RA and Broken shoulder and treatment options

I've had R A since 1992 and currently take 25 mgs of methotrexate and Enbril injection weekly along with usual anti inflamataries etc. A couple of days ago I fell and caused significant injury to my left shoulder, 3 fractures to my humerus one being across the ball joint leaving this partially dislocated. I am currently in an orthopaedic ward in a lot of pain. Yesterday options for surgery were discussed with me, no surgery being the preferred option of the shoulder consultant. The option of pinning, partial and full shoulder replacement was explained. Due to high risk of infection due to anti tnfs and methotrexate the consultant wasn't keen to operate. He said whatever option I took I would have some loss of movement and likely hood of future pain. Except for full shoulder replacement but this may only last 10 years and I am currently 60. I was given half an hour to consider If wanted surgery that morning. Because of long term RA and drugs I have been treated with he thought by bone would be to soft to pin successfully but wouldn't know this until they opened me up. I think I was subtedly persuaded to go for leaving the shoulder strapped up to heal naturally for 4 weeks followed by physio. I live on my own so would need a care package at home I was also promised a full shoulder joint replacement in the future if if the level of pain or disability was too much. Which would leave me with some restricted movement but no pain. After spending a third night in considerable pain in hospital I don't know if I have made the right decision. I did ask if they would speak to my rheumatologist but they saw little point and thought he would just say the same. I would love to hear from anyone with RA who has been in similar situations and outcomes of shoulder surgery versus leaving alone, for those with RA and significant fractures. Best wishes to all I'm looking forward to replies. Xx

19 Replies

  • Sorry to hear your story, I have not had anything like this happen, but if it was me in this situation I would contact my rheumy team myself and ask their advice. Take care and I hope you receive answers from others soon.

  • Thanks for your reply and yes I will contact my rhuemy team next week. Best wishes


  • I can't help any I'm afraid but just wanted to let you know that if I was me needing to make such an important decision I'd want to know how he knew just what he he'd see once he got in there? l'd want more evidence, especially in regards to the state of your bones. Has he questioned if you have osteoporosis for example, has he had sight of any testing that's been done, your latest DEXA scan results? I think as Georje says your Rheumy needs to at least be consulted, give him the opportunity to give his opinion of your likely outcome following surgery, physio & rehab. I think you need to know this to form your opinion to ask the surgeon to go ahead or not. Has he even asked to see your Rheumy file? You need time, more time to consider & the input of your Rheumy.

    I hope you come to the decision that's right for you.

  • Thanks for your quick reply and sensible advice and questions I need to be asking. In a crisis like this thinking logically and calmly go out the window. That's where this forum proves to be invaluable .all the best


  • I just hope the correct choice is made, the one which will leave you with the least problems in the future, I think that's all you can do but to reach that decision more help is needed from your Rheumy, they need to meet up to discuss you & your disease & treatments. Yes, you're in crisis & it's easier for us not being in your position to look at things objectively, we're not the ones in the hospital bed in pain from a damaged shoulder but from what you've told us you've not really been given any options, the decision has been made by your surgeon without full consideration of the implications of someone who lives alone.

    I hope whatever is decided your recuperation isn't overly lengthy & a smooth one. Do let us know what's decided & how you are when you are able. Til then my thoughts are with you. x

  • Thank you for your supportive reply. X

  • sorry to hear your story, yours is similar to mine, have RA on mtx, plaqinel, an retux infusions. I fell in December 2014 breaking my proximal humerus in 3 parts. It's been treated conservatively, rather than surgery route. like you I live alone needed help with everything, luckily I've 2 wonderful daughters who have rallied around..

    please pm me if you want more information.


  • Thank you and I will get in touch.

  • Hi Anna I think I received Yuit message and replied to you but for some reason it didn't seem to load. I will try again. Thank you for your support and it is good to hear you have made a good progress with physio. There are many questions I would like to ask so I may seek. Your advice in the future if that's ok. Best wishes. Mall

  • I am so sorry to hear what you are going through. I can remember very clearly what that pain feels like. I broke my humorous in 2011. This was before being diagnosed with RA admittedly but had the surgery and was successfully pinned and plated. I was in a lot of pain after ,but now my arm is ok. I can move it normally ,only I find reaching up for things difficult due to the plate and RA. If I were you I would speak to my rheumatologist. I have been told that I will get future pain with my shoulder,but I am in so much pain with RA anyway .

    I think you need to speak with the Rheumatologist and see what he has to say.

    Take care.I hope what ever you decide, you get all the help and support you need.look after your self .


  • Thank you for your kind reply. Some of the surgeons concerns stem from long term use of methotrexate and and high infection risk due to anti tnfs and methotrexate. Sounds like your surgery was successful and I sincerely hope the pain stays away.

  • Hi I was diagnosed with ra in 2012 & take mix and hydroxychloroquine . On Dec 28 I slipped on black ice & broke my left shoulder - the humeral head in 2 places. The orthopaedic drs couldn't decide if it could be treated with a collar & cuff sling or if I should go to theatre to have a plate & pins. Eventually they decided to go for the sling & pain relief. I was seen in fracture clinic 10 days later & asked how I felt about an op as the break wasn't aligned. I'm petrified of operations & was reluctant so having checked with the consultant it was agreed to let me carry on with the sling. 13 weeks on I'm still in pain even with painkillers & still have to 'sleep' propped up in bed. At the time I was told it is the most painful break you can do as the shoulder joint has to perform the most movement of any joint in the body. It is also a long recovery time so don't expect miracles. I am now in the middle of physio & started hydrotherapy 2 weeks ago. That is very helpful & soothing but hard work & painful afterwards at night. There are times when I've been very low as I don't feel as if I'm improving & I wonder if declining the op was the right thing but the physio has reassured me. I've been warned that I might need a shoulder replacement in the future but I'm not dwelling on that for now. Don't think they can predict the outcome & for me the conservative approach was the right option particularly as the break has somehow aligned itself better. You can have an op if things change but can't undo an op if that's what you had first. It's a traumatic experience & it started a flare & goosebumps skin & fast growing nails with me! Also upset all my bloods so felt as if I was dropping to pieces inside & out! Try to be guided by the medics. It is very painful & you'll take a long time to recover. I keep being told 13 weeks is still early in the recovery time & I'm unlikely to gain full movement in that I won't be able to lift that arm vertically in the air but the physios will help you get the most out of your situation. It's normal to feel low & you'll feel that you're not improving then 1 day you'll feel that you've turned a corner. I hope you've got someone to look after you because you need help. I'm lucky to have my husband at home who has been and is still being marvellous. Have also had fantastic care from all nhs staff. I wish you well & feel free to ask me any questions. I'll help if I can.

  • Think I lost my remaining brain cell when I fell. Sorry I now realise that you live on your own. Whatever you decide you'll need help. Linda

  • Thanks for your reply. I hope your pain eases and you begin to see results of your physio. It is good for me to hear of folks experiences. It seems that most folk folk go for the conservative leaving alone option on the first instance. I am still on hospital. An immediate Problem you might be able to advise me on os what to wear to cover my upper body. Best wishes. Mal

  • Initially I found putting anything on my shoulder painful but I found large loose fitting things that button the easiest such as my husband's shirts. I put it on over the top of my sling but for much of the time my sling was the temporary thing they put on in a & e. I got a proper thing at the fracture clinic appointment when they told me to take my arm out & start exercising. When I wore that I wore the shirt & put the sling over the top on the advice of the nurse. You need things that are easy as you're unable to move your arm to put on t shirts etc although I've seen people wearing vests & things I've no idea how they've got them on! I'm sure you'll work out what's best for you. I wish you well. Let us know how you get on & try to be patient & stay positive. Linda

  • Thanks. I'll see if my big brother in law will contribute a couple of his old shirts. X

  • Seems to be an issue I will need to report with my posts disappearing after I wrote them. Fingers too sore to re-type.

    I will just like to say.

    Love, love, love people who post stories of how good they are doing.....if it helps just one person on the forum out of thousands, by giving someone hope.... Inst that a good thing?

    Hope is the one thing psychically speaking that helps some of go on, when we feel like giving up.

    Please everyone continue to post the good along with the bad. You can not worry about offending some. Every post is generally answered by the the ones that read it and it somehow it triggered them to respond. But, there are many on here who don't post, they just read and your positive post may give someone you don't even know about, hope.

    What works for you will not work on the next person. Every drug effects each very different. But I still like to hear what meds and med combos people take.

    This insidious disease needs a ray of hope.

    I am greatful you posted.

  • *psychologically ( not physically)

    *too sore to re-type every post.

  • Thanks hobbits. What you said is right. The support I have received from the forum at this time of crisis has been brilliant. It has helped both psychologically and in giving practical advice for which I have been very grateful. What a wonderful community. Mall xx

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