The scapula, also known as the shoulder blade, is a flat, triangular bone that serves as an attachment point for muscles in the back, neck, chest, and arm. It consists of three main parts: the body, the neck, and the spine.
Scapular fractures are not very common but can happen when there is a significant amount of force applied. These injuries typically result from severe trauma, such as a high-speed car crash or a fall from a height onto the back. They may also occur from a fall on an outstretched arm, where the humeral head hits the glenoid cavity.
Symptoms of a scapular fracture include the following:
- Pain: Usually severe and immediate following injury to the scapula.
- Swelling: The scapular area quickly swells following the injury.
- Bruising: Bruising occurs soon after injury.
- Impaired Mobility: Decreased range of motion of the joint occurs, often with inability to straighten the arm.
- Numbness: Numbness, tingling, or coldness of the hand and forearm can occur if blood supply is impaired or nerves are injured.
- Popping Sound: A cracking or popping sound, also referred to as crepitus, can often be heard or felt at the time of the fracture.
Scapular fractures should be evaluated by an orthopaedic surgeon for proper diagnosis and treatment.
Your surgeon will perform the following:
- Medical History
- Physical Examination
Diagnostic Studies may include:
- X-rays: A form of electromagnetic radiation that is used to take pictures of bones.
- CT scan: This test creates images from multiple X-rays and shows your physician structures not seen on regular X-ray.
- MRI: Magnetic and radio waves are used to create a computer image of soft tissue such as nerves and ligaments.
Most scapular fractures typically do not involve significant displacement because the area is well-supported by strong soft tissues. As a result, the majority of these fractures are managed with conservative treatment and early movement to prevent stiffness, and they usually heal without causing any long-term issues with shoulder function.
Conservative treatment options include:
- Immobilization: A sling is used for comfort and to support the shoulder to allow healing to take place. This is usually worn about 3-6 weeks depending on the type of fracture and how well you heal.
- Prescription Medications: Pain medications will be prescribed for your comfort during the healing process.
- Physical Therapy: Early progressive range of motion exercises is essential in restoring full shoulder function. 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.
Surgical Introduction
Fractures of the scapula that affect the neck or glenoid area, or that involve significant displacement, are typically linked to worse results when treated without surgery. These injuries generally require surgical treatment to correctly align the bones and regain a functional, pain-free movement of the shoulder joint.
In the past, surgery for scapular fractures was usually done with a large open incision. However, more advanced and less invasive methods have been developed, allowing for scapular fracture repairs to be performed using arthroscopy.
