What are the types of scapula fractures?
The scapula consists of a flat body, neck, glenoid cavity, as well as the coracoid and acromial processes. Most often the body is affected - such fractures are usually stable because the surrounding muscles support the fragments. Fractures of the glenoid cavity and neck are much more important: they affect the shoulder joint, and if displaced can lead to shoulder instability and arthrosis. Fractures of the appendages disrupt the functioning of the muscles and ligaments of the shoulder girdle. Separately, there are situations when the scapula and collarbone break at the same time - then the shoulder girdle loses support and becomes unstable.
- Fracture of the body of the scapula is the most common and usually stable
- Scapula neck fracture
- Glenoid fracture involving the joint
- Acromion fracture
- Fracture of the coracoid process
- Combination of scapula and clavicle fracture with shoulder girdle instability
How does injury occur?
It takes serious force to break a scapula. Typical situations are a car accident, a fall from a height, being run over, being crushed, or a direct blow to the back of the shoulder with a heavy object. In older people with osteoporosis, a fracture may occur from a less severe injury. A separate mechanism is a fall on an outstretched arm or on the shoulder, in which the head of the humerus is driven into the glenoid cavity. Sometimes the processes of the scapula are torn off by a powerful muscle contraction during a jerk.
- Road traffic accident
- Fall from height
- Direct blow to the shoulder blade area
- Falling onto an outstretched arm or shoulder
- Severance of the appendage due to sudden muscle contraction
- Osteoporosis as a factor in the elderly
Symptoms
The pain in the area of the shoulder blade and the back of the shoulder increases sharply with any attempt to raise or abduct the arm, so the person instinctively presses it to the body and supports it with the healthy arm. Swelling and bruising appear, which due to the thickness of the muscles may not appear immediately. Breathing often becomes shallow because deep breaths intensify the pain. With a fracture of the glenoid cavity, movement in the shoulder is sharply limited, and a feeling of instability may occur. Be sure to check the sensitivity and strength in your hand.
- Pain in the area of the shoulder blade and shoulder girdle
- Sharp increase in pain when moving your arm
- Forced position of the arm pressed to the body
- Swelling and bruising that appears gradually
- Shallow breathing due to pain
- Crunching and crepitation on examination
Diagnostics
They start with an X-ray of the shoulder joint and chest: the images reveal the fracture and at the same time allow you to see rib fractures, pneumothorax or fluid accumulation in the pleural cavity. However, x-rays poorly convey the complex anatomy of the scapula, and some fractures are not visible. Therefore, if a fracture of the glenoid cavity, neck is suspected, or if the picture is unclear, computed tomography with three-dimensional reconstruction is performed - it is considered the main method for treatment planning. Be sure to evaluate the nerves and blood vessels of the arm and exclude concomitant injuries.
- X-ray of the shoulder joint in several projections
- Chest X-ray to evaluate the ribs and lungs
- CT scan of the scapula with three-dimensional reconstruction
- CT chest for high-energy trauma
- Assessment of the neurological status of the hand
- Examination for associated injuries
Treatment and recovery
Most fractures of the body of the scapula are treated without surgery: the arm is immobilized with a bandage or orthosis for a short period of time, pain relief is prescribed, and passive and then active movements are started as early as possible so that shoulder stiffness does not develop. Prolonged immobility here is more dangerous than the fracture itself. Surgery is needed for significant displacement of the glenoid cavity, unstable shoulder girdle, displaced fractures of the processes and open injuries: the fragments are fixed with plates and screws. Full restoration of function usually takes two to four months and requires consistent physical therapy.
- Bandage or orthosis for 2–3 weeks
- Early onset of passive shoulder movements
- Gradual transition to active movements and muscle strengthening
- Pain relief as prescribed by a doctor
- Surgery for displacement of the glenoid cavity and instability of the shoulder girdle
- Control images during treatment