Common causes include:Motor vehicle or motorcycle accidentsFalls from a significant heightHigh-energy sports injuriesDirect blows to the back or side of the shoulderCrush injuriesBecause these injuries usually result from high-energy trauma, other injuries to the chest, ribs, lungs, collarbone, or spine may also be present.

Symptoms may include:Severe pain over the back of the shoulderSwelling and bruisingPain with any shoulder movementDifficulty lifting the armTenderness over the shoulder bladePain when taking a deep breath if rib injuries are also present

Your orthopedic specialist will perform a thorough examination and obtain imaging studies that may include:X-raysCT scan to better define the fracture patternMRI if associated muscle, tendon, or ligament injuries are suspectedBecause scapular fractures often occur after major trauma, additional imaging may be necessary to evaluate for other injuries.

Surgery is less commonly required but may be recommended if:The fracture is significantly displacedThe shoulder girdle becomes unstableMultiple fractures affect shoulder functionThe fracture extends into the shoulder jointWhen surgery is needed, the fracture is carefully realigned and stabilized using specially designed plates and screws.

Most patients recover well with appropriate treatment.Typical recovery includes:Sling for 2-4 weeksPhysical therapy beginning once pain allowsBone healing in approximately 8-12 weeksContinued improvement in strength and motion over 6-12 monthsMost patients eventually return to normal daily activities, work, and recreational sports.

Acromion fractures may occur after:Falls directly onto the shoulderMotor vehicle accidentsContact sports injuriesBicycle accidentsDirect blows to the shoulderOccasionally, an acromion fracture can occur from stress on weakened bone following shoulder replacement surgery or in individuals with osteoporosis.

Patients commonly experience:Pain on the top of the shoulderSwelling and tendernessPain when raising the armWeaknessDifficulty sleeping on the affected sideOccasionally a visible deformity

Diagnosis typically includes:Physical examinationShoulder X-raysCT scan when additional detail is neededMRI if associated rotator cuff injuries are suspected

Surgery may be recommended if:The fracture is significantly displacedThe fracture narrows the space beneath the acromion and may pinch the rotator cuffThe fracture fails to heal (nonunion)The shoulder loses normal functionSurgery generally involves repositioning the fracture and securing it with plates and screws.

Recovery depends on the severity of the fracture.Typical recovery includes:Sling for 3-6 weeksGradual rehabilitationBone healing within 8-12 weeksFull recovery often takes 6-12 monthsMost patients return to normal activities once healing is complete.

Scapular spine fractures may occur from:High-energy traumaFallsMotor vehicle accidentsDirect blows to the shoulderThey may also occur as stress fractures following reverse total shoulder replacement, particularly in patients with osteoporosis or weakened bone.

Symptoms include:Pain across the back and top of the shoulderDifficulty lifting the armWeaknessSwelling and tendernessPain with overhead activitiesReduced shoulder functionPatients who have previously undergone reverse shoulder replacement may notice a sudden increase in pain and decreased ability to lift the arm after what seems like a minor injury.

Evaluation may include:Physical examinationX-raysCT scan to define the fractureMRI in selected patientsEarly diagnosis is particularly important after shoulder replacement surgery because these fractures may initially be difficult to detect.

Surgery may be recommended when:The fracture is significantly displacedThe fracture does not healShoulder function is severely affectedThe fracture compromises the function of a shoulder replacementSurgery typically involves fixation with specialized plates and screws, although treatment decisions are individualized based on the patient’s bone quality, activity level, and overall health.

Recovery generally includes:Sling for 4-6 weeksGradual physical therapyBone healing over 8-12 weeksImprovement in strength and function over 6-12 monthsPatients recovering from fractures associated with reverse shoulder replacement often require a slower rehabilitation program to protect healing bone.

Scapular Body, Acromion, and Scapular Spine Fractures

Detailed guidance on scapular body, acromion, and scapular spine fractures — three distinct types of shoulder blade fractures. At Midwest Orthopedic and Musculoskeletal Alliance, our fellowship-trained orthopedic surgeons provide comprehensive evaluation and treatment for each.

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Scapular Body, Acromion, and Scapular Spine Fractures

Q: Non-Surgical Treatment

Many acromion fractures heal successfully without surgery.Treatment may include:Sling immobilizationIce and anti-inflammatory medications when appropriateGradual range-of-motion exercisesPhysical therapy

The scapula (shoulder blade) can fracture in several distinct locations, each with its own causes, symptoms, and treatment considerations. Below is detailed guidance on three specific types of scapular fractures: the scapular body, the acromion, and the scapular spine.

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Scapular Body Fractures

What Is Scapular Body Fracture?

The scapula, also called the shoulder blade, is a large, flat bone located on the back of the shoulder. It serves as the attachment point for many muscles that move and stabilize the shoulder. A scapular body fracture is a break through the main portion of the shoulder blade.

Scapular fractures are uncommon because the shoulder blade is well protected by surrounding muscles and the chest wall. Most occur after significant trauma, such as a motor vehicle accident or a fall from height.

Causes

Common causes include:

Motor vehicle or motorcycle accidents
Falls from a significant height
High-energy sports injuries
Direct blows to the back or side of the shoulder
Crush injuries

Because these injuries usually result from high-energy trauma, other injuries to the chest, ribs, lungs, collarbone, or spine may also be present.

Symptoms

Symptoms may include:

Severe pain over the back of the shoulder
Swelling and bruising
Pain with any shoulder movement
Difficulty lifting the arm
Tenderness over the shoulder blade
Pain when taking a deep breath if rib injuries are also present

Diagnosis

Your orthopedic specialist will perform a thorough examination and obtain imaging studies that may include:

X-rays
CT scan to better define the fracture pattern
MRI if associated muscle, tendon, or ligament injuries are suspected

Because scapular fractures often occur after major trauma, additional imaging may be necessary to evaluate for other injuries.

Non-Surgical Treatment

Most scapular body fractures heal very well without surgery because the surrounding muscles naturally help hold the fracture in place.

Treatment typically includes:

Sling immobilization for comfort
Ice and pain medication
Early gentle shoulder motion as pain improves
Physical therapy to restore motion, strength, and function

Surgical Treatment

Surgery is less commonly required but may be recommended if:

The fracture is significantly displaced
The shoulder girdle becomes unstable
Multiple fractures affect shoulder function
The fracture extends into the shoulder joint

When surgery is needed, the fracture is carefully realigned and stabilized using specially designed plates and screws.

Recovery

Most patients recover well with appropriate treatment.

Typical recovery includes:

Sling for 2-4 weeks
Physical therapy beginning once pain allows
Bone healing in approximately 8-12 weeks
Continued improvement in strength and motion over 6-12 months

Most patients eventually return to normal daily activities, work, and recreational sports.

Acromion Fractures

What Is Acromion Fracture?

The acromion is the bony projection on the top of the shoulder that forms the roof over the shoulder joint. It is part of the scapula (shoulder blade) and provides attachment for important shoulder muscles and ligaments.

An acromion fracture is a break in this portion of the shoulder blade.

Causes

Acromion fractures may occur after:

Falls directly onto the shoulder
Motor vehicle accidents
Contact sports injuries
Bicycle accidents
Direct blows to the shoulder

Occasionally, an acromion fracture can occur from stress on weakened bone following shoulder replacement surgery or in individuals with osteoporosis.

Symptoms

Patients commonly experience:

Pain on the top of the shoulder
Swelling and tenderness
Pain when raising the arm
Weakness
Difficulty sleeping on the affected side
Occasionally a visible deformity

Diagnosis

Diagnosis typically includes:

Physical examination
Shoulder X-rays
CT scan when additional detail is needed
MRI if associated rotator cuff injuries are suspected

Non-Surgical Treatment

Many acromion fractures heal successfully without surgery.

Treatment may include:

Sling immobilization
Ice and anti-inflammatory medications when appropriate
Gradual range-of-motion exercises
Physical therapy

Surgical Treatment

Surgery may be recommended if:

The fracture is significantly displaced
The fracture narrows the space beneath the acromion and may pinch the rotator cuff
The fracture fails to heal (nonunion)
The shoulder loses normal function

Surgery generally involves repositioning the fracture and securing it with plates and screws.

Recovery

Recovery depends on the severity of the fracture.

Typical recovery includes:

Sling for 3-6 weeks
Gradual rehabilitation
Bone healing within 8-12 weeks
Full recovery often takes 6-12 months

Most patients return to normal activities once healing is complete.

Scapular Spine Fractures

What Is Scapular Spine Fracture?

The scapular spine is the ridge of bone that runs across the back of the shoulder blade. It separates important shoulder muscles and serves as an attachment point for the deltoid and trapezius muscles.

Fractures of the scapular spine are uncommon but can significantly affect shoulder function.

Causes

Scapular spine fractures may occur from:

High-energy trauma
Falls
Motor vehicle accidents
Direct blows to the shoulder

They may also occur as stress fractures following reverse total shoulder replacement, particularly in patients with osteoporosis or weakened bone.

Symptoms

Symptoms include:

Pain across the back and top of the shoulder
Difficulty lifting the arm
Weakness
Swelling and tenderness
Pain with overhead activities
Reduced shoulder function

Patients who have previously undergone reverse shoulder replacement may notice a sudden increase in pain and decreased ability to lift the arm after what seems like a minor injury.

Diagnosis

Evaluation may include:

Physical examination
X-rays
CT scan to define the fracture
MRI in selected patients

Early diagnosis is particularly important after shoulder replacement surgery because these fractures may initially be difficult to detect.

Non-Surgical Treatment

Many minimally displaced fractures can heal without surgery.

Treatment may include:

Sling immobilization
Activity modification
Pain management
Physical therapy after healing has begun

Surgical Treatment

Surgery may be recommended when:

The fracture is significantly displaced
The fracture does not heal
Shoulder function is severely affected
The fracture compromises the function of a shoulder replacement

Surgery typically involves fixation with specialized plates and screws, although treatment decisions are individualized based on the patient’s bone quality, activity level, and overall health.

Recovery

Recovery generally includes:

Sling for 4-6 weeks
Gradual physical therapy
Bone healing over 8-12 weeks
Improvement in strength and function over 6-12 months

Patients recovering from fractures associated with reverse shoulder replacement often require a slower rehabilitation program to protect healing bone.

When Should You See an Orthopedic Specialist?

You should seek prompt medical evaluation if you experience:

Severe shoulder pain after a fall or accident
Difficulty moving your shoulder or arm
Significant swelling or bruising
A visible deformity
Pain that does not improve
New weakness following shoulder replacement surgery

Early evaluation allows your orthopedic specialist to determine the best treatment plan and reduce the risk of long-term complications.

Why Choose Midwest Orthopedic and Musculoskeletal Alliance?

The fellowship-trained orthopedic surgeons at Midwest Orthopedic and Musculoskeletal Alliance have extensive experience treating both routine and complex shoulder fractures. Whether your injury can be treated without surgery or requires advanced reconstruction, our team provides comprehensive care using the latest imaging technology, modern surgical techniques, and personalized rehabilitation programs. Our goal is to relieve pain, restore shoulder function, and help you safely return to work, sports, and the activities you enjoy.

By Dr. William T. Pennington, MD | Board-Certified Orthopedic Surgeon

Schedule Your Shoulder Blade Fracture Consultation

If you have experienced a shoulder blade fracture or significant shoulder injury, contact Midwest Orthopedic and Musculoskeletal Alliance today at 414-384-6700. Our team in Southeastern Wisconsin is here to help.