Scapular Fracture Clinical Presentation

Updated: Oct 21, 2015
  • Author: Joseph C Schmidt, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Presentation

History

The mechanisms of injury for various scapular fractures include the following:

  • Body or spine fracture (40-75%): Fractures of the body or the spine of the scapula usually result from a severe direct blow, as in a fall or a motor vehicle accident.
  • Acromion fracture (8-16%): Acromion fractures typically result from a downward blow to the shoulder. Superiorly displaced fractures may occur as the result of a superior dislocation of the shoulder.
  • Neck fracture (5-32%): A direct anterior or posterior blow to the shoulder is the typical mechanism for a scapular neck fracture.
  • Glenoid fracture (10-25%): Glenoid rim fractures often result from a fall onto a flexed elbow. A direct lateral blow is the common mechanism for a stellate fracture of the glenoid.
  • Coracoid fracture (3-13%): Coracoid process fractures usually result from 1 of 2 mechanisms. A coracoid process fracture is the result of a direct blow to the superior point of the shoulder or humeral head in an anterior shoulder dislocation. An avulsion fracture may result from abrupt contractions of the coracoacromial muscle, short head of the biceps, or coracohumeral muscle.
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Physical

Findings at physical examination may include the following:

Body or spine fracture

Most common findings are tenderness, edema, and ecchymosis over the affected area.

The upper extremity is held in adduction, and any attempt to abduct the extremity (which results in scapular rotation) increases pain.

Acromion fracture

Tenderness directly over the acromion process is the most common finding.

Deltoid contraction and arm abduction exacerbate pain.

Perform a careful neurologic examination to determine the presence of an associated brachial plexus injury.

Neck fracture

A patient with a scapular neck fracture resists all movement of the shoulder and holds the extremity in adduction.

Maximal tenderness occurs at the lateral humeral head.

Glenoid fracture

Stellate fractures of the glenoid have a presentation similar to that of scapular neck fractures, with severe pain on shoulder movement.

Avulsion fractures are occasionally associated with shoulder dislocations.

Coracoid fracture

Patients with coracoid process fractures present with tenderness over the coracoid.

Forced adduction of the shoulder or flexion of the elbow exacerbates pain.

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Causes

Scapular fractures are usually the result of significant blunt trauma.

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