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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Shoulder Blade (SCAPULA) Fracture | Broken Treatment Las Vegas, Mesquite Nevada

Broken Shoulder Blade Treatment

Shoulder blade fractures are not very common injuries. They can result in inflammation and pain in the shoulder arc. Shoulder blade fractures can be caused by blunt and high energy trauma incidents. This can be in the form of car accidents or falls. This fracture type is generally treated in non-surgical ways. However, they may require surgery in some instances depending on its severity.

Shoulder blade fractures can often result in severe injuries to the chest, lungs, and internal organs. It is important, for this reason, to attain medical attention if you fracture your shoulder blade.

Thomas & Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic surgery to patients in Las Vegas, Nevada, while also serving areas such as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV.

Anatomy of Your Shoulder Blade

A complex system of muscles protects your shoulder blade, which is in a triangular shape. The rotator cuff, which is again a combination of tendons and muscles, helps in keeping your arm bone centered within the shoulder socket. The rotator cuff is responsible for covering the upper arm bone’s head and keeping it attached to the shoulder blade.

Why Do Shoulder Blade Fractures Take Place?

Shoulder blade fractures occur during blunt trauma injuries, such as falls or car accidents. The injury is often accompanied by trauma to the lungs, chest, and other internal organs as well. This is why it is important to get in touch with an orthopedic surgeon to prevent any injury from taking a downturn.

Fortunately, shoulder blade fractures are not very common. They constitute to 1% of all broken bones. Men aged 25 to 45 suffer from the most shoulder blade fractures.

Symptoms of Shoulder Blade Fracture

These are a few common symptoms of fracture of the shoulder blade:

• Inflammation at the back of the shoulder
• Severe pain while using the arm
• Bruises around the shoulder
• Scraps around the shoulder

You should seek immediate medical attention if you have the following symptoms:

• Shortness of breath
• Abdominal pain
• Decreased sensation

Fractures of the shoulder blade can be treated in both surgical and nonsurgical ways.

Non-Surgical Approach

You may not need a surgery depending on the severity of your fracture. It is important that you immobilize your arm and shoulder immediately after the injury. You should also apply ice to reduce inflammation and discomfort. Non-surgical treatments typically involve slings to keep the arm from moving accidentally.

Your physician may prescribe rehabilitation exercises after the first one week to prevent the risk of elbow and shoulder stiffness. You should continue with stretching exercises until you regain complete shoulder motion. This can take anywhere from 6 months to a year.

Surgical Approach

Surgery may be necessary if your shoulder blade fracture is extensive. Fragments of your shoulder blade bone will be repositioned in a proper alignment. They will be held in place using metal plates and special screws on the bone’s outer surface.

Orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada as well as greater Pahrump, Bullhead City, Lake Havasu, and Mesquite, NV for orthopedic surgery.

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Board Certified Surgeons Dr. Bigler or Dr. Thomas at the Knee and Shoulder Institute in Las Vegas, NV to Schedule an Appointment:

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

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We are excited to announce that within the next few months Thomas and Bigler Knee and Shoulder Institute will be expanding our Institute with the addition of 3 additional fellowship trained Orthopedic Surgeons.  Two of them will specialize in general orthopedic surgery of all body parts with special emphasis on sports related injuries and joint replacement surgery.   The third will specifically specialize in Joint Replacement surgery of the Hip and Knee.  Hip, Shoulder, and Knee replacement and revision surgery will be available, as well as general care of all other orthopedics conditions.  This will increase our Doctors to 5 of the most highly trained and qualified orthopedic surgeons in our community.

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Fracture of the scapula – causes, symptoms, diagnosis and treatment

Fracture of the scapula is a violation of the integrity of the scapula as a result of traumatic impact. Occurs quite rarely and is usually combined with fractures of the ribs. It is manifested by pain in the scapular region, swelling and limitation of movements of the upper limb. In some cases, subcutaneous hemorrhage or brachial hemarthrosis is noted. Pathology is diagnosed on the basis of anamnesis, physical examination data and X-ray examination. The method of treatment depends on the site of the fracture of the scapula, may consist in the imposition of a fixing bandage or skeletal traction for 1 month.

General information

Fractures of the scapula are quite rare in traumatology, accounting for 0.3-1.5% of the total number of skeletal injuries. As a rule, occur simultaneously with fractures of the ribs. A fracture of the acromial process may be combined with a fracture or dislocation of the acromial end of the clavicle, a fracture of the articular process with dislocation of the shoulder. Traumatic injury is more often detected in men of working age, the peak incidence occurs at 40-60 years.

Causes

Fractures of the scapula occur due to domestic, street and industrial injuries, road accidents. Localization of damage is determined by the mechanism of injury:

• Direct impact : fall on the back, strong blow. It prevails in the structure of morbidity, observed in fractures of the angles, spine, body of the scapula.
• Indirect impact : fall with emphasis on the hand or on the area of ​​the elbow joint with the limb abducted. It causes fractures of the neck, coracoid, acromial processes of the scapula, articular cavity.

Pathogenesis

The scapula is a flat paired bone. It is located on the back of the chest on the side of the spine. It is part of the so-called upper shoulder girdle and is involved in the movements of the upper limb. It has a complex structure, including the body, spine, two processes, neck and articular cavity. Fractures of the scapula due to the peculiarities of its location are usually not accompanied by a pronounced displacement.

The most complex are multi-comminuted fractures of the body, as well as fractures of the acromial process, the neck of the scapula, in which displacement of bone fragments is more often observed. A fracture of the glenoid cavity belongs to the category of intra-articular, and can have a negative impact on the function of the shoulder joint due to a violation of the integrity of the articular surface, especially in the presence of free-lying fragments.

Classification

In modern traumatology and orthopedics systematization of fractures of the scapula is used, taking into account localization, which allows choosing the optimal treatment tactics and making a prognosis. There are the following types of injuries:

• multifragmented, transverse, longitudinal fractures of the body of the scapula;
• fractures of the acromial and coracoid processes of the scapula;
• fracture of the surgical and anatomic neck of the scapula;
• fracture of the articular cavity;
• fracture of the lower and upper inner corners;
• fracture of the spine of the scapula.

Symptoms of a scapular fracture

The clinical picture is determined by the location of the fracture. In case of damage to the corners, spine and body of the bone, pain occurs, swelling appears in the affected area due to hemorrhage into nearby soft tissues. Local edema usually corresponds to the shape of the scapula, interpreted as a symptom of a “triangular pillow”. Moderate restrictions on the movements of the upper limb are revealed, independent lifting of the arm is impossible.

Deformity in displaced fractures is not always visualized due to severe swelling, which also makes palpation difficult and can cause underdiagnosis. When feeling, the displacement of fragments, bone crepitus, and pathological mobility can be determined. Palpation of the damaged area is sharply painful.

In case of fractures of the articular cavity, the patient complains of pain in the projection of the shoulder joint. The joint is swollen, deformed, a sharp limitation of movements is detected. The contours of the surrounding bone structures are changed, the protrusion of the acromion is noted, the retraction of tissues under the acromial process. Palpation sometimes reveals a bone crunch.

Fractures of the coracoid process and acromion are manifested by local pain and swelling of the surrounding soft tissue structures. In the projection of the fracture, a bruise is formed, reaching a maximum by 2-3 days. Movements are limited, palpation is painful, sometimes crepitus is found.

Complications

Rarely, scapular fractures are complicated by trauma to the brachial plexus, axillary artery, or nerve. If the integrity of the vessel is violated, intense internal bleeding can be observed. When the nerve is ruptured and compressed, sensation and movement disorders are noted, which sometimes completely or partially persist after the fracture has healed. When the glenoid cavity of the scapula is damaged, hemarthrosis occurs.

In some patients, a “floating” (excessively mobile) scapula is detected in the long-term period, the development of which is due to atrophy of the surrounding muscles. Among the late complications of intra-articular fractures include arthrosis of the shoulder joint, limitation of movements of varying severity. After conservative treatment of intra-articular injuries, habitual dislocations of the shoulder are sometimes diagnosed.

Diagnosis

Examination is carried out in the emergency room of the trauma department, the diagnosis is made based on the results of a consultation with a traumatologist. The following methods apply:

• Visual inspection . In favor of a fracture of the scapula, depending on its location, the presence of a “triangular pillow”, a characteristic limitation of movements, and severe pain testify. Undoubted signs of a fracture are pathological mobility of fragments and bone crepitus.
• Radiography . It is the main method of instrumental diagnostics. For most fractures, radiographs of the scapula are performed in frontal and lateral projections. If the glenoid cavity is damaged, an x-ray of the shoulder joint is shown.
• Other imaging techniques . They are of secondary importance. To clarify the features of the fracture and the location of the fragments in multi-fractured fractures, CT of the scapula is prescribed. To assess the state of the surrounding structures, an MRI of soft tissues is performed.
• Shoulder puncture . It is carried out with injuries of the articular cavity. It is a therapeutic and diagnostic manipulation that allows you to confirm the presence of blood in the joint cavity, to carry out its evacuation.

In the presence of concomitant injuries (injuries to the chest, spine), the list of diagnostic methods is expanded. In case of rupture or compression of the neurovascular bundle, the examination plan includes consultations with a vascular surgeon, neurologist or neurosurgeon.

KT OGK. Fracture of the wing of the right scapula.

Treatment of a fractured scapula

First aid

At the prehospital stage, the hand on the side of the lesion is fixed with a bandage or a wire splint. If intra-articular damage or rupture of the vessel is suspected, cold is applied (an ice pack or heating pad wrapped in a towel) to the joint area. With intense pain, give analgesics. Attempts to reduce are strictly prohibited due to the possibility of developing a secondary displacement.

Conservative therapy

Upon admission, the traumatologist performs local anesthesia of the fracture area. The method of immobilization is determined by the location of the injury:

• In case of fractures without displacement, a Dezo bandage is applied to support the forearm and fix the shoulder to the chest. A roller is placed in the armpit. On the 10-11th day, the bandage is removed, the patient’s hand is hung on a scarf bandage.
• In case of fracture of the acromion with displacement of the fragments, an abduction splint is used for a period of 4-6 weeks.
• Treatment of fractures of the articular cavity and neck of the scapula with displacement is carried out using cutaneous or skeletal traction for a period of 1 month. Subsequently, a thoracobrachial bandage is applied for 3 weeks.

Complete fusion occurs within 1-2.5 months. In the early days, with severe pain, analgesics are administered intramuscularly. Patients are prescribed physical therapy, massage, physiotherapy. Apply the following physiotherapy:

• UHF – promotes vasodilation, activation of blood circulation and tissue metabolism;
• magnetotherapy – stimulates the formation of bone tissue;
• interference currents – accelerate the resorption of bruises, reduce pain, eliminate swelling;
• drug electrophoresis – the use of local anesthetics can reduce the severity of pain, the use of hydrocortisone reduces inflammation.

Surgical treatment

Surgical treatment of scapular fractures is rarely used.

• intra-articular injuries are considered as indications, if the fragments are displaced by 5 or more millimeters, the fracture line extends to a quarter or more of the articular surface;
• fractures of the neck, if the fragments are displaced by more than 10 mm, the angle of the articular cavity is changed by 40 or more degrees;
• shoulder subluxations;
• damage to the upper supporting complex (dislocations and fractures of the clavicle).

In case of isolated injuries, bone osteosynthesis of the scapula with small plates is usually performed. Damage to the supporting complex may require complex interventions with simultaneous plasty of the acromioclavicular joint, external or intramedullary fixation of the clavicle, immobilization of the scapula using screws or plates. After the operation, the upper limb is fixed in the abduction position. The patient is prescribed antibiotic therapy and painkillers, and rehabilitation measures are carried out.

Prognosis

The prognosis for scapula fracture is favorable in most cases. Fractures without displacement heal well, do not entail negative consequences. In case of injuries with displacement, especially intra-articular, movement restrictions, degenerative-dystrophic changes are possible. With concomitant nerve injuries, neuropathies can be observed.

Prevention

Preventive measures include the prevention of domestic injuries, following the rules of the road, following the rules of occupational safety. In case of injuries of the upper parts of the chest, the traumatologist’s alertness regarding possible concomitant injuries of the scapula is important.

Fractures of the scapula, causes, symptoms and treatment

A fracture of the scapula is an injury to the bony structure that is located in the upper back and connects the chest and shoulder. The scapula forms the articular cavity of the shoulder joint, which connects to the humerus, and the bony protrusions – the coracoid process and acromion – connect the scapula and collarbone. A fracture can damage any of these areas of the bone structure.

Fracture of the scapula is a rare injury, accounting for less than 1% of all fractures. As a rule, it occurs in men aged 25-45 years and is associated with sports and professional activities. A fracture should be suspected with severe pain in the scapula, swelling and bruising. With these signs of injury, you should immediately contact a traumatologist and undergo a diagnosis.

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Symptoms of scapula fractures

Visually, a scapula fracture makes itself felt by swelling and bruising in the upper back or shoulder – above the acromion and coracoid process. The patient is also worried about severe pain, which increases with hand movements and even breathing, since the chest is involved in the process and its movement leads to displacement of the damaged bone. The listed pain sensations can also occur with other injuries, but if they persist for longer than 3-5 days, the cause is most likely a fracture of the scapula.

Typically, patients with fractures cannot raise their arm from the side of the injury and must keep it pressed against their body to reduce pain. Often the injury is accompanied by flattening or deformity in the injured area.

Article checked

Kuchenkov A.V.

Orthopedist • Traumatologist • Surgeon • Phlebologist • Sports doctor • 25 years of experience

Publication date: March 24, 2021

Review date: February 22, 2023

Article content

Causes

Varieties

Diagnosis

Fractures of the scapula are determined on the basis of examination, palpation, hand mobility tests and the results of instrumental diagnostic methods.