Humerus Fracture Clinical Presentation

  • Author: Adarsh K Srivastava, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Sep 19, 2011
 

History

History may be of a benign fall in which the elbow is either struck directly or axially loaded in a fall onto an outstretched hand.

Motor vehicle and sport injuries account for most humeral injuries for younger males.

Pathologic fractures of the humerus may occur with minimal trauma. Suspect these in patients with the following history:

  • Cancer metastatic to bone
  • Paget disease
  • Osteoporosis/osteopenia
  • HIV infection
  • Solid organ transplantation
  • Chronic kidney disease
  • Bone cyst
  • Pain without trauma
  • Edema of the upper extremity
  • Decreased range of motion (ROM) of the upper extremity
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Physical

  • Pain occurs with palpation or movement of shoulder or elbow.
  • Ecchymosis and edema are usually present.
  • Perform a careful neurovascular examination. Radial nerve injury following humerus shaft fractures is relatively common.
  • Proximal
    • Patients present with a painful shoulder and a very restricted range of motion.
    • Obvious deformity is suggestive of glenohumeral dislocation; swelling and ecchymosis are the common examination findings.
    • Nerve damage with a proximal humerus fracture is rare.
  • Diaphyseal
    • Patients present with a painful deformed arm that may be associated with a radial nerve palsy. Usually, the radial nerve palsy is reversible.
    • Crepitus may be observed.
    • Shortening of the arm suggests displacement.
  • Patients who complain of pain while throwing, lifting, or pushing off on affected arm should raise a clinical suspicion of humeral stress fracture.
    • Examination may reveal focal tenderness and increased pain with strength testing.
  • Assessment of the radial nerve
    • The radial nerve's primary motor function is to innervate the dorsal extrinsic muscles in the forearm. Motor testing should include extension of the wrist and metacarpophalangeal (MCP) joints as well as abduction and extension of the thumb. Proximal injury of the radial nerve causes wrist drop.
    • On examination, the fingers are in flexion at the MCP joints and the thumb is adducted.
  • Rarely, the median or ulnar nerves are affected.
  • With all humerus fractures, ensure strong radial and ulnar pulses.
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Causes

  • The most common cause of proximal humeral fractures is a fall from standing, followed by motor vehicle accident and a fall involving stairs. Additional mechanisms include violent muscle contractions from seizure activity, electrical shock, and athletic-related trauma. Proximal humeral fractures are most often closed.
  • Humeral diaphyseal fractures causes include a fall from standing, motor vehicle accident, a fall from height, and pathological.
  • Humeral stress fractures are often missed. Patients have described a prodrome of milder, chronic pain with focal tenderness prior to the injury while throwing. These fractures are generally mid to distal shaft spiral fractures that are minimally displaced.[4, 5, 6]
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Contributor Information and Disclosures
Author

Adarsh K Srivastava, MD  Staff Physician, Department of Emergency Medicine/Internal Medicine, Allegheny General Hospital

Adarsh K Srivastava, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Andrew A Aronson, MD, FACEP  Vice President, Physician Practices, Bravo Health Advanced Care Center; Consulting Staff, Department of Emergency Medicine, Taylor Hospital

Andrew A Aronson, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, and Society of Hospital Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Michelle Ervin, MD  Chair, Department of Emergency Medicine, Howard University Hospital

Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

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Diaphyseal humerus fracture.
Neer classification.
 
 
 
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