Glenoid Fracture Treatment
The glenoid is the socket of the shoulder, a shallow dish on the outer edge of the shoulder blade that the ball of the arm bone rests against. Because the socket is shallow by design, a fracture of its rim removes part of what little containment the joint has, and the consequence is often instability rather than the pain and immobility patients expect from a fracture.
That connection between a broken socket and a shoulder that keeps slipping is the thing most commonly missed. Steven Struhl, MD is board certified in orthopedic surgery and separately in sports medicine, has performed more than 5,000 arthroscopic procedures, and is an attending surgeon at NYU Hospital for Joint Diseases. He treats shoulder fractures and instability at offices in Manhattan and White Plains.
What Is a Glenoid Fracture?
Glenoid fractures divide into two meaningfully different injuries. A fracture of the rim usually accompanies a shoulder dislocation, as the ball shears off a piece of the socket edge on its way out. A fracture through the body of the glenoid is a higher energy injury, typically from a motor vehicle accident or a significant fall.
- Rim Fractures: a fragment sheared from the socket edge, usually during a dislocation.
- Body Fractures: a break through the main portion of the glenoid, from higher energy trauma.
- Bony Bankart: a rim fracture with the labrum still attached to the fragment.
- Associated Injuries: fractures of the scapula, ribs, or clavicle in high energy trauma.
Glenoid Fracture Symptoms
- Deep Shoulder Pain: pain within the joint that intensifies with any attempt to move it.
- Marked Swelling: swelling and bruising across the shoulder and upper back.
- Motion Loss: significant restriction of movement in every direction.
- A Sense Of Instability: the feeling that the shoulder shifts or may come out again.
The instability piece is what distinguishes this fracture from the others in the cluster. A patient whose shoulder has dislocated and continues to feel unstable afterward may have lost bone from the socket rim, and that changes the treatment.
Glenoid Fracture Treatment and Surgery
- Non Surgical Care: sling immobilization then progressive motion for minimally displaced fractures.
- Physical Therapy: restoring motion first and stability afterward, in that order.
- Arthroscopic Fixation: rim fragments secured with anchors or screws through small incisions.
- Open Reduction: displaced body fractures fixed with plates and screws through an open approach.
- Bone Restoring Procedures: rebuilding the socket when enough rim bone has been lost.
Dr. Struhl treats the amount of remaining socket bone as the number that drives the plan, since a soft tissue repair over a deficient socket tends not to hold, noting that “by using high quality imaging modalities such as MRI early in the treatment process, we get to the heart of the problem quickly and precisely.” – Steven Struhl, MD, Board Certified Orthopedic and Sports Medicine Surgeon
Frequently Asked Questions About Glenoid Fractures
- It involves the joint surface itself rather than the bones around it, so the concerns are joint alignment and stability rather than simply bone healing. A fragment lost from the socket rim can leave the shoulder prone to dislocating again even after the bone heals.
- No. Minimally displaced fractures with a stable shoulder are frequently treated without surgery. Surgery is considered when the fragment is significantly displaced, when the joint surface is no longer aligned, or when enough rim bone has been lost that the shoulder remains unstable.
- A fracture of the front rim of the socket in which the labrum remains attached to the bone fragment. It occurs during a dislocation, and because both the bone and the soft tissue restraint are involved, it carries a higher risk of recurrent instability than a soft tissue tear alone.
- That depends primarily on how much socket bone was lost. Small rim fractures that heal in good position generally leave a stable shoulder. Significant bone loss can leave a socket too shallow to contain the ball reliably, which is when a bone restoring procedure is considered.
- Plain X rays identify the fracture, but CT is generally required to assess the fragment position and measure bone loss accurately, and MRI is added when labral or ligament injury is suspected alongside the fracture.
- Non surgical treatment typically involves a sling for several weeks followed by progressive motion and strengthening over the following months. Surgical recovery follows a similar arc with a more protected early phase, and return to contact sport is generally measured in months rather than weeks.
Schedule a Glenoid Fracture Evaluation in New York City
A shoulder that dislocated and still feels unreliable weeks later is describing a possible bone problem rather than a soft tissue one, and that distinction changes the entire treatment plan. Dr. Struhl evaluates glenoid fractures and post traumatic instability at his Manhattan and White Plains offices. Call the New York City office at (212) 207-1990 or the Westchester office at (914) 328-4111 to schedule an appointment.
