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Anteroposterior radiograph of a 16-year-old male 2 days after sustaining a left shoulder injury falling off his friend’s shoulders
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Lateral radiograph of the patient
A 16-year-old male presents 2 days after sustaining a left shoulder injury. He was on the shoulders of a friend and fell backward onto the ground, landing on the back of his left shoulder. He has had pain with shoulder motion since the accident. On examination, the patient has tenderness to palpation over the scapula body and full active range of motion of the shoulder. Anteroposterior and lateral radiographs of the scapula are taken.
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The patient sustained a nondisplaced left scapula body fracture, as evidenced by a subtle linear lucency 2 to 3 cm inferior to the glenoid. Scapula fractures in general are rare injuries, with body fractures representing the majority of all scapula fractures. Fractures of the scapula can also occur at the scapula neck, glenoid, acromion, or coracoid.
Scapula fractures generally result from a high-energy injury such as a motor vehicle accident but can also result from a direct impact or fall. Those with high-energy injuries resulting in displaced scapula fractures commonly have other associated injuries such as clavicle and rib fractures and head, neck, and lung injuries.1
The scapula body provides attachment sites for several muscles of the shoulder. These muscles include the serratus anterior muscle, which helps hold the scapula against the thoracic wall; the infraspinatus and teres minor muscles, which rotate the humerus externally; and the teres major muscle, which rotates the humerus internally. These muscular attachments explain why those with scapula body fractures have significant pain with shoulder motion. Patients may also complain of pseudoparalysis, or “my shoulder doesn’t work,” until the fracture heals and the pain subsides. Deep inspiration may also cause pain with scapula body fractures because of pulling of the serratus anterior muscle.1,2
Initial treatment includes placing a sling to immobilize the shoulder. Scapular body fractures generally heal uneventfully because even displaced fractures that end in malunion rarely restrict shoulder function. Physical therapy should be initiated early for passive range-of-motion exercises so that the shoulder does not become stiff during the 4- to 6-week period of immobilization. Improved pain control is associated with clinical healing, so once the pain has subsided, patients can begin physical therapy to achieve full active range of motion. Full recovery time or return to full activities is generally accomplished in 3 months.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
References
- Weatherford B. Scapula Fractures. OrthoBullets website. http://www.orthobullets.com/trauma/1013/scapula-fractures. Accessed February 13, 2017.
- Bucholz RW, Heckman JD, Court-Brown C, eds. Rockwood and Green’s Fractures in Adults. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.
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