Triangular, mobile and protected by a complex of surrounding muscles, the shoulder blade (scapula) is rarely broken. Scapula fractures represent less than 1 percent of all broken bones. High-energy, blunt trauma such as a motorcycle or car crash or falling from significant height can fracture the scapula and cause other major injuries such as broken ribs or damage to the head, lungs or spinal cord. Symptoms include:
- Extreme pain when you move the arm
- Swelling around the back of the shoulder
- Skin abrasions
Without treatment, a fractured scapula can result in chronic shoulder pain and disability.
Classification and Evaluation
To give you appropriate treatment, your doctor will probably need to take X-rays of your shoulder and chest to describe and classify the location(s) of fracture to the scapula. In some cases, your doctor may also need to use other diagnostic imaging tools such as CT scan (computerized tomography).
One or more parts of the scapula may be fractured:
- Scapular body (50-60 percent of cases)
- Scapular neck (25 percent)
Your doctor will evaluate the position and posture of the shoulder and treat any soft tissue damage (i.e., abrasions, open wounds, and muscular trauma). Your doctor may want a detailed neurovascular examination, which may not be possible if you have other severe injuries.
Nonsurgical treatment with a simple sling works for most fractures of the scapula. The immobilization devices holds your shoulder in place while the bone heals. In many cases, your doctor may want you to start early range of motion exercises within the first week after the injury. Other fractures may need 2 to 4 weeks of immobilization. Your shoulder may feel stiff when the doctor removes the sling. Begin limited active use of your shoulder immediately. Continue passive stretching exercises until complete shoulder motion returns. This may take 6 months to a year.
If you have an isolated scapular body fracture, your doctor may want you to stay in the hospital. Certain types of scapular fractures may need further evaluation:
- Fractures of the glenoid articular surface in which bone has moved out of place (displaced) significantly
- Fractures of the neck of the scapula with severe angular deformity
- Fractures of the acromion process with impingement syndrome
In these cases, you may need surgery in which the doctor uses plates and screws to hold together the bone.
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