A fractured scapula is a break in the scapula, commonly known as the shoulder blade. This large, flat, triangular bone is located on the upper back, connecting the collarbone and the upper arm bone to the torso. Because the bone is shielded by surrounding musculature, a scapular fracture typically results only from a high-force traumatic event.
Anatomy and Mechanisms of Injury
The scapula is a foundational component of the shoulder girdle, serving as a mobile base for the arm’s movement. It articulates with the humerus to form the ball-and-socket shoulder joint and with the clavicle at the acromioclavicular joint. The scapula’s deep position and its muscular envelope mean that these fractures represent less than one percent of all skeletal fractures.
The force required to break the scapula is substantial, which is why the injury mechanism is almost always high-energy trauma. Motor vehicle collisions, falls from significant heights, and direct blunt impacts account for the majority of cases. Due to the violence of the injury, a scapular fracture is frequently associated with other serious, potentially life-threatening injuries, such as rib fractures or lung contusions.
Fractures are typically categorized by the part of the bone affected, including the body, the neck (the narrowed part connecting the body to the joint), or the glenoid (the socket component). Fractures of the scapular body are the most common pattern. Breaks involving the glenoid or the neck often carry more serious implications for shoulder function. The surrounding muscles tend to hold most broken pieces in place, which is why displacement is often minimal.
Recognizing the Signs
A person with a fractured scapula experiences severe, immediate pain localized to the upper back and shoulder area following the trauma. This pain is aggravated by any attempt to move the arm or shoulder, leading to muscle guarding and spasms. Swelling and significant bruising usually develop quickly over the back of the shoulder blade.
Moving the arm may be difficult or impossible, particularly when trying to lift it away from the body. A grinding or cracking sensation, known as crepitus, can be felt or heard near the fracture site during attempts at movement. Any combination of these symptoms following high-energy trauma necessitates immediate medical evaluation.
Medical Confirmation and Immediate Care
Diagnosis begins with a thorough physical examination and standard X-ray imaging. Because the scapula is obscured by the chest wall and ribs, a Computed Tomography (CT) scan is frequently necessary to fully visualize the fracture pattern. The CT scan is especially useful for determining the exact extent of bone displacement and whether the fracture involves the glenoid joint surface.
Immediate care focuses on pain control, often managed through medication, and temporary immobilization using a sling or shoulder immobilizer. The decision for definitive treatment is based on the fracture type and the degree of displacement. Up to 90 percent of scapular fractures are treated non-surgically with immobilization and early motion exercises.
Surgical intervention is reserved for specific fracture patterns that threaten long-term shoulder function. This includes fractures of the glenoid surface where displaced fragments can lead to joint instability or post-traumatic arthritis. Surgery may also be indicated for highly angulated fractures of the scapular neck or when the scapula fracture is combined with a clavicle fracture, severely destabilizing the shoulder complex. In these cases, plates and screws are used to stabilize the bony fragments and restore the joint’s correct alignment.
Rehabilitation and Recovery Timeline
Recovery begins shortly after the injury to prevent the complication of shoulder stiffness. The initial phase involves brief immobilization, typically lasting two to four weeks, used primarily for comfort and pain management. Gentle exercises, such as pendulum swings and passive range of motion of the elbow, wrist, and hand, are encouraged to maintain mobility in the rest of the limb.
Once the initial pain subsides, the focus shifts to controlled mobility under the guidance of a physical therapist. This phase involves gradually introducing self-assisted and active range-of-motion exercises, working toward regaining movement in all planes. The goal is to restore full range of motion without placing excessive stress on the healing bone fragments.
The final stage of rehabilitation focuses on strengthening the periscapular and rotator cuff muscles. Strengthening is introduced around six to eight weeks post-injury, or once the fracture shows signs of clinical healing, to ensure the shoulder has the stability required for daily activities. A full recovery, including the return to demanding sports or heavy labor, typically requires three to six months of dedicated physical therapy.