What are the treatment options for hip and shoulder pain after a fall?

Patient Education for Hip and Shoulder Pain After a Fall

If you have hip or shoulder pain after a fall, you need immediate X-rays to rule out a fracture, as physical examination alone cannot reliably exclude broken bones, and delays in diagnosis significantly increase your risk of complications and death.

Understanding the Seriousness of Your Injury

Hip Injuries After a Fall

• Hip fractures from falls are extremely serious, particularly in older adults, with a 1-year mortality rate of 22% in women and 33% in men 1
• Most hip fractures (98%) result from falls, typically when falling directly to the side and impacting the greater trochanter (the bony prominence on the outer hip) 2
• Delays in diagnosis and treatment increase your risk of complications, longer hospital stays, and both short-term and long-term death 1
• You cannot rely on your ability to walk or the severity of pain to determine if you have a fracture—imaging is essential 1

Shoulder Injuries After a Fall

• Shoulder injuries from trauma commonly include fractures of the clavicle, scapula, or upper arm bone, as well as soft tissue injuries like rotator cuff tears and dislocations 1
• Some injuries require immediate surgery (unstable fractures and dislocations), while others can be managed conservatively initially 1

What Imaging You Need

For Hip Pain

• First step: X-rays of your pelvis and hip (anteroposterior and cross-table lateral views) should be obtained immediately 1, 3
• If X-rays are negative but you still have significant pain: You need a CT scan without contrast, as this detects hidden fractures in 24% of patients with normal X-rays and changes treatment decisions in 20% of cases 3
• CT scanning has 94% sensitivity and 100% specificity for detecting fractures missed on X-rays 3

For Shoulder Pain

• First step: X-rays with at least three views (anteroposterior views in internal and external rotation, plus an axillary or scapula-Y view) 1
• The axillary or Y-view is critical because dislocations can be missed on standard front views alone 1
• X-rays should be taken with you sitting or standing upright, as shoulder malalignment can be missed when lying down 1

Pain Management Options

First-Line Pain Control

• Acetaminophen (Tylenol) 1000mg intravenously every 6 hours is the recommended first-line treatment for acute trauma pain 1
• For severe pain, NSAIDs (like ibuprofen) may be added, but your doctor must carefully consider side effects and drug interactions, especially if you're older 1

Advanced Pain Control for Hip Fractures

• Nerve blocks placed near your hip at the time of presentation significantly reduce opioid needs both before and after surgery 1
• Epidural analgesia or regional anesthesia may be used in selected patients with severe hip fracture pain 1
• A multimodal approach combining acetaminophen, nerve medications (gabapentinoids), NSAIDs, lidocaine patches, and tramadol is recommended, with opioids reserved only for breakthrough pain at the lowest effective dose for the shortest time 1

Pain Control for Rib Fractures (if present from fall)

• Thoracic epidural or paravertebral nerve blocks combined with systemic pain medications provide excellent pain control, reduce opioid use, and decrease infections and delirium 1

Non-Drug Measures

• Immobilizing injured limbs and applying ice packs should be used alongside medications 1

Preventing Blood Clots

• You need blood clot prevention medication (low molecular weight heparin or unfractionated heparin) as soon as possible after your injury if you're at moderate or high risk 1
• If blood thinners are unsafe for you, mechanical devices (compression stockings or pumps) should be used instead 1

Infection Prevention

• Antibiotics are not routinely needed for blunt trauma (like a fall) unless you show signs of infection 1
• Antibiotics are needed if you have an open fracture (bone breaking through skin) or penetrating injury 1

Common Pitfalls to Avoid

• Do not assume you don't have a fracture just because you can bear weight or the pain isn't severe—fractures cannot be reliably diagnosed by physical examination alone 1, 3
• Do not accept reassurance without proper imaging—if X-rays are negative but you have ongoing significant pain, insist on CT scanning 3
• Do not delay seeking care—every hour of delay increases your risk of complications and death 1
• Do not refuse nerve blocks for hip fractures—they significantly improve pain control and reduce dangerous opioid side effects 1

What Happens Next

If You Have a Hip Fracture

• Surgery should occur within 24-48 hours to significantly reduce your risk of death and complications 3
• Rapid diagnosis and treatment reduce the length of time you're immobilized and decrease the risk of bone death (osteonecrosis) 3

If You Have a Shoulder Fracture or Dislocation

• Unstable or significantly displaced fractures and joint dislocations require immediate surgical treatment 1
• Most soft-tissue injuries (labral tears, rotator cuff tears) can undergo a period of conservative management before considering surgery 1

Long-Term Considerations

• After hip surgery, 23% of patients fall again within the first year, with most falls occurring 6-12 months after surgery 4
• Having a previous joint replacement increases your fall risk 7-fold 4
• Falls after hip surgery result in minor injuries in 44% and major injuries in 12% of cases 4