Sports Medicine
Sports Injury Prevention & Rehabilitation

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Scapula Fracture

(Also known as Fractured Scapula, Shoulder Blade Fracture, Fractured Shoulder Blade)
What is a scapula fracture?
A scapula fracture is an uncommon condition characterized by a break in the shoulder blade (scapula).
The shoulder blade (scapula) lies on top of the rib cage. The scapula joins with the long bone of the upper arm (humerus) to form the shoulder joint. The scapula also forms a joint with the collar bone (clavicle) at the front of the shoulder (AC joint).
Following a fall onto the shoulder blade or following a direct impact to the back or side of the shoulder, stress is placed on the scapula. If these forces are beyond what the scapula can withstand, a break in the bone may occur. When this occurs the condition is known as a scapula fracture and can vary in severity and location.
A scapula fracture may occur in various locations including:
  • the body of the scapula
  • bony prominences of the scapula situated at the front or side of the shoulder (coracoid and acromion processes)
  • the glenoid fossa (i.e. the socket of the ball and socket joint of the shoulder)
Causes of a scapula fracture
A scapula fracture usually occurs due to a direct blow to the scapula, such as a motor vehicle accident or following a heavy collision with another player during contact sports, such as rugby or football. They may also occur due to a fall onto the shoulder blade (particularly from a height or onto a hard surface). Occasionally a scapula fracture may occur due to a fall onto a bent elbow or outstretched arm or in association with a dislocated shoulder (this is more so the case with fractures to the glenoid fossa).

Signs and symptoms of a scapula fracture
Patients with a scapula fracture typically experience a sudden onset of sharp, intense pain at the time of injury. Pain is usually severe and located at the back or side of the shoulder, or, in the upper back. Occasionally pain may radiate into the front of the shoulder, the neck, upper arm or less commonly, the forearm or hand. Pain may increase when attempting to perform movements of the upper limb such as arm elevation (to the front or side of the body), overhead activities, taking the arm across the chest or during pushing, pulling or lifting activities. Pain may also increase when lying on the affected shoulder blade, applying pressure to the shoulder, or on firmly touching the scapula at the site of injury. Sometimes deep breathing or coughing may also elicit pain. An ache in the shoulder or shoulder blade may also be present that is particularly prominent at night or first thing in the morning (especially during the first few days following injury).
Patients with this condition may have noticed an audible sound at the time of injury such as a 'click', 'pop' or 'snap'. There is usually swelling at the site of injury, and, depending on the severity, a bony deformity may be evident. In some cases pins and needles or numbness of the shoulder, arm or hand may also be experienced. Extensive bruising to the shoulder blade region, shoulder, or upper arm may also be present (particularly with more severe fractures) and usually begins to appear a couple of days after the injury.

Diagnosis of a scapula fracture
A thorough subjective and objective examination from a doctor is important to assist with diagnosis of a scapula fracture. An X-ray is required to confirm diagnosis and should always be taken if a fracture is suspected.

Treatment for a scapula fracture
Because the scapula has extensive muscular attachments, there is usually no significant displacement of the bone particularly with fractures to the body of the scapula. As such, treatment typically involves the use of a sling for a certain period of time, followed by gradual pain free active shoulder exercises and guided restoration of shoulder function by the physical therapist.
  • In the unlikely event that the scapula fracture is significantly displaced and is unlikely to respond to conservative management, treatment may involve anatomical reduction (i.e. re-alignment of the fracture by careful manipulation under anaesthetic) followed by surgical internal fixation to stabilize the fracture (using plates, screws or wires). This may be followed by the use of a sling for a number of weeks.
  • For those fractures that are not displaced (and for some that are displaced and are likely to respond to conservative management), treatment may involve the use of a sling for comfort followed by active movement as pain allows. The orthopaedic specialist will advise the patient as to which management is most appropriate based on a number of factors, including the location, severity and type of scapula fracture.
  • Evaluation of the fracture with follow up X-rays is important to ensure the fracture is healing in an ideal position. Once healing is confirmed, rehabilitation can progress as guided by the treating physical therapist.
  • One of the most important components of rehabilitation following a scapula fracture is that the patient rests sufficiently from any activity that increases their pain (a sling is often required). Activities which place large amounts of stress through the scapula should also be avoided, particularly lifting, pushing or pulling, lying on the affected shoulder blade and arm elevation activities. Rest from aggravating activities allows the healing process to take place in the absence of further damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms. This should take place over a period of weeks to months with direction from the treating physical therapist.
  • Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to cause further damage and may slow healing or prevent healing of the scapula fracture altogether.
  • Manual "hands-on" therapy from the therapist such as massage, trigger point release techniques, dry needling, joint mobilization, stretches, and electrotherapy can assist with hastening healing and improving range of movement, pain and function. This can generally commence once the orthopaedic specialist and therapist have indicated it is safe to do so.
  • Patients with a scapula fracture should perform pain free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome. This is particularly important as soft tissue flexibility and strength are quickly lost with inactivity. The treating therapist can advise which exercises are most appropriate for the patient and when they should be commenced. In the final stages of rehabilitation for a scapula fracture, a gradual return to activity or sport can occur as guided by the treating physiotherapist provided there is no increase in symptoms.

Prognosis of a scapula fracture
Patients with a scapula fracture usually make a full recovery with appropriate management (whether surgical or conservative). Return to activity or sport can usually take place in a number of weeks to months and should be guided by the treating physical therapist and specialist. In patients with severe injuries involving damage to other bones, soft tissue, nerves or blood vessels, recovery time may be significantly prolonged. In patients with only very minor fractures that are un-displaced return to sport can sometimes occur in as little as 6 – 8 weeks as guided by the treating physical therapist.

Physical therapy for a scapula fracture
Physical therapy treatment for patients with a scapula fracture is important to ensure an optimal outcome and allow a safe return to activity. Treatment may comprise:
  • education
  • the use of a sling
  • postural taping
  • exercises to improve posture, flexibility and strength
  • soft tissue massage
  • dry needling
  • joint mobilization (following completion of fracture healing)
  • joint manipulation (e.g. to the thoracic or cervical spine – following completion of fracture healing)
  • electrotherapy (e.g. ultrasound)
  • activity modification advice
  • a graduated return to activity plan
Other intervention for a scapula fracture
Despite appropriate physical therapy management, some patients with a scapula fracture do not improve adequately and may require other intervention. The treating therapist or doctor can advise on the best course of management when this is the case. This may include further investigations such as X-rays, CT scan, MRI or bone scan, extended periods of sling immobilization or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the fractured scapula. In very rare circumstances, patients with fractures that are initially managed without surgical intervention may require surgery to stabilize the fracture and a bone graft to aid fracture healing.