Diseases & Conditions
Scapula (Shoulder Blade) Fractures
The scapula (shoulder blade) is a bone, shaped somewhat like a triangle, that is protected by a complex system of surrounding muscles.
High-energy, blunt trauma injuries, such as those experienced in a motor vehicle collision or after 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.
Scapula fractures are rare, representing less than 1% of all broken bones, and the vast majority can be treated without surgery.
Anatomy
The shoulder is made up of three bones:
- The scapula (shoulder blade)
- The clavicle (collar bone)
- The humerus (arm bone)
These bones are joined together by soft tissues (ligaments, tendons, muscles, and joint capsule) to form a platform for the arm to work.
Your shoulder joint is a ball-and-socket joint.
- The head of the humerus is the ball, and the scapula forms the socket.
- The humeral head (top of the humerus bone) rests in a shallow socket in the shoulder blade called the glenoid.
The scapula and arm are connected to the body by multiple muscle and ligament attachments. The front of the scapula (acromion) is also connected to the clavicle (collarbone) through the acromioclavicular (AC) joint.
Description
Because the scapula is protected by the chest and surrounding muscles, it is not easily fractured. Therefore, fractures of the scapula are usually caused by high-energy trauma, such as a high-speed motor vehicle collision, or a fall from a great height.
One or more parts of the scapula may be fractured.
- Scapular body (50 to 60% of fractures)
- Scapular neck (25% of fractures)
- 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
Physical Examination
To determine appropriate treatment, your doctor will:
- Evaluate the position and posture of your shoulder
- Look for additional injuries, since other injuries are often present with scapula fractures
The doctor will also treat any soft-tissue damage (abrasions, open wounds, and damage to the muscles.
A detailed physical examination may not be possible if you have other severe injuries.
Imaging Tests
Your doctor may 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.
- A computed tomography (CT) scan provides a more detailed image, if necessary.
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 you once again have complete shoulder motion. This may take 6 months to 1 year.
Surgical Treatment
Certain types of scapular fractures may need surgery:
- Fractures of the glenoid involving the shoulder joint in which bone has moved out of place (displaced)
- Fractures of the neck of the scapula with a lot of angulation (the bones are tilted away from each other)
- 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 screws to the outer surface of the bone.
Pain Management
Pain after an injury or surgery is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover faster.
Medications are often prescribed for short-term pain relief after surgery or an injury. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.
Be aware that although opioids help relieve pain after surgery or an injury, they are narcotics and can be addictive. Opioid dependency and overdose have become critical public health issues in the U.S. It is important to use opioids only as directed by your doctor and to stop taking them as your pain begins to improve. Talk to your doctor if your pain has not begun to improve within a few days of your treatment.
Outcomes
Generally speaking, fractures of the scapula heal at a faster rate than other fractures elsewhere in the body. The actual fracture typically heals within 3 to 4 months, with patients recovering muscle strength and mobility a few months later.
- Scapula fractures that do not require surgery typically heal more quickly, and patients may be able to return to activities without restriction in 6 to 8 weeks.
- When a scapula fracture is treated with surgery, it typically means there is a more complex injury involving the shoulder joint. Patients will likely take longer to recover and return to pre-injury activity levels.
Last Reviewed
November 2023
Contributed and/or Updated by
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AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.