The scapula (shoulder blade) is a flat, triangular bone providing attachment to the muscles of the back, neck, chest and arm. The scapula has a body, neck and spine portion.
Scapular fractures are uncommon but do occur and require a large amount of force to fracture. They are usually the result of intense trauma, such as a high-speed motor vehicle accident or a fall from height. They can also occur from a fall on an outstretched arm if the humeral head impacts on the glenoid cavity.
Symptoms of a scapular fracture include the following:
- Pain: Usually severe and immediate following injury to the scapula.
- Swelling: The scapular area quickly swells following the injury.
- Bruising: Bruising occurs soon after injury.
- Impaired Mobility: Decreased range of motion of the joint occurs, often with inability to lift the arm.
- Numbness: Numbness, tingling, or coldness of the hand and forearm can occur if blood supply is impaired or nerves are injured.
- Popping Sound: A cracking or popping sound, also referred to as crepitus, can often be heard or felt at the time of the fracture.
Scapular fractures can be complex, and should be evaluated by an orthopaedic surgeon with a special interest in shoulders.
Dr Bala will perform the following:
- Medical History
- Physical Examination
Diagnostic Studies may include:
- CT scan: provides details of the fracture
- MRI: provides more details of the soft tissue such as nerves and ligaments.
Most scapular fractures are not significantly displaced due to the strong supporting soft tissue structures surrounding it. Therefore, most scapular fractures are treated conservatively and with early motion to reduce the risk of stiffness and will usually heal without affecting shoulder movement.
Conservative treatment options include:
- Immobilisation: Dr Bala may suggest a sling for comfort and to support the shoulder to allow healing to take place. This is usually worn for a few weeks depending on the type of fracture and how well it is healing.
- Prescription Medications: Dr Bala may prescribe pain medications for your comfort during the healing process.
- Physiotherapy: Early progressive range of motion exercises is essential in restoring full shoulder function. A Physiotherapist will instruct you on proper exercises and early motion of the shoulder to minimise complications.
Severely displaced fractures of the scapula involving the neck of the scapula or glenoid have been associated with poor outcomes when treated non-operatively. Those will usually require surgical intervention to realign the bones properly and restore a functional, pain free range of motion to the shoulder joint.
Scapular fracture repair surgery has historically been performed through a large, open incision. Newer techniques have evolved and Dr Bala will discuss these with you. Some glenoid fractures can now be performed through keyhole surgery.
As these are complex injuries, recovery is often slow and it is common to not regain full motion or strength.