Scapula Fracture
A break in the shoulder blade, usually from high-force trauma
Quick Facts
- Type: Bone fracture
- Bone affected: Scapula (shoulder blade)
- Common cause: High-energy trauma, such as a crash or fall
- Often treated with: Sling, rest, and physical therapy
Overview
A scapula fracture is a break in the shoulder blade, the flat, triangular bone that sits over the back of the upper ribcage and connects the arm to the collarbone. The scapula is surrounded and cushioned by muscle, so it is well protected and breaks much less often than many other bones.
Because it takes a strong force to break the scapula, these fractures are usually the result of high-energy trauma such as a car crash, a fall from a height, or a hard sports collision. For the same reason, scapula fractures are frequently accompanied by other injuries to the chest, ribs, lungs, or shoulder that may be more serious than the fracture itself.
Symptoms
A scapula fracture typically causes:
- Pain in the shoulder blade and back of the shoulder, made worse by moving the arm
- Swelling and bruising over the shoulder blade area
- Tenderness when the area is touched
- Reduced ability to move the arm, with the person often holding it close to the body
- In some cases, a scraping sensation with movement
Because these injuries often come with chest trauma, watch for shortness of breath or chest pain, which can indicate a more serious associated injury and needs urgent attention.
Causes
Most scapula fractures result from a strong, direct force to the shoulder or upper back. Common causes include:
- Motor vehicle and motorcycle crashes
- Falls from a height
- Direct blows during contact sports
- Pedestrian or bicycle accidents
Less commonly, a fracture can occur with lower force in people whose bones are weakened, such as by osteoporosis. The high force usually involved is why other injuries frequently occur at the same time. Because of this, medical teams treat a scapula fracture as a signal to look carefully for damage to the chest, lungs, ribs, head, and spine. In many cases the associated injuries, rather than the broken shoulder blade itself, are what most affect a person's recovery and need the most urgent attention.
Risk Factors
- Involvement in high-speed activities or contact sports
- Occupations or activities with a risk of falls from height
- Conditions that weaken bone, such as osteoporosis
- Older age, with higher fall and fracture risk
Diagnosis
Diagnosis combines examination with imaging, and importantly, a check for other injuries.
- Physical exam: assessing the shoulder, arm movement, and nearby structures
- X-rays: the first imaging test to identify the fracture
- CT scan: often used to show the fracture in detail and plan treatment, especially for breaks near the shoulder joint
- Evaluation for associated injuries: assessing the chest, ribs, lungs, and other areas, since scapula fractures often accompany other trauma
Treatment
Most scapula fractures heal well without surgery because the surrounding muscles help hold the bone in place.
- Sling and rest: immobilizing the arm in a sling for comfort and to allow healing
- Pain relief and ice: to manage pain and swelling in the early days
- Gradual movement: starting gentle shoulder motion early, under guidance, to prevent stiffness
- Physical therapy: a program to restore strength and range of motion as healing progresses
Surgery is reserved for certain fractures, such as those that involve the shoulder joint surface or are badly out of place. Treating any associated injuries is also a key part of overall care.
Prevention
- Wear seat belts and use appropriate protective gear in vehicles and sports
- Take steps to prevent falls, especially in older adults
- Keep bones healthy with adequate calcium, vitamin D, and weight-bearing activity
- Manage osteoporosis if present, especially in older adults
- Stay active to maintain strength and balance and reduce fall risk
When to See a Doctor
Because scapula fractures usually follow significant trauma, seek emergency care after a serious injury to the shoulder or upper back, especially if you have:
- Severe shoulder or back pain after a crash, fall, or hard blow
- Inability to move the arm
- Shortness of breath or chest pain, which may signal a chest injury
- Numbness, tingling, or weakness in the arm
- Obvious deformity, severe swelling, or an open wound
Prompt evaluation ensures both the fracture and any associated injuries are identified and treated.
Frequently Asked Questions
How does a scapula fracture usually happen?
The shoulder blade is well protected by muscle and takes strong force to break, so most fractures come from high-energy trauma like car crashes, falls from a height, or hard sports collisions. Lower-force breaks can occur in people with weakened bones.
Do scapula fractures need surgery?
Most do not. Because the surrounding muscles help hold the bone in place, the majority heal with a sling, rest, pain control, and physical therapy. Surgery is reserved for fractures involving the shoulder joint surface or that are badly out of place.
Why are other injuries common with a scapula fracture?
It takes a large amount of force to break the scapula, and that same force often injures nearby structures. Chest, rib, lung, and shoulder injuries frequently occur at the same time and may be more serious than the fracture itself.
How long does a scapula fracture take to heal?
Many scapula fractures heal over several weeks, with a gradual return of shoulder motion and strength through physical therapy. Recovery time varies with the severity of the fracture and any associated injuries, so your doctor will guide your timeline.
When should I seek emergency care?
Seek emergency care after any significant injury to the shoulder or upper back, especially with severe pain, inability to move the arm, shortness of breath, chest pain, arm numbness or weakness, or an open wound.
References
- American Academy of Orthopaedic Surgeons (AAOS). Scapula (Shoulder Blade) Fractures.
- MedlinePlus, U.S. National Library of Medicine. Fractures.
- Mayo Clinic. Broken shoulder blade.
- OrthoInfo, AAOS.