may recommend a sling if a fracture occurs in the radial head, which is located at the end of the forearm bone called the radius.

Splints

A splint is a rigid device that conforms to the shape of your arm and is held in place with soft straps. Your doctor may recommend a splint if you have a fractured distal humerus or olecranon, the bony tip of the elbow.

A splint may be used to hold your elbow at a specific angle, if your doctor determines that is the best position to allow the fracture to heal. Splints are typically required for one to three weeks, or longer for people who have more severe fractures.

Casts

If you have fractured the bony tip of your elbow, the olecranon, your doctor may recommend immobilizing the arm in a plaster cast for about three weeks.

To make a cast, doctors apply soft, malleable plaster to the arm. The plaster hardens when it dries, protecting the injured bone and preventing you from moving your elbow while it heals.

No matter which type of immobilization your doctor determines is right for you, he or she may schedule follow-up visits at NYU Langone once a week during the first two months after the injury to monitor the healing process. During these follow-up visits, a doctor may take new X-rays of the shoulder or elbow to see how well the bone is healing.

Bone Stimulation

Bone stimulation uses a low electric current or low-intensity pulsed ultrasound—high-frequency sound waves—to help speed up bone healing. It is administered at a doctor’s office or at NYU Langone’s Bone Healing Center. There are two types of bone stimulation: electronic and ultrasonic. 

In electronic bone stimulation, a doctor places a small electrode or electrodes—flat discs that conduct electricity—onto the skin near the fractured bone. These electrodes are connected to a machine that sends a low electrical current to the affected bone. 

Electronic bone stimulation jump-starts the healing process by tricking the body into thinking an injury has occurred. In response, your body produces proteins that begin to repair cells at the injury site.

To perform ultrasonic bone stimulation, a doctor applies a gel to the skin that helps conduct ultrasonic sound waves, which are produced by a small machine, through the affected bone. 

Ultrasound enhances bone healing by encouraging the bones to take in calcium as well as stimulating certain protein-coding genes involved in the healing process. 

If a fracture is slow to heal, your doctor may also recommend a portable unit that can be used daily at home.

Physical Therapy

While the injured shoulder or elbow is immobilized, a physical therapist at NYU Langone’s Rusk Rehabilitation can help you exercise other parts of the arm to preserve range of motion and strength in the joints and muscles. 

These exercises prevent muscles in those parts of the arm from getting weak while your arm is immobilized in a sling, splint, or cast. 

Physical therapy may also help a fracture heal more quickly than immobilization alone. Even small movements in the hands increase blood flow throughout the arm, which brings more oxygen and nutrients to injured parts of the bone and helps it to heal more quickly. 

Doctors often recommend additional physical therapy after the bone has healed and the sling is removed to further strengthen muscles in the shoulder and arm, increase flexibility in muscles that were not moving while the bone healed, and to restore range of motion in the affected joint or joints. 

Your doctor and physical therapist determine the length of time physical therapy should continue, depending on factors such as the location and extent of the injury and how long your arm was immobilized.

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