Treating a Scapula Fracture

Most scapula fractures heal with a combination of non-surgical treatments. Surgery is rare and may be required if a fracture displaces bones, forcing them out of their normal positions.

Treatment Goals

Treatment aims to:

• Manage pain to improve comfort and function
• Keep the fractured bone immobilized and stable to promote bone healing
• Restore muscle strength and shoulder joint motion and function through guided physical therapy

Regular physician appointments ensure that the fractured bone pieces are healing in their correct location, as the fracture can shift out of place.

Success Rates

Both surgical and non-surgical treatments yield high success rates. The majority of patients achieve good to excellent functional outcomes following either type of intervention.¹Libby 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/

Individual outcomes vary depending on factors such as the severity of the fracture, the patient’s overall health, the physician’s skill and expertise, and adherence to treatment plans.

When Non-Surgical Treatment Is Recommended

Most cases of scapula fractures are treated without surgery. Non-surgical treatment is typically the preferred option for scapular body fractures – the most common scapula fractures – and often heal well with non-surgical care.²Scapula (Shoulder Blade) Fractures. American Academy of Orthopaedic Surgeons website. https://orthoinfo.aaos.org/en/diseases--conditions/scapula-shoulder-blade-fractures. Last reviewed Nov 2023. Accessed Aug 16, 2024.^,3Greiwe RM. Shoulder and Elbow Trauma and its Complications Volume 1: The Shoulder. Cambridge, UK: Woodhead Publishing; 2015.

Types of Non-Surgical Treatments

Non-surgical management of scapula fractures typically involves:

Medication

Over-the-counter or prescription pain-relieving medication helps reduce pain in the initial stages and is recommended for a short duration. Common medications include:

• Acetaminophen (Tylenol): for mild pain
• Codeine and acetaminophen (Tylenol with Codeine): for mild to moderate pain
• Hydrocodone and acetaminophen (Lortab, Norcet, Vicodin): for moderate to severe pain

NSAIDs, such as ibuprofen (Advil),  are typically avoided because they reduce inflammation, which can delay or inhibit bone healing and fusion.

Immobilization

A sling or shoulder immobilizer is used to prevent movement. Shoulder immobilizers may have additional straps and cuffs for the arm, wrist, and fingers for more stabilization. 
The shoulder is immobilized until the broken ends of the bone heal, typically 3 or 4 weeks depending on the type or severity of the fracture.

Ice therapy

Ice the fractured shoulder with a shoulder-contoured ice pack for 15 to 20 minutes several times a day to reduce swelling. If using a regular ice pack, wrap the pack in a towel to prevent ice burn. Wait at least 2 hours before reapplying the pack.

See 3 Useful Tips for Icing Your Injury

Heat therapy

After the acute inflammation phase, when the swelling has subsided, heat therapy may be helpful to loosen up soft tissues and improve mobility, especially before engaging in physical activities or exercise. Heat packs must be wrapped in a towel or cloth to prevent skin burns and patients must wait for at least 2 hours before re-applying the pack.

Watch Video: How to Make a Homemade Heat Pack

Activity restrictions

Heavy lifting, overhead arm movements, and shrugging are generally avoided to prevent further displacement of the fractured bone.

Physical therapy

Therapeutic exercises are recommended once the shoulder blade begins to heal.

• Initial exercises include¹Libby 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/:
  • Active range of motion exercises: Performed entirely by the patient, using their muscles to move a joint.
  • Active-assisted range of motion (AAROM) exercises: The patient moves a joint with some assistance from the therapist. This method is used when a patient has limited strength or range of motion.
• After about 3 to 4 months, strength training exercises, such as push-ups, are started.¹Libby 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/

Physical therapy often continues for several months to a year after the bone has healed to strengthen the shoulder muscles and reduce the risk of future injury.

When Surgery Is Necessary for a Scapula Fracture

Surgery is rare and required in cases where there is a high risk of complications or when the displaced bone cannot heal non-surgically. These situations include

• The angle of the bone causes a deformity in the limb (angular deformity)
• The bone positioning is no longer in its correct, anatomical position (displacement)
• The glenoid socket is fractured, causing instability of the ball and socket joint
• Additional bones, such as the clavicle, are fractured
• There’s an open fracture where the skin is broken, and bone fragments are visible
• The nerves and/or blood vessels are damaged

Surgical intervention is more common in younger patients than in older individuals.

Types of Surgery

Surgical options for scapula repair include:

• Open reduction and internal fixation (ORIF): Involves surgically exposing the fracture site, realigning the bone fragments, and stabilizing them with internal fixation devices such as screws, plates, or wires.
• Arthroscopic surgery: A minimally invasive technique that uses a small camera and surgical instruments to visualize and treat the fracture. Arthroscopic repairs are typically used for scapular fractures involving the glenoid fossa.

As with any surgical procedure, there are potential risks and complications involved, such as infection, severe bleeding, and nerve or blood vessel damage.

Post-Surgical Rehabilitation

The surgeon provides specific post-surgery instructions to fit the patient’s individual needs and goals. General guidelines include:

• Wearing a sling for a few weeks after surgery.
• Icing the shoulder blade several times a day to reduce swelling.
• Applying a heat pack to the shoulder blade area or soaking in a hot bath before engaging in physical activities or exercise to loosen up soft tissues and improve mobility.
• Restraining from lifting objects weighing over five pounds during the first six weeks post-surgery.
• Following up with the physician and getting the appropriate x-rays to confirm healing.
• Participating in physical therapy and exercises as formulated by the therapist.

Healing is generally slower in people who have diabetes or who use nicotine-based products (smoking, vaping, or chewing tobacco) since nicotine inhibits bone healing.