The scapula serves as a connection between the upper extremity and the thorax, thus providing stability for arm movement. A high-force blow to the scapula or thorax can cause a scapular fracture [1], which can occur at various anatomic locations of the scapula such as the spine/body, acromion, neck, and glenoid [2]. Generally, this type of fracture is not common as it composes about 1% of all fractures [3] [4]. With regards to patient demographics, a scapular fracture is more predominant in men, which is correlated to the associated prevalence of blunt trauma.

Patients with a scapular fracture present with pain at the site of the injury and exacerbation with movements such as an arm abduction [1]. Additionally, patients will exhibit shoulder asymmetry in the upright position, which is secondary to shoulder displacement [3].

Affected patients are at risk for concomitant fractures of the ribs and clavicles [5] [6]. Furthermore, scapular fractures are associated with life-threatening consequences of trauma such as a pneumothorax, pulmonary contusion, vascular injury, head injury, and laceration of liver or spleen [7] [8]. Another complication of a scapular fracture is an injury to the brachial plexus, which can especially affect the radial nerve [9].

A careful physical examination will yield findings such as tenderness, bruises, and swelling at the site of the fracture(s). The ipsilateral extremity is typically held in adduction since abduction causes pain. Also, the range of motion is restricted. Moreover, shoulder asymmetry is notable in both the sitting and standing positions [3]. Inspection may reveal abrasions over the fracture site [3]. Finally, neurological deficits indicative of brachial plexus injury may be present.

• Pain

  Patients with a scapular fracture present with pain at the site of the injury and exacerbation with movements such as an arm abduction. [symptoma.com]

  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. [emedicinehealth.com]

  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. [orthoinfo.aaos.org]

  Always seek medical advice if pain is severe or you are in any doubt. [sportsinjuryclinic.net]

• Shoulder Pain

  Previous Galleries Next » Scapula fracture Hover on/off image to show/hide findings Tap on/off image to show/hide findings Scapula fracture Transverse fracture of the scapula body Always check for a fracture of the scapula in the context of post-traumatic shoulder [radiologymasterclass.co.uk]

  C/O shoulder pain after trauma. Evaluate for tenderness, ecchymosis, soft tissue injury. Document axillary, median, ulnar, radial nerve function and radial pulse. Scapula Fx Xray / Diagnositc Tests AP, scapular lateral and axillary views. [eorif.com]

  Case 5 This 79 year old female presented to the Emergency Department with right shoulder pain following a low speed motorvehicle accident. [wikiradiography.net]

  Symptoms include sudden shoulder pain and a feeling that something has torn. Pain may also radiate down into the arm. Rotator cuff strains can range from mild to very severe. [sportsinjuryclinic.net]

  Pain with movement of the affected 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. [emedicinehealth.com]

• Upper Back Pain

  Call a doctor if these conditions exist, especially if they are associated with any trauma to the shoulder area or upper back. [emedicinehealth.com]

• Distractibility

  […] of the left scapula Diagnosis [ edit ] X-ray showing a fracture of the clavicula and scapula Most fractures of the scapula can be seen on a chest X-ray ; however, they may be missed during examination of the film. [1] Serious associated injuries may distract [en.wikipedia.org]

• Loss of Initiative

  Brachial plexus injuries may be discovered on neurologic assessment, particularly suprascapular nerve deficits, such as loss of initial arm abduction via supraspinatus or loss of external rotation via infraspinatus. [orthopaedicsone.com]

• Forgetful

   Identification of a fracture lucency can be difficult  Fracture of the body most common, but don’t forget to carefully examine the acromion and glenoid  Consider adding scapular Y view if clinical concern  Necessary for two-plane evaluation of [slideshare.net]

Post-trauma patients should undergo a thorough workup consisting of the individual's history, the account of the trauma (as told by the patient, witnesses, and/or emergency responders), a physical exam, and appropriate studies.

To identify scapular fractures, radiographic studies include anteroposterior (AP), lateral scapular, and axillary views of the shoulder. Once these are obtained, the clinician will use radiographic parameters based on measurements of anatomic landmarks to determine the treatment (surgical versus conservative management) [3].

Moreover, a computed tomography (CT) scan of the shoulder can assess glenoid and coracoid fractures but this modality is not routinely needed to evaluate scapular fractures [10]. However, in cases with significant displacement, 3-D CT imaging is required for accurate assessment and surgical decision-making [11] [12]. Another consideration in the management of nonoperative scapular fractures is to perform weekly upright X-rays since scapular fractures pose a risk of progressive deformity in the early phases [3] [13].

Chest radiography and/or CT scan are obtained in post-trauma patients presenting to the emergency department to rule out associated injuries such as pneumothorax [1] [3]. Also, a lateral cervical spine radiograph or CT scan is used to diagnose spinal fractures [3]. Other studies will be ordered in multi-trauma patients as well.

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