Scapula (Shoulder Blade) Fractures

Fracture patterns in the scapula

(Reproduced with permission 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 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

Symptoms

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.

Doctor Examination

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.

Treatment

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.