You can fracture your shoulder blade, known medically as the scapula, although it is an uncommon injury. The scapula is a large, flat, triangular bone positioned over the back of the rib cage. Because it is covered by substantial muscle and protected by the torso, fracturing it requires a significant amount of force, resulting in the injury’s relative rarity.
Understanding the Rarity and Causes
The structure of the shoulder blade, which is encased in muscle and floats over the ribs, means that a scapula fracture is typically the result of high-energy trauma. These fractures represent less than 1% of all broken bones. The force required to break the scapula often comes from blunt impact, with high-speed motor vehicle accidents being the most frequent cause.
Other mechanisms of injury include falls from a significant height or a direct, severe blow to the back of the shoulder. The extreme force involved means that scapula fractures are often associated with other severe injuries in the chest, head, or elsewhere in the body, collectively referred to as polytrauma. For this reason, the scapula injury can sometimes be overlooked initially as doctors focus on more life-threatening problems.
The fracture can occur in various parts of the bone, with the scapular body and the glenoid neck being the most common sites. Fractures to the body are generally the most frequent. A break in the glenoid, the socket portion of the shoulder joint, is a specific concern because it directly affects shoulder stability. The specific location of the break influences the necessary treatment plan.
Recognizing the Immediate Signs
Following the traumatic event, a person with a fractured scapula will experience severe, immediate, and localized pain over the back of the shoulder. This intense pain is often accompanied by noticeable swelling and bruising in the area immediately surrounding the shoulder blade. A patient may also feel or hear crepitus, which is a grinding or popping sensation caused by the fractured bone fragments rubbing against each other.
One of the most telling signs is a significant functional limitation in the arm and shoulder. The pain makes it extremely difficult, if not impossible, to move the arm, particularly in an upward direction. Patients instinctively hold the injured arm close to their body, a protective posture known as splinting, to minimize any movement of the shoulder joint. Anyone experiencing these symptoms must seek immediate medical attention to assess for all potential injuries.
How Doctors Diagnose and Treat Scapula Fractures
The diagnostic process begins with standard X-rays of the shoulder and chest, which can identify the presence of a fracture. However, because the scapula is obscured by the overlying ribs and chest wall, the full extent of the break can be difficult to see. Due to the complex anatomy and the frequent presence of other injuries, a Computed Tomography (CT) scan is often required to fully evaluate the fracture pattern.
The CT scan provides a detailed, three-dimensional view of the bone, which is especially important for assessing complex or displaced fractures, particularly those involving the glenoid. This detailed imaging helps doctors measure the degree of displacement and angulation, which are critical factors in determining the course of treatment. The majority of scapula fractures, roughly 90%, are treated non-surgically because the surrounding muscle provides natural stabilization, preventing significant displacement.
Non-operative management involves immobilizing the arm in a sling for a few weeks, along with pain management. Early, gentle motion exercises are often introduced quickly to prevent the shoulder from becoming stiff. Surgical intervention is reserved for specific, less common cases, such as highly displaced fractures, or those where the break involves the joint surface of the glenoid, causing shoulder instability. The goal of surgery, which involves using plates and screws to restore the bone’s alignment, is to ensure a smooth joint surface and stable shoulder mechanics.
The Recovery Process and Rehabilitation
Recovery from a scapula fracture is generally prolonged, with the bone itself taking approximately 6 to 12 weeks to unite and heal. Achieving full functional recovery of the shoulder and arm often requires several months. The primary focus after the initial healing phase is physical therapy, which is a necessary component of the long-term recovery process.
Physical therapy typically begins with passive range of motion exercises, where the therapist moves the patient’s arm to prevent stiffness without engaging the shoulder muscles. This is followed by active-assisted motion, and then strengthening exercises focused on the rotator cuff and periscapular muscles. The timing of each phase is carefully managed to avoid putting stress on the still-healing fracture site.
Potential long-term complications can include persistent shoulder stiffness, chronic pain, or instability, especially if the fracture involved the glenoid joint surface. If the fracture heals in a poor position, a condition called malunion, it can alter the shoulder’s mechanics and lead to issues like impingement. With consistent adherence to a structured rehabilitation plan, most individuals can expect a good outcome, with a return to daily activities and sports over a period of three to six months.