Broken Shoulder Blade (Fractured Scapula)

The shoulder blade or scapula is responsible for the complex, smooth movement of the shoulder muscles, and it takes lots of trauma to break it.

• The scapula or shoulder blade is a bony structure found on the upper back that connects the upper arm to the chest wall (thorax). It also forms the socket part of the shoulder joint connecting the upper arm (humerus) to the socket (glenoid). The acromion and coracoid processes are bony bumps found on the upper part of the scapula, and they function to connect the scapula to the collarbone. The scapula is surrounded by thick layers of muscle that are responsible for the smooth movement of the shoulder joint.
• The shoulder blade (scapula) is rarely broken (broken bones are also called fractures). Shoulder blades breaks comprise very few of all fractures.
• Scapular fractures occur more often in young men aged 25-45 years because of the activities and trauma they encounter. These occur with athletic activities, motor vehicle accidents, and other forms of blunt trauma.
• A heavy force is usually required to break a shoulder blade; therefore, the health care professional will explore other injuries when a patient has a broken shoulder blade.
• Fractures (breaks) have been reported at the many areas of bone that comprise the scapula.

1. Pain, swelling, and bruising may occur over the shoulder blade in the upper back or on the top of the shoulder overlying the coracoid and acromion processes.
2. The person will hold the arm connected to the injured scapula close to the body.
3. Movement of the arm will increase the scapular pain.
4. The person will be unable to lift the arm connected to the fractured scapula.
5. The person may have pain with each deep breath due to movement of the chest wall with each breath. This movement may cause movement of the broken shoulder blade causing pain.
6. The person's shoulder with the fractured scapula may appear flattened or deformed.

Call a doctor if these conditions exist, especially if they are associated with any trauma to the shoulder area or upper back.

1. Pain with movement of the affected shoulder
2. Swelling of the shoulder
3. Bruising around the shoulder
4. If shoulder pain fails to improve within 3-5 days

Significant trauma to the shoulder, chest wall, back, or neck can cause severe injuries. If you experience any of these symptoms and signs call 911 and for an ambulance immediatley.

1. Severe pain or deformity of the shoulder
2. Inability to move the shoulder or arm
3. Weakness, numbness, or persistent tingling in the injured arm
4. Shortness of breath
5. Decreased sensation in the affected arm
6. Abdominal pain

Scapular fractures are caused by direct trauma involving a large amount of force or violence. Associated injuries to chest wall, lungs, and shoulder occur in a majority of people with broken shoulder blades. Consequently, if a scapula is fractured, other areas of the body should be diligently examined for additional problems. Common causes of broken shoulder blades include the following:

• Motor vehicle accidents
• Falls with direct trauma to the shoulder
• Falls onto an outstretched arm
• Direct trauma such as from a baseball bat or hammer

A doctor will be able to diagnose a broken shoulder blade after a thorough physical examination and imaging.

• Shoulder and chest X-rays are taken.
• CT scans of the abdomen and chest are sometimes indicated to evaluate other injuries.
• CT scans of the shoulder are sometimes needed to diagnose fractures of the shoulder socket (glenoid).
• Fractures of the scapula are sometimes discovered during extensive evaluations after major trauma from falls, motor vehicle accidents, or direct trauma.

A broken shoulder blade should receive ongoing treatment by an orthopedic surgeon or sports medicine specialist to ensure proper healing. Follow the instructions given when leaving the hospital and avoid potential trauma while recovering.

Pain medications and immobilization will likely be needed to control pain while early in the recovery and rehabilitation period. Patients need to keep follow-up appointments and understand that within a timeframe, should be tapered off pain medicines; many pain medicines (hydrocodone, for example), have the potential to become addictive. Problems with pain and pain medicines need to be discussed with the primary care and specialist doctors that treat the individual.

Early physical therapy with exercises designed to improve the range of shoulder motion are started about one week after the injury. It is important to start these exercises early to avoid a frozen shoulder (a loss of motion in the shoulder can occur if the shoulder is not used for a prolonged period).

The goal of treatment is to maintain the function of the shoulder. Most fractures of the body of the scapula are treated without surgery.

• Ice is used for swelling, and pain medications are used for pain control.
• The shoulder is immobilized in a shoulder sling for 3-4 weeks until the pain goes away.
• Pain management is likely to be required; nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, hydrocodone, and morphine are common medications used to reduce pain while the fracture heals. The medication schedule should be determined by the patient's overall condition and associated injuries. The prescribing doctor should take into account the length of time medications can begin to be tapered off; follow-up appointments are useful to help determine this medication schedule.

Because shoulder blade fractures are often associated with severe, potentially life-threatening injuries, they should be evaluated in a hospital's emergency department.

1. Immobilize the arm immediately. Don't move it. This can be accomplished with a sling looped over the neck and the elbow bent, which holds the affected arm close to the body.
2. Apply ice to the area to reduce swelling and discomfort.
3. Apply ice for 20 minutes at a time, and avoid direct contact of the ice to the skin.
4. Because there is a high chance that other injuries have been sustained at the time of the shoulder injury, the injured person should be transported by ambulance to a hospital, preferably one that is a trauma center for evaluation of the shoulder and other injuries.

• Broken shoulder blades can be prevented by avoiding high-risk activities or at least attempting to protect the body when participating in the following sports:
• Activities with potential for falls from significant heights such as rock climbing, hang-gliding, or skydiving
• Contact sports (football, hockey), dirt-bike racing, car racing
• Gang or street fighting (especially with blunt objects used as weapons such as bricks, boards, baseball bats)
• Always wear a seatbelt while driving, and all passengers in the car should wear a seatbelt.

Most fractures of the shoulder blade heal without complications within 6-8 weeks. Fractures that involve the shoulder socket or scapular neck develop more complications.

Complications may include the following:

• Loss of range of motion
• Loss of strength
• Persistent pain
• Bursitis
• Early arthritis
• Many people with scapular fractures have other serious injuries, and their prognosis often depends more on the nature of these other injuries (for example, spinal fractures, head injuries, organ damaged such as lacerated spleen or liver).