A fractured scapula, commonly known as a broken shoulder blade, is a flat, triangular bone located in the upper back. Because the scapula is protected by a complex network of surrounding muscles and the chest wall, a fracture usually results from a significant application of force. This high-impact trauma often indicates other serious injuries are present.
Anatomy, Causes, and Immediate Symptoms
The scapula connects the upper arm bone (humerus) and collarbone (clavicle) to the torso, serving as an anchor point for many muscles. Its primary function is to provide a stable base for shoulder movement and act as a shield for the underlying ribs and lungs. Because the bone is so well-protected, most scapula fractures are caused by high-energy blunt trauma.
Motor vehicle accidents are responsible for up to 75% of scapula fractures. Falls from a significant height or direct, severe blows to the back of the shoulder are also common mechanisms of injury. The intense force required to break the bone means that other injuries, such as rib fractures, lung contusions, or head trauma, are present in up to 90% of cases.
Immediate symptoms are severe and localized to the upper back and shoulder area. Patients experience extreme pain worsened by any attempt to move the arm. Swelling and bruising around the shoulder blade are noticeable, and a grinding or popping sensation, known as crepitus, may be felt with movement. The pain results in an inability to lift or hold the arm still.
Determining the Type of Fracture
Scapula fractures are classified based on the specific anatomical location of the break, which directly influences the treatment plan. The fracture type determines whether the break is likely to heal without surgery. The most common location is the scapular body, the flat, triangular portion of the bone.
Scapular body fractures account for 50% to 60% of all cases and are often managed without surgery because surrounding muscles help hold the fragments in place. Fractures of the scapular neck, the narrow segment connecting the body to the shoulder joint socket, are more complicated. These are especially concerning if significantly displaced or if they occur alongside a broken clavicle, sometimes referred to as a “floating shoulder.”
The most complex type is a glenoid fracture, involving the shallow socket that forms the ball-and-socket shoulder joint. Because these are intra-articular fractures, they can lead to long-term problems like arthritis or instability if not perfectly realigned. Glenoid fractures often require surgery if the bone fragments are displaced by more than a few millimeters or if the shoulder joint is unstable.
Diagnosis and Treatment Pathways
Diagnosis begins with a physical examination and standard X-rays of the shoulder and chest. To accurately determine the extent of the injury, a Computed Tomography (CT) scan is considered the gold standard. The CT scan provides a detailed, three-dimensional view of the fracture pattern and is particularly useful for assessing involvement of the glenoid joint surface.
Treatment pathways involve non-surgical and surgical approaches. Non-surgical management is the standard for most body fractures and those that are minimally displaced, focusing on pain control and immobilization with a sling. The sling is worn for the first few weeks to allow soft tissues to settle and initial bone healing to begin.
Surgical intervention is indicated for displaced fractures that meet specific criteria, such as those involving the glenoid with a step-off or gap in the joint surface. Surgery is also indicated for severely angled neck fractures or when the injury contributes to instability of the shoulder joint. The goal is to restore the anatomical alignment of the bone, particularly the smooth surface of the glenoid, using plates and screws for stable fixation.
Rehabilitation and Recovery Timeline
Recovery from a fractured scapula requires a structured rehabilitation program. For non-surgically treated fractures, gentle range-of-motion exercises may begin as early as the first week to prevent shoulder stiffness. Initial healing of the bone fragments takes between six and twelve weeks, depending on the severity of the injury.
Physical therapy is a necessary component of the long-term recovery, working progressively to restore full range of motion and strength to the shoulder. The rehabilitation protocol often moves from passive motion exercises, where the arm is moved without muscle effort, to active exercises and eventually resistance training.
Patients who were treated non-surgically may return to most daily activities without restriction within six to eight weeks. Full recovery, including the recovery of pre-injury muscle strength, can take three to six months, and for those who required surgery, the process is generally longer and more involved.