Scapula Fractures – Symptoms, Causes and Diagnosis

The scapula refers to bones in the shoulder and scapula fractures are not very common and are often accompanied by severe pain. They make up just about 1% of all fractures and up to 75% of all such fractures are caused by motor accidents, contact sports, rock climbing and other such traumatic events.

Scapula Fracture and Shoulder Anatomy

The scapula bones are on either side of the upper back and connect the clavicle to the humerus. It is a large, triangular bone that can be divided into:

Scapular body
Acromion
Coracoid
Glenoid
Scapular neck

More than half the scapula fractures affect the scapular body while 25% of these fractures affect the scapular neck fracture.

Symptoms of Scapula Fractures

Severe pain is one of the most typical symptoms of the fracture. This pain is usually localized to the shoulder blades and upper back. It may be worsened by moving the arm or taking deep breaths. The person may be unable to lift the arm because of severe pain. The condition has other symptoms too which include:

Swelling in the shoulder and upper back
Bruising
Inability to lift the arm and hold it still
Weakness and a tingling sensation in the arm
If movement is possible, the person may feel a grinding sensation
The shoulder appears disfigured or flattened

Scapula fractures are often accompanied by fractures to other bones in the shoulder or ribs.

Causes and Risk Factors Of Scapula Fractures

Some of the factors that increase a person’s risk of having a scapula fracture are:

Driving without wearing a seatbelt
Underlying conditions like osteoporosis that weaken bone mass
Participating in activities like horseback riding, rock climbing, cycling, etc.
Playing contact sports like football and rugby

Scapula Fractures Diagnosis

In many cases, the diagnosis is delayed because the person usually has many other fractures and injuries. To diagnose this one, doctors will need to conduct a thorough physical examination. In addition, tests such as an X-ray of the chest and shoulder and CT scan of the shoulder, chest and mid-section may also be required.

Scapula Fractures Treatment

In most cases, surgery is not required to treat a scapula fracture. It can be treated with non-surgical methods of treatment such as:

Immobilizing the shoulder with a sling or shoulder immobilizer
Nonsteroidal anti-inflammatory drugs to manage the pain
Icing the shoulder to reduce inflammation. Icepacks should not be applied directly to the skin but covered with a thick cloth or towel.
Physical therapy

It may take anywhere between 6 and 12 months for the fracture to heal completely and to restore full shoulder movement.

Post Surgery Care

Surgery is typically required only if the fracture has displaced or the glenoid socket or clavicle is fractured. A surgical procedure is typically followed by about 8 weeks of mild exercise and more aggressive shoulder exercises post the first 8 weeks. After 12 weeks, resistant exercises may also be made part of the physical therapy. Most people recover fully from a scapula fracture with timely diagnosis and treatment.

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Q&As on Scapular Fractures

1) What are some of the complications associated with scapula fractures?

Any major blunt trauma mainly causes scapular fractures. They include fractures in the body or the spine of the scapula, glenoid rim fracture, scapular neck fracture, coracoid process fracture, and acromion fracture. Significant complications occur when associated injuries occur in adjacent and distant skeletal and soft tissue structures. In some cases, the ipsilateral shoulder girdle, chest wall and lungs are also affected. Pulmonary injuries include pulmonary contusion and hemopneumothorax. Some complications also occur during the treatment of scapula fractures. Two such complications are Nonunion and malunion, which are associated with non-operative treatment of scapula fracture. Another significant complication includes nerve injury, especially the musculocutaneous nerve, and the injury occurs during surgical fixation.

2) How is scapula fracture treated?

Maximum cases of scapula fractures can be treated without any surgery. Treatment mainly includes immobilization with a sling or shoulder immobilizer, pain medications, and icing. Usually, the sling is placed for comfort for the initial two weeks, and then the range of motion of the shoulder is gradually increased. There is no limitation of shoulder motion, and it all depends on how far one can tolerate mobility, weight lifting, and weight bearing. Scapula fractures that need surgery generally have fracture fragments involving the shoulder joint or clavicle fracture. With surgery, the fracture fragments are fixed using screws and plates.

3) How painful is a scapula fracture?

Scapula fracture is not very common and often leads to severe pain. More than 75% of scapula fractures occur because of traumatic events like motor vehicle accidents. They also occur because of contact sports like football or any sports that involve heights like cheerleading or rock climbing. Of all fractures, scapula fractures make up only 1%, while 3 – 5% make up for shoulder fractures. Maximum shoulder fractures affect the other two bones present in the shoulder joint, i.e. clavicle and humerus bones. Scapula fracture is very common in men of the age group 25 to 45 years.

4) How long does a fractured scapula hurt?

Maximum scapula fractures take about 6 – 7 weeks to heal completely, but the shoulder motion will become normal in six months to one year. In some cases, even full motion does not come back, and some kinds of scapula fractures require surgery. Even the doctor checks carefully, but issues might arise later. It is often recommended by a doctor to take over-the-counter pain relievers like acetaminophen. They suggest avoiding taking non-steroidal anti-inflammatory medications like naproxen and ibuprofen as they might slow down the healing process.

5) What are the various causes of scapula fracture?

Scapula fractures also called the broken shoulder, are often caused by high-force trauma. This is why a maximum number of scapula fractures are associated with injuries in the chest, internal organs, and lungs. Some of the major causes of scapula fractures are

Contact sports
Accidents while riding a motor vehicle
When the shoulder is hit hard
Falling into outstretched arms
Falling from a height
Direct trauma like from a hammer or bat