What is Fracture of the Shoulder Blade (Scapula)?
A fracture of the shoulder blade, also known as a scapular fracture, is a break in the scapula, a large, flat triangular bone that sits at the back of the shoulder. Scapular fractures are relatively rare, accounting for less than 1% of all fractures, due to the bone's protected position and the considerable force required to fracture it.
Anatomy of the Scapula
The scapula has several important parts that can be involved in a fracture:
- Body: The main flat, triangular part of the bone.
- Spine: A prominent ridge running across the back of the scapula.
- Acromion: The bony projection off the spine of the scapula that forms the highest point of the shoulder.
- Coracoid Process: A hook-like bony projection on the front of the scapula.
- Glenoid Cavity: The shallow socket that articulates with the head of the humerus to form the shoulder joint.
Causes of Fracture of the Shoulder Blade (Scapula)
Scapular fracture usually occur as a result of high-energy trauma, such as motor vehicle accidents, falls from significant heights, or direct blows during contact sports.They can also occur from a strong force directly applied to the back or side of the shoulder.
Symptoms of Scapular Fractures
- Severe Pain: Immediate and intense pain at the time of injury.
- Swelling and Bruising: Around the shoulder and upper back.
- Limited Range of Motion: Difficulty moving the arm and shoulder.
- Deformity: In some cases, an obvious deformity may be present.
- Tenderness: Pain upon palpation of the shoulder area.
- Crepitus: A grinding or crunching sensation when moving the shoulder.
Diagnosis of Scapular Fractures
- Medical History: Assessment of the injury mechanism and symptoms.
- Physical Examination: Checking for tenderness, swelling, deformity, and range of motion.
- Imaging Studies:
- X-Rays: Initial imaging to identify the fracture and its extent.
- CT Scans: Provide detailed images to better understand the fracture pattern and involvement of surrounding structures.
Treatment of Scapular Fractures
Non-Surgical Treatment
- Rest and Immobilization: Use of a sling or shoulder immobilizer to keep the shoulder in place and allow healing.
- Pain Management: NSAIDs and analgesics to control pain and inflammation.
- Physical Therapy: Once the initial pain and swelling subside, gentle range-of-motion exercises to prevent stiffness, followed by strengthening exercises.
Surgical Treatment
- Indications: Surgery may be necessary for significantly displaced fractures, fractures involving the glenoid cavity affecting shoulder stability, or fractures associated with other injuries.
- Procedures:
- Open Reduction and Internal Fixation (ORIF): Aligning and securing the fractured bone fragments using plates, screws, or wires.
- Rehabilitation: Post-surgical physical therapy to restore range of motion, strength, and function.
