In most cases proximal humerus fractures cause pain, pressure pain, swelling or local muscular defense representing an acute situation mostly caused by fall or traffic accidents. In this mostly acute situation in the emergency room or even on scene of the accident palpation of the bony contours is usually not possible. In case of a proximal humerus fracture during the inspection of the affected extremity a diffuse swelling associated with signs of a hematoma, which can extend in the course of the following 4–5 days onto the lower arm or the corresponding thorax side might be apparent. The presence of such hematomas might be an indicator for vascular damage secondary to the primary fracture incident [3], when diagnostics and therapy could only be initiated with delay

Is a dislocated fracture suspected often characteristic changes of the physiological shoulder contours might be present. Regarding an anterior dislocation fracture usually a prominent anterior portion of the humeral head along with a protruding acromion, an almost not palpable coracoid process and a flattening of the dorsal articular portion are apparent. Correspondingly contrary findings are visible in case of a rather rare occurring posterior dislocation of the shoulder.

In general the characteristic position of the arm in case of a dislocation fracture can be helpful in the diagnostics so that in case of an anterior dislocation the arm is positioned in slight abduction and external rotation along with a blocked internal rotation whereas in case of a posterior dislocation the arm is positioned in rather internal rotation along with a blocked external rotation.

In addition for the clinical examination the treating doctor should pay attention to external injury of the skin or soft tissue damage, which might influence the further treatment.

As it is common knowledge unnecessary manipulation of the fractured arm should be avoided if possible. The vascular and neurological state should be ascertained again after each manipulation/each reposition manoeuvre at the shoulder. At that it should be considered that the risk of vascular and neurological injuries increases because of adhesions after preceding surgeries [13].