Scapula Fractures: Diagnosis, Management, and Rehabilitation

Posted September 30, 2025

A scapula fracture, often called a shoulder blade fracture is rare, but when it happens, it can significantly impact shoulder function. These fractures make up less than 1% of all broken bones and about 3–5% of shoulder injuries (Pires et al., 2021; Abdrabou et al., 2025). Because the scapula sits under layers of muscle and is shielded by the rib cage, it usually takes a major accident such as a car crash, a hard fall, or a heavy collision in sport to break it.

For athletes, manual workers, and active people, understanding how these injuries are diagnosed, treated, and rehabilitated is crucial. For clinicians, the challenge is balancing conservative treatment with surgical indications, while guiding patients safely back to full function.

How Scapula Fractures Happen

Scapula fractures almost always result from high-energy trauma. Common causes include:

Motor vehicle or motorcycle accidents
Falls from height
Workplace or industrial injuries
High-impact sports collisions (rugby, football, combat sports)

Sometimes, a fall onto an outstretched arm can transmit force through the shoulder joint and fracture the scapula (Armstrong & Van der Spuy, 1984).

Because they usually occur alongside other injuries (like rib fractures, collarbone fractures, or chest trauma), scapula fractures require a thorough trauma assessment (NCBI, 2019).

Signs and Symptoms

People with a scapula fracture often report:

Sharp pain over the back of the shoulder
Swelling and bruising in the area
Difficulty lifting or moving the arm
Tenderness over the shoulder blade
Sometimes a grinding or popping feeling (crepitus)

In severe cases such as a scapulothoracic dissociation, there may be nerve or blood vessel injuries, which can threaten limb function if not recognised quickly (Zelle et al., 2004).

How Scapula Fractures Are Diagnosed

Clinical Examination

A hands-on exam helps localise tenderness, test range of motion, and rule out associated injuries.

Imaging

X-rays are the first step, but scapula fractures can be missed unless special views (like the scapular Y-view) are taken (Abdrabou et al., 2025).
CT scans are the gold standard. They give a detailed picture of the fracture pattern, displacement, and whether the shoulder joint is affected (NCBI, 2019).
MRI may be useful in athletes where soft tissue or labral damage is suspected.

Types of Scapula Fractures

The scapula has several parts, and fractures can occur in different regions:

Body fractures → most common, usually heal well without surgery
Neck fractures → can disrupt shoulder mechanics if displaced
Glenoid fractures → involve the joint surface, important for shoulder stability
Acromion and coracoid fractures → can affect muscle attachments and rotator cuff function

Understanding the fracture location helps guide treatment and predict recovery (Voleti et al., 2013).

Treatment Options

Non-Surgical (Conservative)

Most scapula fractures are treated without surgery. If the bone fragments are not badly displaced and the shoulder joint remains stable, the standard approach is:

Sling immobilisation for 2–3 weeks
Pain management and rest during the early phase
Gentle movement exercises once pain decreases
Progressive rehab to restore strength and function

Research shows that conservative treatment leads to good outcomes in most cases, especially for scapula body fractures (Armstrong & Van der Spuy, 1984).

Surgical Management

Surgery may be required when the fracture is more complex. Indications include:

Intra-articular glenoid fractures displaced >4 mm
Neck fractures with >40° angulation or >1 cm displacement
Open fractures or those involving nerves/blood vessels
“Floating shoulder” injuries (scapula + clavicle fracture) (Voleti et al., 2013; Pires et al., 2021).

Surgical fixation aims to restore anatomy and prevent complications like malunion or arthritis. While surgery has become more common, it carries risks such as infection, stiffness, and hardware irritation (Vidović et al., 2020). This makes patient selection critical. However**,** not every displaced fracture needs surgery, but when the joint surface is involved, fixation often improves long-term function (Zlowodzki et al., 2006).

Rehabilitation: Returning to Function

Rehab is just as important as the initial treatment. A structured program helps patients regain mobility, strength, and confidence.

Phase 1: Protection and Pain Control (0–3 weeks)

Sling for comfort
Ice, pain management, and gentle pendulum exercises
Keep the hand, wrist, and elbow moving

Phase 2: Controlled Mobility (3–6 weeks)

Begin gentle active-assisted and active movements
Introduce scapular mobility and stability drills
Avoid heavy lifting or overhead motions

Phase 3: Strength and Stability (6–12 weeks)

Strengthen scapular stabilizers (serratus anterior, trapezius, rhomboids)
Rotator cuff strengthening with resistance bands
Proprioceptive and neuromuscular training

Phase 4: Return to Sport/Work (>12 weeks)

Progressive strengthening with weights and functional drills
Sport-specific or work-specific conditioning
Plyometric and overhead activities as tolerated (Pires et al., 2021).

For athletes, the goal is to restore explosive strength and coordination. For patients, the goal may be pain-free daily function. Clinicians should adapt rehab to each person’s needs.

Prognosis and Possible Complications

Most patients recover well, especially when fractures are managed properly. However, complications can occur, including:

Malunion (bone heals in the wrong position, altering shoulder mechanics)
Post-traumatic arthritis after glenoid fractures
Persistent pain or stiffness
Weakness from prolonged immobilization
Nerve or vascular issues in severe trauma (Zelle et al., 2004; Vidović et al., 2020)

Early diagnosis, appropriate treatment, and dedicated rehab help reduce these risks.

Key Takeaways

Scapula fractures are rare but often linked to high-energy accidents.
Most heal well without surgery, but complex or displaced fractures may require fixation.
CT scans are the gold standard for diagnosis.
Rehab is essential and should progress through phases of mobility, strength, and return-to-activity.
Outcomes are generally positive, but long-term problems like arthritis or stiffness can occur if treatment is delayed or incomplete.

For patients and athletes: expect at least 3–4 months before full return to sport or heavy work.

For clinicians: careful assessment of fracture type and displacement is critical in choosing between conservative and surgical treatment.

Abe Ofosu
Physiotherapist (APAM)

References

Abdrabou, A., Ranchod, A., Bell, D., et al. (2025). Scapular fracture. Radiopaedia.org. https://doi.org/10.53347/rID-24260

Armstrong, C. P., & Van der Spuy, J. (1984). The fractured scapula: Importance and management based on a series of 62 patients. Injury, 15(5), 324–329. https://doi.org/10.1016/0020-1383(84)90004-2

National Center for Biotechnology Information. (2019). Scapula fractures. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537312/

Pires, R. E., Giordano, V., de Souza, F. S., & Labronici, P. J. (2021). Current challenges and controversies in the management of scapular fractures: A review. Patient Safety in Surgery, 15(1), 1–8. https://doi.org/10.1186/s13037-021-00297-2

Vidović, D., Benčić, I., Ćuti, T., Bakota, B., Bekić, M., Dobrić, I., Sabalić, S., & Blažević, D. (2020). Surgical treatment of scapular fractures: Results and complications. Injury. Advance online publication. https://doi.org/10.1016/j.injury.2020.09.031

Voleti, P., Namdari, S., & Mehta, S. (2013). Fractures of the scapula: Diagnosis, indications, and operative technique. University of Pennsylvania Orthopaedic Journal, 23, 57–61.

Zelle, B. A., Pape, H. C., Gerich, T. G., Garapati, R., Ceylan, B., & Krettek, C. (2004). Functional outcome following scapulothoracic dissociation. The Journal of Bone and Joint Surgery. American Volume, 86(1), 2–8. https://doi.org/10.2106/00004623-200401000-00002

Zlowodzki, M., Bhandari, M., Zelle, B. A., Kregor, P. J., & Cole, P. A. (2006). Treatment of scapula fractures: Systematic review of 520 fractures in 22 case series. Journal of Orthopaedic Trauma, 20(3), 230–233. https://doi.org/10.1097/00005131-200603000-00009