What is a bruised scapula? What are the causes and symptoms of scapular (shoulder blade) problems and disorders? How are they diagnosed and treated?

Understanding the Scapula and Its Role in Shoulder Function

The scapula, or shoulder blade, is a large triangular-shaped bone that lies in the upper back. This bone is surrounded and supported by a complex system of muscles that work together to help you move your arm. If an injury or condition causes these muscles to become weak or imbalanced, it can alter the position of the scapula at rest or in motion.

An alteration in scapular positioning or motion can make it difficult to move your arm, especially when performing overhead activities, may cause your shoulder to feel weak, and can lead to injury if the normal ball-and-socket alignment of your shoulder joint is not maintained. Treatment for scapular disorders usually involves physical therapy designed to strengthen the muscles in the shoulder and restore the proper position and motion of the scapula.

Anatomy of the Shoulder and Scapula

Your shoulder joint is a ball-and-socket joint, where the head of the humerus (upper arm bone) is the ball and the scapula (shoulder blade) forms the socket. The scapula and arm are connected to the body by multiple muscle and ligament attachments, and the front of the scapula (acromion) is also connected to the clavicle (collarbone) through the acromioclavicular joint.

As you move your arm around your body, your scapula must also move to maintain the ball and socket in normal alignment. The scapula serves as a site for the attachment of multiple muscles around the shoulder, which are essential for proper shoulder function.

What is Scapular Dyskinesis?

Disorders of the scapula result in a deviation or alteration in the normal resting position of the scapula, or its normal motion as the arm moves. This is known as scapular dyskinesis, which means “alteration of movement”.

In most cases, alterations of the scapula can be seen by looking at the patient from behind. The medial (inner) border of the affected shoulder blade will appear more prominent than the one on the opposite side, and this prominence will often be exaggerated as the patient moves their arm away from the body. This is commonly called a “winged” scapula.

Causes of Scapular Dyskinesis

The most common causes of scapular dyskinesis include:

• Weakness, imbalance, tightness, or (rarely) detachment of the muscles that control the scapula
• Injuries to the nerves that supply the muscles
• Injuries to the bones that support the scapula or injuries within the shoulder joint

Symptoms of Scapular Dyskinesis

The most common symptoms of scapular dyskinesis include:

• Pain and/or tenderness around the scapula, especially on the top and medial (inner) border
• Weakness in the affected arm — your arm may feel tired or “dead” when you try to use it vigorously
• Fatigue with repetitive activities, especially overhead movements
• Limited range of motion — you may be unable to raise your arm above shoulder height
• A crunching or snapping sound with shoulder movement
• Noticeable protrusion or “winging” of the scapula
• A drooped or forward tilted posture on the affected side

Home Treatment for Scapular Dyskinesis

In some cases, the symptoms of scapular dyskinesis may improve with simple home treatment that includes:

1. Restoring good posture by pulling your shoulder blades back together and bending your elbows down and back as if you are trying to put them in your back pockets.
2. Balancing your exercise routine by ensuring that for every set of “presses” you perform, you do one set of “flys” and two sets of “rows”. Your program should also include stretching exercises for your front shoulder muscles and for shoulder joint rotation.
3. Using heat therapy, such as soaking in a hot bath or using a heating pad, to help alleviate tight shoulder muscles.

When to Seek Medical Attention

If your symptoms persist, it is important to contact your doctor. They can help determine the exact cause of your dyskinesis and provide appropriate treatment options, which may include physical therapy or other interventions.

Diagnosis and Physical Examination

During the physical examination, your doctor will look at your affected scapula from behind, comparing it to the non-involved side. They may ask you to move your arms up and down 3 to 5 times, sometimes with light weights in your hands, to see if scapular dyskinesis is present and to assess the strength and motion of the muscles.

Scapular (Shoulder Blade) Problems and Disorders – OrthoInfo

The scapula, or shoulder blade, is a large triangular-shaped bone that lies in the upper back. The bone is surrounded and supported by a complex system of muscles that work together to help you move your arm. If an injury or condition causes these muscles to become weak or imbalanced, it can alter the position of the scapula at rest or in motion.

An alteration (change) in scapular positioning or motion:

• Can make it difficult to move your arm, especially when performing overhead activities
• May cause your shoulder to feel weak
• Can lead to injury if the normal ball-and-socket alignment of your shoulder joint is not maintained

Treatment for scapular disorders usually involves physical therapy designed to strengthen the muscles in the shoulder and restore the proper position and motion of the scapula.

Your shoulder joint is a ball-and-socket joint. The head of the humerus (upper arm bone) is the ball and the scapula (shoulder blade) forms the socket.

The scapula and arm are connected to the body by multiple muscle and ligament attachments. The front of the scapula (acromion) is also connected to the clavicle (collarbone) through the acromioclavicular joint.

As you move your arm around your body, your scapula must also move to maintain the ball and socket in normal alignment.

(Left) The bones of the shoulder. The scapula serves as a site for the attachment of multiple muscles around the shoulder. (Right) The muscles and soft tissues of the shoulder.

Reproduced from JF Sarwak, ed: Essentials of Musculoskeletal Care, ed. 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

This photo shows a patient with a “winged” scapula (arrow). Note the prominence of the medial (inner) border of the bone.

Disorders of the scapula result in a deviation, or alteration, in the:

• Normal resting position of the scapula, or
• Normal motion of the scapula as the arm moves

The medical term for these alterations is scapular dyskinesis (“dys”= alteration of, “kinesis” = movement).

In most cases, alterations of the scapula can be seen by looking at the patient from behind. The medial (inner) border of the affected shoulder blade will appear more prominent than the one on the opposite side. This prominence will often be exaggerated as the patient moves their arm away from the body. This is commonly called a “winged” scapula.

Causes of scapular dyskinesis include:

• Weakness, imbalance, tightness, or (rarely) detachment of the muscles that control the scapula
• Injuries to the nerves that supply the muscles
• Injuries to the bones that support the scapula or injuries within the shoulder joint

The most common symptoms of scapular dyskinesis include:

• Pain and/or tenderness around the scapula, especially on the top and medial (inner) border
• Weakness in the affected arm — your arm may feel tired or “dead” when you try to use it vigorously
• Fatigue with repetitive activities, especially overhead movements
• Limited range of motion — you may be unable to raise your arm above shoulder height
• A crunching or snapping sound with shoulder movement
• Noticeable protrusion or “winging” of the scapula
• A drooped or forward tilted posture on the affected side

In some cases, the symptoms of scapular dyskinesis may improve with simple home treatment that includes:

Restoring good posture. As you perform your everyday activities, try to stand and sit properly. To do this, pull your shoulder blades back together, and bend your elbows down and back as if you are trying to put them in your back pockets.

Balancing your exercise routine. If you are in a regular exercise program, make sure your upper body strength sessions are balanced. For every set of “presses” that you perform, you should do one set of “flys” and two sets of “rows.” Your program should also include stretching exercises for your front shoulder muscles and for shoulder joint rotation.

Heat therapy. Soaking in a hot bath or using a heating pad may help alleviate tight shoulder muscles.

If your symptoms persist, it is important to contact your doctor. They can help determine the exact cause of your dyskinesis and provide treatment options.

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Physical Examination

Your doctor will talk with you about your medical history and general health and ask about your symptoms. They will examine your entire shoulder and scapula, looking for injury, weakness, or tightness. In most cases, the physical exam will include the following:

Visual observation. Your doctor will look at your affected scapula from behind, comparing it to the non-involved side. To see if scapular dyskinesis is present, your doctor may ask you to move your arms up and down 3 to 5 times, sometimes with light weights in your hands. This will usually reveal any weakness in the muscles and display the abnormal motion patterns.

Manual muscle testing. Your doctor will perform strength testing of your shoulder and scapular muscles to determine if muscle weakness is contributing to the abnormal scapular motion.

Corrective maneuvers. Specific tests involve corrective maneuvers that will help your doctor learn more about your condition. These tests include:

• Scapular assistance test (SAT). In this test, the doctor will apply gentle pressure to your scapula to assist it upward as you elevate your arm. If your symptoms are relieved and the arc of motion is increased, it is an indication that your muscles are not strong enough to raise your arm.

In the scapular assistance test, the doctor manually assists the scapula upward as the patient elevates their arm.

Reproduced from Nicholson GP (ed): Orthopaedic Knowledge Update: Shoulder and Elbow 4. Rosemont, IL. American Academy of Orthopaedic Surgeons, 2003, p. 589.

• Scapular retraction test (SRT). In this test, the doctor will test your arm strength by pushing down on your extended arm. They will then manually place the scapula in a retracted position and test your strength again. In patients with scapular dyskinesis, muscle strength will improve when the shoulder blade is retracted.

In the scapular retraction test, the doctor manually retracts the scapula while pushing down on the patient’s extended arm.

Reproduced from Nicholson GP (ed): Orthopaedic Knowledge Update: Shoulder and Elbow 4. Rosemont, IL. American Academy of Orthopaedic Surgeons, 2003, p. 590.

Imaging Tests

Imaging tests are not always necessary to diagnose scapular dyskinesis. Your doctor may, however, order an imaging study, such as an X-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI) scan, if they suspect a bony abnormality of the scapula (such as an osteochondroma) or an injury to another part of the shoulder.

Physical therapy exercises will focus on strengthening and stretching the muscles around the shoulder.

Nonsurgical Treatment

In almost all cases, the symptoms of scapular dyskinesis will improve with nonsurgical treatment.

Nonsurgical treatment may include:

Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen and naproxen, can help relieve pain and swelling.

Physical therapy. Your doctor or physical therapist will provide an exercise program that targets the specific causes of your dyskinesis. Physical therapy usually focuses on:

• Strengthening the muscles that stabilize and move the scapula
• Stretching the tight muscles that are limiting scapular motion

Surgical Treatment

Most patients who have general dyskinesis due to muscle weakness or tightness do not need surgery.

However, if your dyskinesis is being caused by an injury to your shoulder joint, your doctor may perform a procedure to repair or reconstruct the injured tissues. This will be followed by rehabilitation to restore the scapula’s normal motion.

Once the causes of your dyskinesis have been addressed and normal scapular position and motion are restored, your doctor may recommend a maintenance conditioning program of flexibility and strengthening. This is especially important if your job or recreational activities involve vigorous or repetitive shoulder and arm movements. These exercises should be done 3 times a week or as recommended by your doctor.

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Scapula (Shoulder Blade) Fractures – OrthoInfo

The shoulder blade (scapula) is a triangular-shaped bone that is protected by a complex system of surrounding muscles. Scapula fractures represent less than 1% of all broken bones and many of them can be treated without surgery.

High-energy, blunt trauma injuries, such as those experienced in a motorcycle or motor vehicle collision or falling from a significant height, can cause a scapula fracture. Other major injuries often accompany scapular fractures, such as fractures in the shoulder, collarbone and ribs, or damage to the head, lungs, or spinal cord.

One or more parts of the scapula may be fractured.

• Scapular body (50% to 60% of patients)
• Scapular neck (25% of patients)
• Glenoid
• Acromion
• Coracoid

Fracture patterns in the scapula

Reproduced from Zuckerman JD, Koval KJ, Cuomo F: Fractures of the scapula, in Heckman JD (ed): Instructional Course Lectures 42. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1993, pp 271-281.

The most common symptoms of a scapula fracture include:

• Extreme pain when you move the arm
• Swelling around the back of the shoulder
• Scrapes around the affected area.

To determine appropriate treatment, your doctor will evaluate the position and posture of your shoulder. Because other injuries are often present with scapula fractures, your doctor will look for additional injuries. He or she will also treat any soft-tissue damage (abrasions, open wounds, and muscular trauma). A detailed physical examination may not be possible if you have other severe injuries.

Your doctor may also order imaging tests of your shoulder and chest to determine the extent of injury to the scapula. X-rays provide clear images of dense structures like bone. Your doctor may also order a computed tomography (CT) scan to provide a more detailed image.

Nonsurgical Treatment

Nonsurgical treatment with a simple sling works for most fractures of the scapula. The sling holds your shoulder in place while the bone heals. Your doctor may want you to start moving your shoulder within the first week after the injury to minimize the risk of shoulder and elbow stiffness. The sling is discontinued as your pain improves. Passive stretching exercises should be continued until complete shoulder motion returns. This may take 6 months to 1 year.

Surgical Treatment

Certain types of scapular fractures may need surgery:

• Fractures of the glenoid articular surface in which bone has moved out of place (displaced)
• Fractures of the neck of the scapula with a lot of angulation
• Fractures of the acromion process that cause the arm bone to hit against it (impingement syndrome)

During this operation, the bone fragments are first repositioned (reduced) in their normal alignment, and then held together by attaching metal plates with special screws to the outer surface of the bone.

Pain Management

Pain after an injury or surgery is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover faster.

Medications are often prescribed for short-term pain relief after surgery or an injury. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.

Be aware that although opioids help relieve pain after surgery or an injury, they are a narcotic and can be addictive. Opioid dependency and overdose has become a critical public health issue in the U.S. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your treatment.

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Bruised spine – symptoms, causes, treatment

This disease is treated by a neurologist.

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Bruising of the spine is an injury to the soft tissues of the back of the paravertebral region. The main causes of occurrence are blows, falling on the back during sports, industrial and household injuries. Symptoms are manifested by pain of varying intensity, hematoma and swelling, and limited mobility. With mild injuries, only tissues suffer, with moderate damage, loss of sensation in the limbs is possible. The most dangerous is a bruise of the cervical region, leading to respiratory arrest. Treatment of bruises is conservative, appointments determine the severity of injuries and timely first aid.

CMRT specialist tells

Kuchenkov A.V.

Orthopedist • Traumatologist • Surgeon • Phlebologist • Sports doctor • 24 years of experience

Publication date: May 14, 2021

Verification date: January 10, 2023

All facts have been verified by a doctor.

Contents of the article

Causes of bruising of the spine

Symptoms

Bruises of the lumbar and sacral spine are expressed by the following symptoms:

• pain, fever in the area of ​​injury
• limitation of mobility, sometimes deformity of the spine
• reflex muscle contraction
• swelling, bruising, wounds or abrasions of tissues

In moderate and severe forms, the internal organs of the injured area suffer. For example, a contusion of the sacral region (spine) during a fall is characterized by damage to the pelvic organs. The genitourinary and excretory systems mainly suffer, problems with urination and defecation are observed.

Disorders of the motor system also develop, the sensitivity of the lower extremities decreases due to damage to the nerve fibers. Similar symptoms are shown by a bruise of the lumbar spine.

Stages of development of spinal contusion

Traumatologists have identified three degrees of severity of the condition:

• Light or first, as a result of which the skin, subcutaneous muscles and fatty tissue – purely superficial tissues – suffer. There are no manifestations of neurology.
• The second (moderate) is characterized by symptoms of concussion of the spinal cord – a reversible violation of conduction, sensitivity, decreased reflexes.
• Severe contusion of the spine, accompanied by contusion of the spinal cord – there are hemorrhages, foci of necrosis of the spinal tissues, dysfunction, disorders of sensitivity and paresis, hypo- or hyperreflexia.

In moderate and severe forms, the internal organs of the injured area suffer. For example, a contusion of the sacral region (spine) during a fall is characterized by damage to the pelvic organs. The genitourinary and excretory systems mainly suffer, problems with urination and defecation are observed.

In case of bruising of the thoracic region, breathing difficulties are possible. Bruises of the third stage lead to respiratory arrest and death. The prognosis directly depends on the timely provision of medical care to the victim.

How to diagnose

Diagnosis is based on the following steps:

• physical examination
• x-ray or CT scan to detect possible displacement or fracture
• MRI to detect damage to the internal organs, spinal cord, location of hemorrhages or necrotic lesions ov

Rehabilitation of the spine: material of the specialists of the RC “Laboratory of Movement”

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Shoulder pain after a fall?

Skiers, snowboarders and many other “extreme” sports enthusiasts often experience an acromioclavicular joint (ACJ) tear. Usually it happens like this: I rode, fell, got bruised shoulders and shoulder blades. When conducting R-graphy of the shoulder joint, it turned out that the ACL was damaged. The wording of the diagnosis can be different: complete or partial rupture. In the first case, surgical treatment is indicated, in the second, conservative therapy may be limited.

According to the degree of severity, injuries are distinguished:

• I degree – tear of the clavicular-acromial ligament is characterized by pain in the projection of the clavicular-acromial joint. R-grams showed no visible damage, sometimes there is a slight (2-3 mm) expansion of the joint space compared to a healthy limb. The clavicular-coracoid ligament is intact;
• II degree – rupture of the clavicular-acromial ligament, tear of the fibers of the clavicular-coracoid ligament. The injury is characterized by pain in the projection of the clavicular-coracoid joint, protrusion of the acromial end of the clavicle, and a positive “key” symptom. On R-grams there is an expansion of the joint space of more than 5 mm. The upper edge of the clavicle protrudes above the acromion to half its diameter;
• III degree – rupture of the clavicular-acromial and clavicular-coracoid ligaments is characterized by pain, dysfunction of the upper limb. The symptom of the “key” is sharply positive, the abduction of the upper limb is limited. On R-grams, there is a pronounced expansion of the joint space (more than 7 mm). The clavicle is displaced upward by more than the diameter of the acromion;
• IV degree – rare cases – posterior dislocation, exfoliation of the acromial end of the clavicle like “banana peel”, etc. (2) According to the time elapsed since the moment of injury, the injuries are divided into: fresh – from the moment of injury no more than 3 days have passed; stale – from 3 days to 3 weeks; old – more than 3 weeks.

Tears of the first and second degree are treated conservatively, with a kerchief or bandage on the shoulder joint. The patient is prescribed non-steroidal anti-inflammatory drugs in ointment and tablet forms, and the simplest local hypothermia (applying an ice pack to the pain site on the first day from the moment of injury).

The main symptom of ACL injury is pain in the shoulder joint and shoulder girdle, from mild pain with a slight sprain of the shoulder ligaments to severe pain with a complete rupture of the ACL. The second and third degree of rupture is accompanied by local edema and the formation of a bruise – a hematoma. A “height” appears in the area of ​​the shoulder girdle, and clicking sounds in the shoulder when moving the hand.

The treatment option for a third-degree tear is chosen by the traumatologist. Perhaps conservative treatment or surgery. A complete rupture of the ligaments triggers degenerative post-traumatic changes in the acromioclavicular joint and contributes to the development of arthrosis. In sports medicine, a complete ACL rupture of the 3rd degree is almost always eliminated with the help of surgery (reposition of the bones and fixation in the anatomical position with a metal structure). After restoring the integrity of the ACS, the metal structure is removed.

Physiotherapy (laser therapy, electroanalgesia and magnetotherapy) is prescribed after the operation. Superficial massage is useful for relieving muscle spasm and swelling.

The development of movements in the shoulder joint begins with passive exercises (the movements of the patient’s hand are performed by the exercise therapy doctor) and active movements 6-8 weeks after the restoration of the anatomical integrity of the injured segment.