surgical neck of the humerus

3 min read 19-03-2025

Meta Description: Learn about the surgical neck of the humerus—its anatomy, common fractures, causes, diagnosis, and treatment options, including non-surgical and surgical approaches. Discover how this critical area of the upper arm can be affected by injuries and the recovery process involved. This comprehensive guide provides valuable insights into understanding and managing surgical neck humerus issues.

Understanding the Surgical Neck of the Humerus

The humerus, your upper arm bone, has a region called the surgical neck. This area is located just below the head of the humerus, where the bone widens. It’s called the "surgical neck" because it's the most common site for humerus fractures, often requiring surgical intervention. Understanding its anatomy is crucial to understanding its vulnerabilities.

Anatomy of the Surgical Neck

The surgical neck is a constricted area connecting the humeral head (the ball of the shoulder joint) to the greater and lesser tuberosities. These tuberosities are bony protrusions where the rotator cuff muscles attach. The axillary nerve and posterior circumflex humeral artery also pass nearby, making fractures in this area potentially problematic. This anatomical location makes the surgical neck susceptible to fractures due to its relatively narrow diameter and the forces applied during falls or impacts.

Blood Supply and Nerve Supply

The blood supply to the surgical neck region is primarily from branches of the posterior circumflex humeral artery. The axillary nerve, responsible for innervating the deltoid and teres minor muscles, also runs close to the surgical neck. Damage to these structures during a fracture can lead to complications.

Fractures of the Surgical Neck of the Humerus

Fractures of the surgical neck are among the most common humerus fractures. These fractures usually result from falls, particularly on an outstretched hand. The force transmitted up the arm causes the humeral head to displace. This leads to a break in the bone's relatively thin surgical neck region.

Causes of Surgical Neck Fractures

Falls: Falls, especially on an outstretched hand or directly onto the shoulder, are the most frequent cause.
High-impact trauma: Motor vehicle accidents or other high-impact injuries can also fracture the surgical neck.
Osteoporosis: Weakened bones due to osteoporosis increase fracture risk, even from minor falls.

Diagnosing Surgical Neck Fractures

Diagnosis typically begins with a physical examination. Doctors will assess the patient’s pain, range of motion, and any noticeable deformity. Imaging studies, such as X-rays, are essential to confirm the fracture and assess its severity. Additional imaging, like CT scans, may be necessary to better visualize the fracture fragments and surrounding structures.

Treatment Options for Surgical Neck Fractures

Treatment depends on several factors, including the patient’s age, overall health, the type of fracture, and the degree of displacement.

Non-Surgical Treatment

For minimally displaced fractures, particularly in older or less active individuals, non-surgical treatment may be an option. This often involves:

Immobilization: Using a sling and swathe to immobilize the arm and allow the fracture to heal naturally.
Pain management: Medications such as analgesics and NSAIDs to manage pain and inflammation.
Physical therapy: Post-healing exercises to restore range of motion and strength.

Surgical Treatment

Surgical intervention may be necessary for significantly displaced fractures or those with complications such as nerve damage or blood vessel injury. Common surgical techniques include:

Open reduction and internal fixation (ORIF): This involves surgically exposing the fracture, realigning the bone fragments, and using plates, screws, or other implants to stabilize the repair.
Hemiarthroplasty: In cases of significant comminution or irreparable damage to the humeral head, a hemiarthroplasty (partial shoulder replacement) may be considered. This replaces only the humeral head, preserving the natural glenoid (shoulder socket).
Reverse total shoulder arthroplasty: This more extensive procedure replaces both the humeral head and the glenoid. It is typically reserved for severe cases or when other options have failed.

Recovery and Rehabilitation

Regardless of the treatment method, recovery from a surgical neck fracture requires time and patience. Rehabilitation is crucial to regain range of motion, strength, and function in the affected arm. Physical therapy plays a pivotal role, guiding patients through a carefully designed program of exercises and stretches. The recovery period can last several weeks or even months, depending on the severity of the fracture and the individual's healing response.

Complications of Surgical Neck Fractures

Potential complications associated with surgical neck fractures include:

Nonunion: The fracture fails to heal properly.
Malunion: The fracture heals in a misaligned position.
Avascular necrosis (AVN): Loss of blood supply to the humeral head, leading to bone death.
Nerve injury: Damage to the axillary nerve, causing weakness or paralysis in the shoulder and arm muscles.
Infection: Infection at the fracture site, especially after surgery.

This information is intended for educational purposes only and should not be considered medical advice. Always consult with a healthcare professional for any health concerns or before making any decisions related to your health or treatment.