Glenoid Fracture: Causes, Symptoms & Treatment

Glenoid fracture is the term used to describe a break in the glenoid cavity of the shoulder. It can have negative effects on the overall stability of the shoulder.

What is a glenoid fracture?

A glenoid fracture is when a fracture of the glenoid cavity (glenoid) occurs. The glenoid exerts a direct influence on the function of the human shoulder. For this reason, a glenoid fracture often causes instability of the shoulder joint. The glenoid is longitudinally oval in shape and is part of the scapula (shoulder blade). Together with the humeral head (head of the humerus), the glenoid forms the glenohumeral joint. The glenoid cavity resembles a small soup plate and is located on the side of the glenoid cavity. The ball of the humeral head fits into the curve of the glenoid plate. Fractures of the glenoid cavity can be divided into two types. These include fracture of the leading edge of the glenoid, which is often associated with dislocation of the shoulder, and fracture of the entire glenoid cavity. A marginal fracture of the glenoid also carries the name Bankart fracture.

Causes

The cause of a glenoid fracture is usually massive force. A glenoid rim fracture is almost always preceded by dislocation of the shoulder, which results in bony avulsion at the joint capsule. In the case of a glenoid rim fracture, the joint capsule and the joint lip (labrum glenoidale) almost always tear as well. Simple falls on the shoulder are usually sufficient to trigger a glenoid rim fracture. A complete glenoid fracture, on the other hand, is usually caused by a severe impact. This usually involves a traffic accident. As a result, concomitant injuries to the clavicle are also common. Likewise, the arm plexus, cervical spine and thorax can be affected.

Symptoms, complaints, and signs

Both forms of glenoid fracture have in common with each other that they cause significant pain in affected individuals. This also applies to the smaller Bankart fractures, whose extent is more minor, but which nevertheless have pronounced functional effects. For example, the cartilaginous enlargement lips, which are firmly attached to the bony parts of the glenoid cavity, can no longer perform their functions. Because the shoulder joint dislocates easily because of this, its significant instability occurs. Complicated comminuted fractures are considered to be particularly painful. For this reason, patients always adopt a completely protective posture. Extensive movements are avoided. The range of motion is also significantly reduced.

Diagnosis and course

If a fracture of the glenoid cavity is suspected, it is important to consult a physician quickly. The physician first conducts an interview with the patient. In doing so, he inquires about the nature of the accident and in what way the pain and restricted movement are noticeable. In order to determine a glenoid fracture with certainty, the doctor performs an X-ray examination of the shoulder. If the fracture is complex, more advanced diagnostic procedures may also be used. These include computed tomography (CT) or magnetic resonance imaging (MRI). If the bone fragments can be returned to their original position as part of therapeutic treatment, the glenoid fracture usually takes a positive course. The chances of recovery are generally good. However, in the case of severe accidents and injuries, extensive damage to the soft tissues is to be feared, which makes the healing process more difficult and costly. Furthermore, a fracture of the glenoid cavity carries a relatively high risk of developing arthrosis. The course of glenoid fracture is not considered good if no surgical intervention is performed. For example, Bankart fractures usually result in unstable shoulder joints, which then often dislocates the shoulder. Complex comminuted fractures, without therapy, result in malalignment, which in turn results in stiffness of the shoulder.

Complications

A glenoid fracture usually puts stress on the entire shoulder. This results in very severe pain in the patient, which can take the form of rest pain or pressure pain. Pain at rest can also occur at night and lead to sleep problems. It is not uncommon for the patient to become irritable and aggressive as a result of the pain. The glenoid fracture leads to considerable movement restrictions.In most cases, it is no longer possible to continue to perform the usual function of the shoulder. Diagnosis is relatively simple and quick, so treatment can begin early. The severe pain can lead to psychological discomfort and depression in many patients. Glenoid fracture is treated with the help of surgery. As a result, the function of the shoulder is restored and the affected person can move normally again. Sporting activities are also possible again in most cases after the operation. There are no particular complications. However, it cannot be ruled out that in severe cases the affected person will continue to suffer from movement restrictions and may no longer be able to engage in sports activities. However, life expectancy is not limited by the glenoid fracture.

When should you see a doctor?

If severe pain is noticed in the shoulder after an accident or fall, a doctor must be consulted. Taking a pain-relieving medication should be discussed with a doctor so that undesirable side effects can be avoided. If visual abnormalities of the shoulder joint occur, a doctor is needed. If chipping of the bones or shoulder joint is felt, the shoulder should be immobilized and a physician should be consulted immediately. If there are changes in mobility, one-sided physical stress or poor posture, a doctor must be consulted. If headaches, sleep disturbances or muscle discomfort develop, medical attention is needed. Excessive instability of the shoulder is considered unusual and must be investigated as well as treated. If the usual performance decreases due to the discomfort, a visit to the doctor is required. If bruising develops or discoloration of the skin is noticed, a physician should be consulted. If the glenoid fracture is caused by violence from another person, the affected person should seek help. Contact can be made with support organizations through various government agencies or a physician. Comprehensive physical as well as emotional care is provided through these. If the affected person suffers from trauma due to the cause of the complaints or if an anxiety disorder develops, a doctor should be consulted.

Treatment and therapy

For effective treatment of glenoid fracture, surgery is usually absolutely necessary. Thus, the full mobility of the shoulder can be restored only in this way. The problem that the different glenoid fractures have in common with each other is their immediate impact on shoulder joint stability. The glenoid cavity is much smaller than the humeral head. For this reason, the surrounding soft tissues located at the rim of the glenoid cavity play an important role in the stability of the shoulder joint. If the rim breaks off, the soft tissue complex is also no longer able to perform its tasks. The result is instability of the entire shoulder. For this reason, surgical treatment is indispensable, especially in young patients who are active in sports. During the surgical procedure, the surgeon brings the bone fragments that shifted during the fracture back to their original position. There they are fixed in order to be able to reattach. Various materials are used to perform the fixation. These include plates, wires, screws or sutures. Smaller Bankart fractures or marginal fractures are usually treated by arthroscopy (keyhole surgery). For this purpose, the surgeon has a special endoscope that is shaped like a narrow tube. At the front of the endoscope there is a small special camera. Using a second tube, the surgeon advances special instruments needed for the procedure to the shoulder joint. With the help of the instruments, the displaced bone can be returned to its original position. There it is finally fixed in place. If it is a complicated glenoid fracture, it must be treated with plates or screws. However, with more modern procedures, arthroscopy can now also be performed.

Outlook and prognosis

With prompt and good medical care, the prognosis of glenoid fracture is favorable. This is especially true in the case of a simple fracture that has not contributed to further damage to the surrounding regions.To support an optimal healing process, most patients undergo surgery. This is to ensure that the mobility of the shoulder is as fully restored as possible after completion of the treatment. Recovery usually takes several months. However, complete freedom from symptoms still requires some time afterwards. Without medical care, permanent damage to the skeletal system can occur. The bones no longer grow together in the necessary way if they have not been sufficiently fixed to each other. This significantly limits the mobility of the shoulder joint and can lead to permanent pain. In the case of a compound fracture, there is also a risk of permanent restriction of movement. This is especially true if cartilage, soft tissue, or other bone fragments were damaged in the fracture. The prognosis in these patients depends on the overall injury and and must be assessed on an individual basis. Although a simple fracture has a good chance of healing, it can lead to sequelae or disease down the road. Often, the chronic disease osteoarthritis is diagnosed in affected individuals at a later stage.

Prevention

Preventing a glenoid fracture is not easy, as it often results from traffic accidents. It is also important to counteract situations that can lead to a fall on the shoulder.

Aftercare

With a glenoid fracture, the options for follow-up care are very limited. Primarily, therefore, the patient must rely on direct medical attention from a physician to properly treat the condition and prevent further complications. In most cases, glenoid fracture is treated by surgical intervention. After such a surgery, the affected person must take care of his body. Therefore, sports activities or other strenuous activities should be avoided in any case. In general, affected persons should rest and move as little as possible. Above all, the weakened part of the body should be spared. Physiotherapy measures are also very useful after the operation. Many of the exercises can also be performed at home, which may accelerate healing. As a rule, even after successful treatment, further regular examinations are necessary in order to detect further damage at an early stage. The life expectancy of those affected is not reduced by the glenoid fracture. In general, a healthy lifestyle also has a positive effect on the further course of this disease. The surgical procedure is usually not associated with any particular complications.

What you can do yourself

If a glenoid fracture is suspected, a doctor should be consulted first. Depending on what diagnosis the medical professional makes and what treatment is initiated, various self-help measures can be taken. First of all, the affected person is advised to take it easy. In particular, the affected shoulder and arm should not be subjected to excessive stress in order to ensure healing without pain. In the case of severe injuries, surgery is usually performed. After such an operation, the patient must comply with the doctor’s instructions regarding wound care and any protective measures. In addition, regular medical check-ups are indicated. The individual symptoms of a glenoid fracture can possibly be alleviated with the help of various home remedies and natural remedies. For example, the homeopathic remedies belladonna and arnica have proven effective. Conservative measures such as cooling or soothing massages also help against typical accompanying symptoms such as pain, tension or muscle and joint pain. In consultation with the doctor, various remedies from Chinese medicine can be tried. If these measures do not have any effect, the fracture must be taken to the doctor again in any case. In the case of severe fractures, self-help measures should be abandoned. The most important measure is then to have the complaints treated professionally.