What is the recovery and healing time after a scapula fracture also known as (shoulder blade bone) and what are the treatment options.
This is one of the first questions that people ask after breaking their scapula.
I will answer your questions based on my experience as a diagnostic radiographer and in-depth research in medical international literature.
Happy reading!😃
Let’s first delve into the basic anatomy of the scapula
A scapula is a shoulder blade bone located in the back of our shoulder between the shoulder and the spine.
A scapula helps to provide motion and stability for the arm by attaching the upper extremity to the chest well.
▶️Is it possible to break a scapula blade?
These kinds of fractures are rare, but it is possible to have a break on any part of the scapula bone. And in 80% to 95% cases, usually the break can be associated with something else around the scapula.
Your scapula blade may break in different parts on the scapula bone for example on the acromion, coracoid, and glenoid.
Regardless of the precise location of the fracture, it does not change much in the treatment behind it
Image showing different extra-articular fractures of the scapula as they are classified in the AO/OTA classification system: Limb 2021
▶️Causes of scapula fractures
During my years of practice as a radiographer, I have seen very few scapula fractures.
Incidents of scapula fractures are accounted to only 1% according to statistics (Jones 2011)
But when they do happen, they can be caused by direct trauma from the back or side. Most of them are comminute, transverse or oblique fractures.
Usually, it takes a large amount of energy to fracture the scapula; the force may be indirect but is more often direct. Most occur in vehicle collisions.
The Good news is there is no obvious fracture displacement because there is muscle protection before and after the scapula. However, sometimes there is a rib fracture or a chest organ injury.
▶️How do you know you have fractured your scapula bone?
The symptoms of scapula fractures are quite classic, and you will be able to tell that something is completely gone wrong following a major trauma to your back
🔴You will feel pain at rest or when moving your arm around the shoulder blade or shoulder which will be radiating to the back and arm
🔴Severe bruising and difficult using the arm
🔴Swelling, Oedema and redness in and around the shoulder
🔴Deformation that can be easily seen.
▶️How serious is a fractured scapula?
Because shoulder blade fractures are often associated with severe, potentially life-threatening injuries such as injury to the brachial plexus where the nerves of the arm pass.
They are usually evaluated in a hospital’s emergency department and the arm is immobilised immediately.
▶️Diagnosis and examination
When you go to the doctor you will be physically examined to see if you have not damaged important blood vessels and nerves that lie underneath the collarbone.
For example, the scapulothoracic dissociation is a common injury where the shoulder blade is pulled so hard that it is disconnected from the chest well
X-rays will be done to evaluate the location, type and severity of the broken scapula.
x-ray images showing a fracture of the scapula
CT scan will only be done if more detail is required to determine need for operative fixation.
▶️What is the treatment of Scapula fracture?
Most scapula fractures do not easily displace like other long bone fractures. so, an operation may not be needed most of the time.
Meaning their consolidation and healing can be quite easy and quick. Your doctor may want you to start moving your shoulder within the first week after the injury to minimise the risk of shoulder and elbow stiffness.
Conservative or non-operation methods of wearing a sling
Most scapula fractures that are minimally displaced are managed by early mobilisation with the expectation that they will heal normally.
You will be given a sling or immobiliser to wear until pain allows motion and function
Patients I see are usually prescribed an elbow splint to the body or a simple scarf for the arm, which are less bulky or a bandage for the shoulder blade.
This will help you immobilise the shoulder and the blade.
The goal is:
♦️To help relieve pain which often increases when you move your arm.
♦️And, to encourage bone consolidation by limiting scapula movement.
You will also be encouraged to resume mobilisation as soon as possible to avoid stiffness of the shoulder.
A research study about patients who had been treated with a sling and started an active range of motion exercises as soon as the associated injuries allowed. Showed No complications during a follow-up despite measurable restrictions (Gosens 2009)
▶️How long should you wear a sling with a broken scapula?
You will normally have specific instructions from your doctor on the recommended duration of immobilisation in your case.
There are different recommendations for the same type of fracture I have observed in different literature studies.
Some medical studies recommend:
🟤The sling to be kept on for comfort for the first 2 weeks with subsequent increase of the shoulder’s range of motion.
🟤Some doctors usually recommend wearing a sling until you can move the shoulder without significant pain between anywhere from 2 to 4 weeks.
🟤Others do not even recommend a splint
🟤Others recommend a stricter immobilisation between 3 to 6 weeks until a control x-ray.
You may need to always keep the sling on to start with, including at night, to limit sudden movement when you are sleeping. But you can remove it daily for personal hygiene and dressing.
The sling has been known for a disadvantage of stiffness of the shoulder. This has a negative effect on your recovery, including increased pain, difficulty regaining range of motion, and adding strain on the repair that was done on the shoulder.
It is important to keep the shoulder moving this will stop it from becoming stiff. You can also discuss it with your doctor to find the right compromise for you.
▶️When does a scapula blade fracture need surgery.
Having surgery is determined based on patient age, injury pattern, fracture displacement and associated injuries
An AP and Y-view x-ray of a postoperative scapula fracture showing screws and plates fixation (Jones 2011)
The aim of a surgery operation is.
🟤To realigned and stabilised the markedly displaced scapular body.
🟤 Restore function of an effective joint without pain.
After operation, you may be advised to insist on functional exercises of the shoulder until union of fracture is solid.
The operation remains rare, less than 15 of scapula fractures (Libby 2023)
▶️How long does it take for a scapula bone fracture to heal?
Treatment for these fractures is usually a sling or other device that supports the shoulder while the bone heals.
Most fractures heal completely in about six weeks but it can take six months to a year for your shoulder motion to return to normal.
Here are some recovery times that were observed and given to me by one of our physiotherapies in the trust where I work. I found very limited empirical data in the studies.
| stage | Proposed Healing time |
| Less pain after the fracture | A few days to weeks |
| You bone starts to consolidate | 6 weeks to 3 months |
| Swelling and bruises disappear | A few days to weeks |
| Stop wearing a splint | Week 0 to 3 wear the sling from 3 to 12 weeks you may be advised to stop wearing it. |
| You can use your arm with eating and dress | Resume after few days in some people or 3 to 12 weeks |
| You can start carrying weights such as bags | 2 to 5 months |
| Resume activities such as sports | Avoid lifting for the full 6 weeks resume 3 to 8 months |
| Driving a car again | A few weeks |
▶️What are some of the rehabilitation sessions with physiotherapy after scapula fracture treatment?
Because scapula fractures are associated with other injuries, it is quite common to have physiotherapy sessions to help with your healing.
Your doctor or surgeon will prescribe physiotherapy sessions if you feel they will help you resume your previous activities.
These exercises are usually begun one month and a half after the fracture. The goal is to help you regain your mobility and strength.
Here is a video I retrieved from the Canadian chiropractic guideline initiative showing scapular motion control training that helps to promote the recovery of scapular fractures, and improve your ability to perform daily activities
You can focus on tensing and squeezing the scapular muscles to generate the motion. (Especially into adduction/retraction) as shown in the video
▶️Why am I feeling shoulder blade pain even after months of treatment?
Most scapula shoulder fractures will heal without any problems in six to 12 weeks.
However, it may take 6 to 12 months for your symptoms to settle completely. These can include pain or discomfort, stiffness, decreased strength, swelling and loss of muscle bulk.
This does not mean that there is a complication or that you are not healing well.
Here are several things you can do to help with the discomfort.
🟡 You may be prescribed pain killers and try to sleep propped up with pillows to help with the pain.
🟡Try resting your shoulder when ever you feel pain for at least 24 to 72 hours
🟡You can apply cold packs wrapped in a towel on the area making sure the ice is not applied direct on the skin.
I have come to the end of this article and any questions let me in the comments section.
Wishing you a quick recovery!🙋
📚Sources:
Limb, D. (2021). Scapula fractures: a review. EFORT Open Reviews, 6(6), 518-525. Retrieved Nov 2, 2024.
Jones CB, Sietsema DL. Analysis of operative versus nonoperative treatment of displaced scapular fractures. Clin Orthop Relat Res. 2011 Dec;469(12):3379-89. doi: 10.1007/s11999-011-2016-6. PMID: 21830167; PMCID: PMC3210281.
Libby C, Frane N, Bentley TP. Scapula Fracture. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
Lian J, Chan FJ, Levy BJ. Classification of Distal Clavicle Fractures and Indications for Conservative Treatment. Clin Sports Med. 2023 Oct;42(4):685-693. doi: 10.1016/j.csm.2023.05.007. Epub 2023 Jun 26. PMID: 37716731.
Gosens T, Speigner B, Minekus J. Fracture of the scapular body: functional outcome after conservative treatment. J Shoulder Elbow Surg. 2009 May-Jun;18(3):443-8. doi: 10.1016/j.jse.2009.01.030. PMID: 19393934.
Zhang GL, Zhang M. [Surgical treatment of scapular fractures]. Zhongguo Gu Shang. 2008 Apr;21(4):313-5. Chinese. PMID: 19102208.