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Symptoms of a broken shoulder blade: Scapula Fracture (Shoulder Blade Fracture)

Broken Shoulder

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  • Broken Shoulder Blade Overview
  • Broken Shoulder Blade Causes
  • Broken Shoulder Blade Symptoms
  • When to Seek Medical Care
  • Exams and Tests
  • Broken Shoulder Blade Treatment Self-Care at Home
  • Medical Treatment
  • Surgery
  • Other Therapy
  • Next Steps Follow-up
  • Prevention
  • Outlook
  • Synonyms and Keywords
  • More

The scapula or shoulder blade is a bony structure found on the upper back that connects the upper arm to the chest wall (thorax). It also forms the socket part of the shoulder joint connecting the upper arm (humerus) to the socket (glenoid). The acromion and coracoid processes are bony bumps found on the upper part of the scapula, and they function to connect the scapula to the collarbone. The scapula is surrounded by thick layers of muscle that are responsible for the smooth movement of the shoulder joint.

  • The shoulder blade (scapula) is rarely broken (broken bones are also called fractures). Of all bone breaks, shoulder blade breaks occur less than 1% of the time.
  • Scapular fractures occur more often in young men ages 25 to 45 because of the activities and trauma they encounter. These occur with athletic activities, motor vehicle accidents, and other forms of blunt trauma.
  • Broken shoulder blades are often caused by heavy forces that might also include severe injuries to the chest, lungs, and internal organs.

Scapular fractures are caused by direct trauma involving a large amount of force or violence. Associated injuries to chest wall, lungs, and shoulder occur in up to 80% of people with broken shoulder blades. Common causes of broken shoulder blades include the following:

  • Motor vehicle accidents
  • Falls with direct trauma to the shoulder
  • Falls onto an outstretched arm
  • Direct trauma such as from a baseball bat or hammer

Pain, swelling, and bruising may occur over the shoulder blade in the upper back or on the top of the shoulder overlying the coracoid and acromion processes.

Other signs of a broken shoulder blade may include:

  • Holding the injured arm close to the body
  • Moving the arm increases the pain
  • Inability to lift the arm
  • Having pain with each deep breath due to movement of the chest wall with each breath; this movement may in turn move the shoulder blade, causing pain.
  • Shoulder appears flattened or deformed

Call your doctor if you notice any of these conditions:

  • Pain with movement of the shoulder
  • Swelling of the shoulder
  • Bruising around the shoulder
  • If shoulder pain fails to improve within 3-5 days

Significant trauma to the shoulder, chest wall, back, or neck can cause severe injuries and should be evaluated in a hospital’s emergency department.

  • If you experience any of the following with an injury, call 911 for an ambulance immediately:
    • Shortness of breath
    • Decreased sensation in the affected arm
    • Abdominal pain
  • Go to the emergency department for evaluation if you experience the following:
    • Severe pain or deformity of the shoulder
    • Inability to move the shoulder or arm
    • Weakness, numbness, or persistent tingling in the injured arm

A doctor will be able to diagnose a broken shoulder blade after a thorough physical examination and imaging.

  • Shoulder and chest X-rays are taken.
  • CT scans of the abdomen and chest are sometimes indicated to evaluate other injuries.
  • MRI or CT scans of the shoulder are sometimes needed to diagnose fractures of the shoulder socket (glenoid).
  • Fractures of the scapula are sometimes discovered during extensive evaluations after major trauma from falls, motor vehicle accidents, or direct trauma.

Because shoulder blade fractures are often associated with severe, potentially life-threatening injuries, they should be evaluated in a hospital’s emergency department.

  • Immobilize the arm immediately. Don’t move it. This can be accomplished with a sling looped over the neck and the bent elbow, which holds the affected arm close to the body.
  • Apply ice to the area to reduce swelling and discomfort.
  • Apply ice for 20 minutes at a time, and avoid direct contact of the ice to the skin.

The goal of treatment is to maintain function of the shoulder. Most fractures of the body of the scapula are treated without surgery.

  • Ice is used for swelling, and pain medications are used for pain control.
  • The shoulder is immobilized in a shoulder sling for 3-4 weeks until the pain goes away.

Surgical treatment may be needed for certain types of scapular fractures, mostly those involving the shoulder socket (glenoid) or neck of the shoulder blade. Early consultation with an orthopedic surgeon (a surgeon who specializes in bone injuries) or a trauma surgeon will help determine what course of treatment is best for you.

Early physical therapy with exercises designed to improve the range of shoulder motion usually is started about one week after the injury. It is important to start these exercises early to avoid a frozen shoulder. A loss of motion in the shoulder can occur if the shoulder is not used for a prolonged period.

Broken shoulder blades should receive ongoing treatment by an orthopedic surgeon or sports medicine specialist to ensure proper healing.

  • Follow the instructions you are given when you leave the hospital and avoid potential trauma while recovering.
  • Pain medications and immobilization will likely be needed to control pain while early in the recovery period.

Broken shoulder blades can be prevented by avoiding high-risk activities such as the following:

  • Activities with potential for falls from significant heights such as rock climbing, hang-gliding, or skydiving
  • Contact sports
  • Driving without a seatbelt

Most fractures of the shoulder blade heal without complications within 6-8 weeks. Fractures that involve the shoulder socket or scapular neck develop more complications.

  • Complications may include the following:
    • Loss of range of motion
    • Loss of strength
    • Persistent pain
    • Early arthritis
  • Many people with scapular fractures have other serious injuries, and their prognosis depends on the nature of these other injuries.

scapula fracture, fractured shoulder blade, broken scapula, broken shoulder blade

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Broken Shoulder

Written by WebMD Editorial Contributors

  • Broken Shoulder Blade Overview
  • Broken Shoulder Blade Causes
  • Broken Shoulder Blade Symptoms
  • When to Seek Medical Care
  • Exams and Tests
  • Broken Shoulder Blade Treatment Self-Care at Home
  • Medical Treatment
  • Surgery
  • Other Therapy
  • Next Steps Follow-up
  • Prevention
  • Outlook
  • Synonyms and Keywords
  • More

The scapula or shoulder blade is a bony structure found on the upper back that connects the upper arm to the chest wall (thorax). It also forms the socket part of the shoulder joint connecting the upper arm (humerus) to the socket (glenoid). The acromion and coracoid processes are bony bumps found on the upper part of the scapula, and they function to connect the scapula to the collarbone. The scapula is surrounded by thick layers of muscle that are responsible for the smooth movement of the shoulder joint.

  • The shoulder blade (scapula) is rarely broken (broken bones are also called fractures). Of all bone breaks, shoulder blade breaks occur less than 1% of the time.
  • Scapular fractures occur more often in young men ages 25 to 45 because of the activities and trauma they encounter. These occur with athletic activities, motor vehicle accidents, and other forms of blunt trauma.
  • Broken shoulder blades are often caused by heavy forces that might also include severe injuries to the chest, lungs, and internal organs.

Scapular fractures are caused by direct trauma involving a large amount of force or violence. Associated injuries to chest wall, lungs, and shoulder occur in up to 80% of people with broken shoulder blades. Common causes of broken shoulder blades include the following:

  • Motor vehicle accidents
  • Falls with direct trauma to the shoulder
  • Falls onto an outstretched arm
  • Direct trauma such as from a baseball bat or hammer

Pain, swelling, and bruising may occur over the shoulder blade in the upper back or on the top of the shoulder overlying the coracoid and acromion processes.

Other signs of a broken shoulder blade may include:

  • Holding the injured arm close to the body
  • Moving the arm increases the pain
  • Inability to lift the arm
  • Having pain with each deep breath due to movement of the chest wall with each breath; this movement may in turn move the shoulder blade, causing pain.
  • Shoulder appears flattened or deformed

Call your doctor if you notice any of these conditions:

  • Pain with movement of the shoulder
  • Swelling of the shoulder
  • Bruising around the shoulder
  • If shoulder pain fails to improve within 3-5 days

Significant trauma to the shoulder, chest wall, back, or neck can cause severe injuries and should be evaluated in a hospital’s emergency department.

  • If you experience any of the following with an injury, call 911 for an ambulance immediately:
    • Shortness of breath
    • Decreased sensation in the affected arm
    • Abdominal pain
  • Go to the emergency department for evaluation if you experience the following:
    • Severe pain or deformity of the shoulder
    • Inability to move the shoulder or arm
    • Weakness, numbness, or persistent tingling in the injured arm

A doctor will be able to diagnose a broken shoulder blade after a thorough physical examination and imaging.

  • Shoulder and chest X-rays are taken.
  • CT scans of the abdomen and chest are sometimes indicated to evaluate other injuries.
  • MRI or CT scans of the shoulder are sometimes needed to diagnose fractures of the shoulder socket (glenoid).
  • Fractures of the scapula are sometimes discovered during extensive evaluations after major trauma from falls, motor vehicle accidents, or direct trauma.

Because shoulder blade fractures are often associated with severe, potentially life-threatening injuries, they should be evaluated in a hospital’s emergency department.

  • Immobilize the arm immediately. Don’t move it. This can be accomplished with a sling looped over the neck and the bent elbow, which holds the affected arm close to the body.
  • Apply ice to the area to reduce swelling and discomfort.
  • Apply ice for 20 minutes at a time, and avoid direct contact of the ice to the skin.

The goal of treatment is to maintain function of the shoulder. Most fractures of the body of the scapula are treated without surgery.

  • Ice is used for swelling, and pain medications are used for pain control.
  • The shoulder is immobilized in a shoulder sling for 3-4 weeks until the pain goes away.

Surgical treatment may be needed for certain types of scapular fractures, mostly those involving the shoulder socket (glenoid) or neck of the shoulder blade. Early consultation with an orthopedic surgeon (a surgeon who specializes in bone injuries) or a trauma surgeon will help determine what course of treatment is best for you.

Early physical therapy with exercises designed to improve the range of shoulder motion usually is started about one week after the injury. It is important to start these exercises early to avoid a frozen shoulder. A loss of motion in the shoulder can occur if the shoulder is not used for a prolonged period.

Broken shoulder blades should receive ongoing treatment by an orthopedic surgeon or sports medicine specialist to ensure proper healing.

  • Follow the instructions you are given when you leave the hospital and avoid potential trauma while recovering.
  • Pain medications and immobilization will likely be needed to control pain while early in the recovery period.

Broken shoulder blades can be prevented by avoiding high-risk activities such as the following:

  • Activities with potential for falls from significant heights such as rock climbing, hang-gliding, or skydiving
  • Contact sports
  • Driving without a seatbelt

Most fractures of the shoulder blade heal without complications within 6-8 weeks. Fractures that involve the shoulder socket or scapular neck develop more complications.

  • Complications may include the following:
    • Loss of range of motion
    • Loss of strength
    • Persistent pain
    • Early arthritis
  • Many people with scapular fractures have other serious injuries, and their prognosis depends on the nature of these other injuries.

scapula fracture, fractured shoulder blade, broken scapula, broken shoulder blade

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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. The traumatologist recommends that the patient undergo an x-ray of the chest and shoulder. In order to exclude an intra-articular fracture, the patient is additionally prescribed computed tomography of the shoulder, and to diagnose the condition of the chest and abdominal organs, CT of these areas is prescribed.