SHOULDER-BLADE (SCAPULA) FRACTURE, GLENOID FOSSA
DEFINITION--A complete or incomplete break in the glenoid fossa of the scapula (wingbone). The glenoid fossa functions as a receptacle--like a socket--for the upper end of the humerus (the large bone between the elbow and shoulder). The glenoid fossa, along with bones, tendons, joint capsules and other soft tissue, forms the shoulder.
BODY PARTS INVOLVED
Glenoid fossa of the scapula.
Soft tissue around the fracture site, including nerves, tendons, ligaments, joint membranes and capsules, and blood vessels.
SIGNS & SYMPTOMS
Severe pain at the fracture site.
Swelling of soft tissue around the fracture.
Visible deformity if the fracture is complete and the bone fragments separate enough to distort normal body contours.
Tenderness to the touch.
Numbness in the arm and hand (sometimes).
Cold arm and hand if the blood supply is impaired.
Direct injury: A direct blow to the side of the shoulder produces a star-shaped minor fracture of the glenoid fossa.
Indirect injury: Falling on a bent elbow can fracture the glenoid fossa.
RISK INCREASES WITH
Participation in contact sports such as football, soccer or hockey.
History or bone or joint disease, especially osteoporosis.
Poor nutrition, especially calcium deficiency.
If surgery or anesthesia is needed, surgical risk increases with smoking and use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers or corticosteroids.
HOW TO PREVENT
Build your strength with a good conditioning program before beginning regular athletic practice or competition. Increased muscle mass helps protect bones and underlying tissue.
Try to avoid falling on a bent elbow.
Use appropriate protective equipment, such as shoulder pads for contact sports.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment to manipulate and set the broken bones.
Hospitalization for anesthesia and surgery to set bones for all except minimal fractures without displacement.
Self-care during rehabilitation.
Ultrasound or massage (to displace excess fluid from the injured joint space).
Your own observation of symptoms.
Medical history and physical exam by a doctor.
X-rays of injured areas.
AT THE TIME OF INJURY:
Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels or connective tissues. AFTER TREATMENT OR SURGERY:
Delayed union or non-union of the fracture.
Impaired blood supply to the fracture site.
Arrest of normal bone growth in children.
Infection in open fractures (skin broken over fracture site), or at the incision if surgical setting was necessary.
Shortening of the injured bones.
Unstable or arthritic joint following repeated injury.
Prolonged healing time if activity is resumed too soon.
Proneness to repeated injury.
PROBABLE OUTCOMEIt is impossible to predict exactly how long it will take for any fracture to heal. Variable factors include age, sex, and previous state of health and conditioning. The average healing time for this fracture is 8 to 10 weeks. Healing is complete when there is no motion at the fracture site and when X-rays show complete bone union.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
Keep the person warm with blankets to decrease the possibility of shock.
Cut away clothing, if possible, but don't move the injured area to do so.
Follow instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
The doctor will set the broken bones with surgery or, if possible, without. This should be done as soon as possible after injury. Six or more hours after the fracture, bleeding and displacement of body fluids may lead to shock. Also, many tissues lose their elasticity and become difficult to return to a normal position. Most injuries to the glenoid fossa require surgical treatment.
Immobilization will be necessary. A triangular sling for 3 to 4 weeks is usually sufficient.
Use frequent ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a baseball. Do this for 15 minutes at a time, 3 or 4 times a day, and before workouts or competition.
After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use hot baths, showers, compresses, heat lamps, heating pads, and heat ointments or liniments.
MEDICATIONYour doctor may prescribe:
General anesthesia, local anesthesia, or muscle relaxants to make bone manipulation possible.
Narcotic or synthetic narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to inactivity.
Acetaminophen (available without prescription) for mild pain after initial treatment.
Actively exercise all muscle groups not immobilized. These muscle contractions promote fracture alignment and hasten healing.
Resume normal activities gradually after treatment. Don't drive until healing is complete.
Begin reconditioning the injured area after clearance from your doctor.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONStart shoulder exercises 2 weeks after injury. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have signs or symptoms of a shoulder-blade fracture.
Any of the following occurs after surgery or other treatment:
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
Nausea or vomiting.
Change in skin color beyond the fracture to blue or gray, particularly under the fingernails.
Numbness or complete loss of feeling below the fracture site.