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

  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]

  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]

  Scapula fractures are not common, and can often cause severe pain. [sports-health.com]

  Head coach Steve Spurrier acknowledged that Shaw’s pain might keep him off the field. “It’s just painful for him,” he said. “And he has trouble lifting his arm right now so it’s pretty hard to play quarterback.” [drdavidgeier.com]

  The symptoms of a scapular fracture typically include pain in the posterior shoulder, but the pain can mimic lung abnormalities (eg, pulmonary embolus or pneumonia). [healio.com]

• 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]

  He was examined and found to have a painful right scapula. He was referred for right shoulder radiography. [wikiradiography.net]

  Symptoms include sudden pain in the upper arm and shoulder at the time of injury with rapid swelling in the shoulder. Attempting to move the arm will be painful and it is possible the shoulder joint may appear deformed. [sportsinjuryclinic.net]

  The shoulder is immobilized in a shoulder sling for 3-4 weeks until the pain goes away. [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]

• Neglect

  […] doi: dx.doi.org/10.5435/JAAOS-20-03-130 Review Article Abstract Author Information Authors Article Metrics Metrics With the exception of displaced articular glenoid fractures, management of scapular fractures has largely consisted of benign neglect, with [journals.lww.com]

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.

Historically, nonsurgical treatment was recommended for both clavicle and scapula fractures. Good functional outcomes were reported with nonsurgical treatment, whereas surgical treatment had a high complication rate. [experts.umn.edu]

A sling support for 3-4 weeks and early rehabilitation is the key to successful nonoperative treatment. However few might require surgical treatment. [boneandspine.com]

Abstract Historically, nonsurgical treatment was recommended for both clavicle and scapula fractures. Good functional outcomes were reported with nonsurgical treatment, whereas surgical treatment had a high complication rate. [ncbi.nlm.nih.gov]

Additional Information Home Treatments: Initial treatment of a scapula fracture involves immobilization by reducing shoulder movement. Ice should be applied on the area by using the unaffected limb or having someone else apply it for you. [fitnesshealth101.com]

Injuries of all 107 patients were classified and the treatment was retrospectively evaluated for non-operative or surgical treatment. [traumamanagement.biomedcentral.com]

 Body of scapula  Immobilization with a sling  Physical therapy as early as one week after injury  Neck or glenoid involvement of scapular fracture  Surgical reduction  Prognosis  Isolated scapular body fracture have excellent prognosis  Fractures [slideshare.net]

Surgeons could reliably and accurately identify superior, medial, and lateral border involvement, which is considered clinically relevant and likely sufficient for the treatment decision process and outcome prognosis. [ncbi.nlm.nih.gov]

[…] body good prognosis for healing neck good prognosis for healing if "operative scapular fractures" is treated non operatively patient may develop abductor weakness & subacromial impingement outcomes: Scapular neck fracture influence of permanent malalignment [orthofracs.com]

What Is the Prognosis for a Broken Shoulder Blade? 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. [emedicinehealth.com]

Prognosis of a scapula fracture Patients with a scapula fracture usually make a full recovery with appropriate management (whether surgical or conservative). [physioadvisor.com.au]

[…] subsequent encounter for fracture with nonunion P - subsequent encounter for fracture with malunion S - sequela Scapula Fx ICD-9 811.00 (fracture of scapula, upper end, unspecifiec part, closed) 811.09 (fracture of other parts of scapula, closed) Scapula Fx Etiology [eorif.com]

Etiology: Treatment: The majority of fractures are treated non-operatively. Treatment includes immobilization for 3-4 weeks followed by pendulum exercises and protected range of motion. [posna.org]

(Etiology) Some causal factors of a Fracture of the Shoulder Blade include: Falling from a significant height; especially landing on one’s shoulders (or the fracture occurring since the individual is overweight) Direct trauma to the shoulder associated [dovemed.com]

Patient Population: Prevalence and Epidemiology Knee // Shoulder & Elbow // Hip // Spine // Foot & Ankle // Hand & Wrist Fragility Fractures: Diagnosis and Treatment Shoulder & Elbow The Characteristics of Surgeons Performing Total Shoulder Arthroplasty [mdedge.com]

[…] fracture Classification System Orthopedic Trauma Association Top Glenoid fractures: Ideberg Classification Ideberg R et al, Acta Orthop Scand, 66:395-397,1995 Based on 100 glenoid fractures reviewed over a 10-year period, and its merit lies largely in the epidemiologic [shoulderdoc.co.uk]

[…] encounter for fracture with nonunion P - subsequent encounter for fracture with malunion S - sequela Scapula Fx ICD-9 811.00 (fracture of scapula, upper end, unspecifiec part, closed) 811.09 (fracture of other parts of scapula, closed) Scapula Fx Etiology / Epidemiology [eorif.com]

Epidemiology: Scapula fractures are uncommon in children. Body fractures are usually the result of high-energy trauma such as motor vehicle collisions or falls. [posna.org]

Epidemiology Scapula fractures are relatively uncommon, accounting for only 3% to 5% of all shoulder fractures and 0.5% to 1% of all fractures. [orthopaedicsone.com]

Exercise Techniques to Prevent Injury: Because a scapula fracture usually occurs from a direct blunt trauma impact that requires a large amount of force, there are no precise exercise techniques to prevent the injury. [fitnesshealth101.com]

Your physician will most likely refer you to a Physical Therapist for instruction on proper exercises and early motion of the shoulder to prevent complications Surgery Fractures of the scapula involving the neck or glenoid or with severe displacement [oregonshoulder.com]

However, scapula fractures resulting in displaced bones may require surgical intervention to prevent significant life-long disability. Less ... [ypo.education]

Immediate first aid is important and strapping or taping the shoulder is usually recommended to prevent long-term deformity of the shoulder. [sportsinjuryclinic.net]

1. Woodward TW, Best TM. The painful shoulder: part II. Acute and chronic disorders. Am Fam Physician. 2000;61(11):3291-300.
2. Bonz J, Tinloy B. Emergency department evaluation and treatment of the shoulder and humerus. Emerg Med Clin North Am. 2015;33(2):297-310.
3. Cole PA, Freeman G, Dubin JR. Scapula fractures. Curr Rev Musculoskelet Med. 2013;6(1):79-87.
4. Zlowodzki M, Bhandari M, Zelle BA, Kregor PJ, Cole PA. Treatment of scapula fractures: systematic review of 520 fractures in 22 case series. J Orthop Trauma. 2006;20(3):230-233.
5. Baldwin KD, Ohman-Strickland P, Mehta S, et al. Scapula fractures: a marker for concomitant injury? a retrospective review of data in the national trauma database. J Trauma. 2008;65(2):430–435.
6. Gottschalk HP, Dumont G, Khanani S, et al. Open clavicle fractures: patterns of trauma and associated injuries. J Orthop Trauma. 2012;26(2):107–109.
7. McGahan JP, Rab GT, Dublin A. Fractures of the scapula. J Trauma. 1980;20(10):880–883.
8. Thompson DA, Flynn TC, Miller PW, Fischer RP. The significance of scapular fractures. J Trauma. 1985;25(10):974–977.
9. Chamata E, Mahabir R, Jupiter D, Weber RA. Prevalence of brachial plexus injuries in patients with scapular fractures: A National Trauma Data Bank review. Plast Surg (Oakv). 2014;22(4):246-248.
10. McAdams TR, Blevins FT, Martin TP, DeCoster TA. The role of plain films and computed tomography in the evaluation of scapular neck fractures. J Orthop Trauma. 2002;16(1):7-11.
11. Armitage BM, Wijdicks CA, Tarkin IS, et al. Mapping of scapular fractures with three-dimensional computed tomography. J Bone Joint Surg Am. 2009;91(9):2222–2228.
12. Anavian J, Conflitti JM, Khanna G, et al. A reliable radiographic measurement technique for extra-articular scapular fractures. Clin Orthop Relat Res. 2011;469(12):3371–3378.
13. Anavian J, Khanna G, Plocher EK, et al. Progressive displacement of scapula fractures. J Trauma. 2010;69(1):156–161.