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The scapulae, or shoulder blades, are fairly sturdy and well-protected bones in the upper chest. A major impact, such as from a high-speed automobile accident, is usually needed to cause a fracture. Treating a broken scapula depends on many factors, including the location and severity of the break and the extent of related injuries. In many cases, a minor fracture can heal with a few weeks of rest, immobilization, ice, and prescription or over-the-counter painkillers. A more serious break may require surgery to realign the shoulder blade and reinforce it with metal plates or screws.
A broken scapula is immediately noticeable in most cases. A person experiences sudden, sharp pain, tenderness, swelling, and a loss of range of motion in the shoulder. While waiting for an ambulance or taking a person to the emergency room, steps should be taken to keep the affected shoulder immobilized. A makeshift sling can be formed with a shirt or towel to prevent excess movement of the joint until professional care is available.
At the hospital, a doctor will usually take x-rays and other imaging scans to determine the exact location of the break. In most cases, the largest, widest part of the scapula, called the body, is fractured but does not move out of place. Treatment for a broken scapula body typically consists of affixing a comfortable sling to the arm and prescribing high-strength painkillers. The patient is instructed to avoid moving his or her arm for at least one week following the injury and to apply an ice pack several times a day to relieve swelling. A minor fracture begins to heal quickly, so most doctors suggest engaging in light exercises after the one-week mark to regain mobility and prevent strength loss.
If the scapula is broken along its neck, the skinny upper region, it is likely that part of the bone will move out of place. In such cases, an orthopedic specialist will try to manually force the broken scapula neck back into alignment. Additional x-rays are taken to confirm that the bone is aligned correctly. A longer immobilization period, usually at least four weeks, is needed before engaging in physical therapy exercises in such cases.
A severely broken scapula is unlikely to heal on its own. Surgery is considered whenever pieces of bone are shattered or the scapula is so out of alignment that it is impossible to put it back into place otherwise. A surgeon can saw away damaged bone, graft new bone tissue onto the scapula if necessary, and shape it back into its proper form. Metal plates, pins, and screws may be necessary if there is not enough healthy bone tissue to allow the scapula to retain its shape and position. Many patients who undergo surgery require at least six months of rest before they can begin physical therapy.