Broken Shoulder Blade (Scapula Fracture)
Written by: Jacob Tiell
What Is a Scapular Fracture?
A scapular fracture is a broken shoulder blade. While not very common, these shoulder blade fractures typically occur due to high-energy blunt trauma through a motor vehicle crash (MVC), falling from a great height, contact sports such as football, etc.
Due to the high energy nature of scapula fractures, 80-95% of people will have additional, possibly more severe injuries (rib fracture, collapsed or bruised lung, clavicle fracture, etc.).
If you have had a recent injury to your shoulder blade and would like to know if you have a shoulder blade fracture, then schedule a consultation with our expert healthcare professionals at OrthoNeuro. Our doctors provide accurate diagnoses and tailor-made treatment plans. Call us or book an appointment online today!
What Does the Scapula Do?
Anatomy of the scapula:
Three bones compose the shoulder joint: the upper arm bone (humerus), the collar bone (clavicle), and the shoulder blade (scapula). The scapula is the flat triangular bone that sits at the back of the shoulder. What most people refer to as the shoulder blade is actually the scapula. It can be easily viewed and palpated upon retracting the shoulder.
The major functions of the scapula are providing stability to the arm by attaching the humerus to the chest wall and providing attachment sites for 18 different muscles. The important rotator cuff muscles originate here and function to keep the humerus centered and attached to the glenoid (part of the scapula).
Diagnosis and Examination
Symptoms of a scapula fracture typically include:
- Pain with arm and shoulder motion
- Pain with deep breaths due to the rib cage expanding and moving the fracture
- Swelling and bruising at the back of the shoulder
More severe fractures, and associated injuries, may present with shortness of breath and/or numbness/tingling within the shoulder or down the arm.
While scapula fractures themselves are not time-sensitive, if these more serious symptoms present, it is crucial to immediately head to the nearest hospital or emergency facility as they could indicate a more severe injury.
A physical exam is typically the first diagnostic tool used to evaluate a scapula fracture. During the physical exam, medical providers will:
- Evaluate for open fractures/wounds
- Provide a neurovascular exam to test the various nerves and vasculature around the scapula
- Examine shoulder positioning and range of motion (if there is any at all)
- Palpate the surrounding area
After the physical exam, imaging will be obtained. An X-ray of the shoulder and chest will provide valuable information in diagnosing the fracture. If needed, a CT or MRI may also be obtained to get a more in-depth look at the bone and surrounding soft tissue (Muscles, ligaments, organs).
Surprisingly, most scapula fractures can be treated non-operatively. This can be done through stabilization and immobilization with a sling, immobilizer, or figure 8 brace for three to four weeks, depending on the severity.
It is also recommended to use NSAIDs, such as ibuprofen or naproxen, to deal with the pain and inflammation/swelling. Icing is also great for reducing swelling. Be sure to wrap ice packs with a towel to prevent ice burn.
Surgical Treatment, Complications, Outcomes
In the case of severe injuries where the scapula fracture was displaced or in a certain anatomic location, surgery may be indicated. For instance, fractures at the glenoid or scapular neck often require surgery. Associated injuries such as clavicle or rib fractures may also need surgery. In surgery, these fractures are fixated using a combination of plates and screws.
As with any surgery, there are possible complications associated with the surgical treatment of a scapula fracture. These can include:
- Neurovascular damage (nerves, arteries, veins)
- The lungs lie close to their respective scapula, adding an additional risk
- Nonunion (bone/fracture not healing) is usually associated with patient non-compliance, diabetes, and/or tobacco use
The outcomes of these surgeries are excellent. At 5-10 years post-operation functional outcomes are near perfect. There has been no significant difference in strength shown between injured and uninjured shoulders, with only a small decrease in external rotation motion relative to the uninjured shoulder.
If you are experiencing pain in your shoulder due to an injury, schedule a consultation Board-Certified Orthopedic Surgeons at one of our 7 Greater Columbus locations. One of our specialists will evaluate your lifestyle and goals to determine the best treatment option for you.
- Greiwe RM. Shoulder and Elbow Trauma and its Complications Volume 1: The Shoulder. Cambridge, UK: Woodhead Publishing; 2015
- Tatro JM, Gilbertson JA, Schroder LK, Cole PA. Five to Ten-Year Outcomes of Operatively Treated Scapular Fractures. J Bone Joint Surg Am. 2018 May 16;100(10):871-878. doi: 10.2106/JBJS.17.00673. PMID: 29762283.