Scapula Fracture Causes and Symptoms

Shoulder blade or scapula fractures cause severe pain and restriction in shoulder mobility.

In most cases, this injury results from high-energy trauma to the shoulder area.

Scapula Fracture Causes

Shoulder blade fractures are uncommon because the bone is protected by the chest and shoulder muscles, and a significant force is needed for a fracture to occur.

Most scapula injuries are caused by direct or indirect trauma to the shoulder region. Common causes include:

• Falling on an outstretched arm
• Direct trauma from contact sports or sporting activities
• High-energy collisions from motor vehicle accidents
• Not wearing a seatbelt while in a motor vehicle accident

Less common causes include penetrating injuries (eg, gunshot wounds) and bone diseases that weaken the scapula.

Risk Factors

The risk of a scapula fracture increases in these cases:

• Sex and age: Males between the ages of 25 and 50 years¹Libby C, Frane N, Bentley TP. Scapula Fracture. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537312/
• Osteoporosis: Weakened bones due to osteoporosis, a condition more common in older individuals
• High-risk activities: Activities with the potential of falling, such as rock climbing, bicycling, cheerleading, or horseback riding
• Contact sports: Injuries from contact sports, such as football, hockey, and rugby
• Bone diseases: Certain bone conditions, such as Paget's disease or bone tumors

In some cases, previous injuries or surgeries to the shoulder joint can weaken the surrounding structures and make the scapula vulnerable to fractures.

Common Symptoms and Signs

A broken shoulder blade causes a variety of symptoms and signs, including:

• Severe pain, which is often felt suddenly. The pain is typically:
  • Localized to the upper back, across the shoulder blade, and/or at the top of the shoulder
  • Aggravated by arm movement or taking deep breaths, because chest wall movement causes the fractured scapula to move
• Swelling and tenderness in the area around the shoulder and/or upper back
• Bruising or discoloration of the skin over the shoulder blade
• Visible bulge or lump at the fracture site
• Limited movement in the arm and shoulder
• Noticeable disfigurement of the shoulder making it appear flattened, sagging, or drooped
• Painful range of motion when attempting to move the shoulder joint in various directions
• Numbness or tingling in the arm or hand, especially if nerves are damaged near the fracture site
• Weakness in the affected arm, particularly when performing overhead activities
• Loss of sensation in the arm or hand
• Grating or crackling sensation when the injured shoulder is moved

Due to the high amount of force needed to break the shoulder blade, scapula fractures are often accompanied by fractures to the ribs and/or other bones in the shoulder and may cause additional symptoms related to those injuries.

Diagnosis

A scapula fracture diagnosis is made through a physical exam and findings on an x-ray or other radiographic imaging test.

Oftentimes, a scapular fracture is associated with more severe medical injuries, such as

• Head injury
• Rib fractures
• Clavicle (collarbone) fracture
• Collapsed lung
• Bruised lung
• Injury to the brachial plexus (a series of nerves based in the neck and shoulder)
• Spine injury

In such cases, the scapular fracture diagnosis and treatment may be delayed because these serious injuries require immediate medical attention.

Physical exam

The physician will try conducting a thorough physical examination. However, a physical exam is not always possible due to the potentially serious injuries that typically occur with a scapular fracture.

If an examination is conducted, the physician may attempt to do the following:

• Evaluate the skin to detect any open fractures (bones that have pierced the skin)
• Note areas of tenderness, swelling, ecchymosis (discoloration of the skin), and crepitus (grinding sensation)
• Check shoulder positioning and range of motion
• Palpate (touch) the chest wall, shoulder joint, and clavicle (collarbone)

Lung sounds are checked with a stethoscope to observe variations in breathing.

A neurovascular examination is performed to check for nerve or artery injury. It is also recommended to test and compare the pulse in both arms.

X-ray

The standard test to evaluate a scapula fracture is an x-ray, which helps determine the location and extent of the injury.

X-rays of the shoulder and chest are typically ordered.

Computed tomography (CT) scan

This imaging tool provides detailed, cross-sectional images of the scapular bone, allowing doctors to identify the location, severity, and type of fracture in more detail than a conventional x-ray.

A CT scan may include scans of the shoulder, midsection, and chest regions.

Magnetic resonance imaging (MRI)

In some cases, an MRI scan is ordered to check on the health of nearby blood vessels and nerves if damage is suspected. These scans also help doctors plan surgery if necessary.