How Glenoid Fractures Are Treated

A glenoid fracture is a fracture of the socket of the glenohumeral joint. This is the ball-and-socket joint in your shoulder that allows you to rotate your arm or move it up and down and side to side. A glenoid fracture is uncommon and usually only occurs as a result of a high-impact injury.

Glenoid fractures can be treated with surgery if there is instability of the shoulder. A rehabilitation program, ideally under the guidance of a physical therapist. is needed to fully recover and regain your pre-injury strength and flexibility.

This article describes the different types of glenoid fractures and why they occur. It also explains what is involved in the diagnosis, treatment, and recovery of this traumatic bone injury.

Types of Glenoid Fractures

Glenoid fractures are relatively uncommon, accounting for only 10% of all shoulder fractures. They most often occur when there is a high-impact trauma to the shoulder.

The two most common fracture patterns are called glenoid lip fractures and glenoid fossa fractures.

Glenoid Lip Fractures

Glenoid lip fractures occur when the ball of the joint comes out of the socket, either fully (shoulder dislocation) or partially (shoulder subluxation). As the ball dislocates, it pushes against the rim of the socket, causing a fragment of the bone to break or break off.

Shoulder dislocation occurs when a sudden force stresses the joint at the point of articulation (movement). Examples include:

• An impact during contact sports like football, rugby, or hockey
• A severe fall
• A motor vehicle collision

The aim of treatment is to the normal contour of the shoulder socket and to prevent repeat dislocations. Surgery is often considered for these injuries, especially when the fracture places the joint out of alignment or a large piece of bone breaks off.

Glenoid Fossa Fractures

The glenoid fossa is the center portion of the socket. Glenoid fossa fractures are much less common and associated with blunt force applied directly to the shoulder joint, such as:

• Being struck on the shoulder at high velocity
• Ramming your shoulder against a wall or door
• Falling directly on the outside of your shoulder during a tackle

There is little data on the ideal treatment of glenoid fossa fractures because they are so rare. Some studies suggest that less than 0.1% of shoulder fractures involve the glenoid fossa.

 With that said, athletes and other physically active people will likely benefit from surgery to avoid any restrictions in the range of motion of their affected shoulder.

How Glenoid Fractures Are Diagnosed

An X-ray may be able to detect a glenoid fracture, but a computed tomography (CT) scan is generally preferred as it can look at the glenohumeral joint from different angles.

Unlike an X-ray that looks at the injury from one angle, a CT scan captures multiple X-ray images and composites them in the computer to create a three-dimensional visualization of the joint. This is especially useful for identifying subtle fractures of the glenoid fossa.

How Glenoid Fractures Are Treated

The treatment of glenoid fractures is controversial as there are very few studies to compare different methods of treatment. Even specialist orthopedic surgeons may see only a handful of these injuries over the course of their careers.

In general, it is agreed that unstable fractures are best treated with surgery whereas stable fractures can be treated conservatively. Stable fractures are ones in which the ball and socket are properly aligned, while unstable fractures are those in which the alignment is off or may become off due to structural damage.

The goal of surgery is to restore the alignment of the normal joint surface. This usually involves the placement of small plates and/or screws to ensure the bones heal in the proper position.

The risks of surgery include infection, shoulder stiffness, nerve injury, and shoulder arthritis. Even if surgery manages to realign the joint, injury to the cartilage can still lead to arthritis and the risk of shoulder replacement surgery later in life.

If surgery is not needed, the joint would be immobilized in a sling for around six weeks, followed by a course of physical therapy.

How Long Does It Take to Recover From Glenoid Fracture Surgery?

Rehabilitation after glenoid fracture surgery is aimed at restoring normal mobility, range of motion, and strength to the shoulder joint. 

Following surgery, your shoulder will need to be immobilized in a sling for several weeks to allow the bones to heal. Pain management may involve nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or a short course of an opioid drug like Oxycontin (oxycodone) if the pain is severe. Ice application can also help.

As soon as your surgeon gives you the OK, you will begin range of motion exercises like external rotations and horizontal abduction exercises. As the healing improves, you will progress to strengthening exercises using isometrics, resistance bands, and eventually light weights.

Depending on the severity of your injury, recovery from a glenoid fracture can take anywhere from four to six months.

Summary

A glenoid fracture is an uncommon injury involving the socket of the shoulder joint. The break may occur in the lip (rim) or fossa (hollow) of the socket, usually as a result of a high-impact injury. Surgery may be considered if the shoulder joint is unstable and the ball and socket are misaligned. Some people may recover with immobilization alone, followed by physical therapy.