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What are the available options for someone who had a fracture of proximal shoulder, which hasn’t united? One, he has a painful shoulder and 2nd he has limited motion.

Mostly this will be found in old individuals with a poor bone stock, which was a contributory factor to non-union in the first place.

A traditional approach which fails very often would be to attempt refixation with bone grafting. However this may not result in union of the fracture besides giving him a very stiff shoulder.

A reverse shoulder replacement comes as a great rescue in these cases. Paul Grammont innovated the use of reverse shoulder in 1992. Since then reverse shoulder has been used in many rotator cuff arthropathy and irreparable rotator cuff. Its use in non unions of proximal humerus is also very valuable and is now considered as an extended indication. An anatomic replacement has also been tried in these in these unions, but since the greater tuberosity is not anatomical, this also gives very poor results.

There may be an absent subscapularis , a non healed and displaced greater tuberosity. Reverse shoulder prosthesis can still work in the absence of a subscapularis and definitely without a supraspinatus and greater tuberosity. Thus a reverse shoulder replacement is a great option in people above 60 with a failed fixation of proximal humerus fracture. It provides good pain relief and reasonably good return of range of shoulder movements.


Most of the minimally displaced proximal humerus fractures in people > 65 years age will unite uneventfully ant the outcomes will be good. However sometimes these fractures are moderately to severely displace and may be accompanied with a head dislocation.

The bone of contention is the highly comminuted and displaced fractures, which pose a significant challenge for the treating physician

Recent literature suggests that in elderly age group, the displaced proximal humerus fractures can also be treated conservatively with outcomes that are comparable to those of a shoulder hemi replacement. What that means it that the average shoulder flexion attained will be around 90-100 degrees in both the scenarios. Sometimes the fractures that are treated non-operatively will not unite. Those fractures will then have to be operated upon and either replaced or fixed with plate etc.

A word of caution with reverse shoulder replacement is that if it fails sometime in the future, the revision is fraught with many complications. Sometimes even a hemi replacement fails and may need to be converted to a reverse shoulder replacement which again has a very high complication rate. So the path to reverse shoulder replacement, although rewarding should be chosen carefully only after giving a good thought to the potential risks ahead


After an exciting win, an Indian cricket fan’s adrenaline levels can be judged by how frantically they move their legs and shoulders in sync to the screams of joy. But as time passes by, age catches up. Cricketers retire to move into commentary boxes and the once energetic fans suffice their craze by good ole clapping. A quick switch to the news and we hear another athlete undergo surgery, while the swift urge to change channels made the shoulder scream in pain.

Injuries to the shoulder can occur from a wide number of reasons. Some of the common reasons cited are manual labour, sporting activities and repetitive movement. The shoulders tend to host a number of issues as time passes, especially after hitting the retirement mark. This is because soft tissues tend to degenerate with age.

So, if your shoulder’s been more painful that productive of late, head straight to the doctor. Trust them to understand your issue and guide you through the ‘not so dreaded’ treatment of shoulder pain. And since the process can take a while and the general patience levels towards pain is quite well known, we bring to you some easy hacks. Hacks that aim to aid the treatment of shoulder pain with better ease.

  1. Icing:Ice bags are extremely efficient in alleviating shoulder pain. Reason – The cold temperature numbs the affected area which reduces pain and inflammation. But beware; do not place ice directly on the sink. It can cause frostbite.
  2. Hot Compress:Just like icing, warm bath or hot bags help in easing out shoulder pain and other related problems. Though it is advised to opt for hot bags after 48 hours of the injury occurring.
  3. Massage:A gentle massage eases out the stress and tension build up in your shoulder muscles. It is also known to improve blood circulation and reduce swelling. Using oil like coconut oil, olive oil, sesame oil etc. provide better relief. But try to get massages from professionals who know their way around it.
  4. Stretching:A likely cause of your shoulder ache can be stiff muscles. Poor posture or lack of use of the muscles can lead to stiffening. Sore and tight muscles respond well to stretching because it reduces muscle tension, promotes blood flow and improves flexibility. Just look out for sharp pain during stretching as they may be warning signs of bigger damage.
  5. Resting:In most cases, the cause of shoulder pain is overuse or exertion. For example, lifting heavy objects over a long period of time can induce pain. Refrain from exerting activities for a few days can prove to be helpful.

The above suggestions should hopefully help you ease you through the treatment of shoulder pain. But don’t stick to this only. Because a doctor is a better candidate for treatment than internet.

Mumbai Shoulder Institute

Provides services for all Shoulder problems with the formation of MUMBAI SHOULDER INSTITUTE™ in Mumbai.

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B407, Galleria mall, central avenue , Hiranandani
garden, Powai, Mumbai, Maharashtra 400076
Monday – Saturday 02:00 pm – 08:00 pm

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Call on: 022 25717084, 022 40717084, 022 62617084
(Between 02:00 pm – 08:00 pm)

In case the above number is inaccessible,
Please call Dr Dipit Sahu on +91 – 9619136962

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