The floating shoulder is defined as ipsilateral fractures of the midshaft of the clavicle and the neck of the glenoid. This rare injury can be difficult to manage without a thorough understanding of the complex anatomy of the shoulder girdle. Surgical intervention needs to be considered for all of these injuries.
What is a Floating Shoulder?
Floating shoulder injuries are typically caused by severe trauma like might occur in a car accident or a hard fall and cause the shoulder to pull out of place and look like it is floating.
The floating shoulder is an uncommon but important injury pattern. Although it is frequently defined as an ipsilateral fracture of the clavicle and scapular neck, recent studies suggest that ligament disruption associated with a scapular neck fracture contributes to the functional equivalent of this injury pattern, with or without an associated clavicle fracture. Determining the specific injury patterns indicates the potential for significant instability, and correlating these patterns with clinical outcome is a challenge. Because the degree of ligament disruption is difficult to assess on radiographs, indications for nonsurgical and surgical management are not well defined. Minimally displaced fractures typically do well with nonsurgical care. However, the degree of fracture displacement and ligament disruption that results in less predictable outcomes after nonsurgical treatment is uncertain, and the indications for surgery can be controversial. Internal fixation of a displaced clavicle fracture restores the contour of the shoulder, regulates soft-tissue tension, and often indirectly reduces the scapular neck fracture. Fixation of both fractures is recommended in certain fracture patterns. Because these controversies cannot be resolved by current evidence, surgeons must choose an individualized approach based on an understanding of the pathoanatomy and personal experience.
If you have any of these symptoms do not assume it is due to a floating shoulder. These may be caused by other conditions. Tell your doctor if you have any of these:
- Severe shoulder pain
- Muscle spasm
- The injured arm hangs lower than the unaffected arm
- Numbness or weakness
A doctor will ask how you were injured. A full physical exam will be done. Your shoulder will be examined more closely. The doctor may ask a specialist to evaluate your shoulder. For example, an orthopedic surgeon specializes in bones.
Tests may include the following:
- X-rays—to look at for broken bones in the shoulder
- CT scan—to look for broken bones in the shoulder and other structures that may be damaged
The location and size of the broken bones, and how severe your other injuries are will determine the options. A floating shoulder may be treated medically or surgically. Talk with your doctor about the best plan for you. Treatment options include the following:
A doctor may choose to use a sling or shoulder immobilizer. If this is the case, you can expect to be in a sling or immobilizer for one to two months. Your doctor may suggest physical therapy to maintain the shoulder range of motion.
Surgical repair will mean inserting a plate and screws into the broken clavicle. Your scapular bone may also be fixed surgically. The surgeon will manually reposition your bones into their normal location during surgery. After surgery, your shoulder will be placed in a sling or shoulder immobilizer. Your doctor will give you instructions as to how long you need to wear it.
After surgery, your doctor will have you work with a PT and or a massage therapist. The therapy will focus on regaining strength and range of motion to your shoulder.
Thanks to the American Academy of Orthopaedic Surgeons
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*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
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