SHOULDER-BLADE (SCAPULA) CONTUSION |
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General Information
DEFINITION--Bruising of skin and underlying tissues caused by a direct blow to the scapula (shoulder blade or wingbone). Contusions cause bleeding from ruptured small capillaries that allow blood to infiltrate muscles, tendons, or other soft tissue.
BODY PARTS INVOLVEDTissues surrounding the scapula, including blood vessels, tendons, nerves, covering to the bone (periosteum) and connective tissue between the scapula and the skin.
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SIGNS & SYMPTOMS
Local swelling--either superficial or deep.
Pain and tenderness over the injury.
Feeling of firmness when pressure is exerted on the injured area.
Discoloration under the skin, beginning with redness and progressing to the characteristic "black and blue" bruise.
Restricted shoulder-blade motion proportional to the extent of injury.
CAUSESDirect blow to the skin, usually from a blunt object.
RISK INCREASES WITH
Contact sports, especially when the shoulder area is not adequately protected.
Medical history of any bleeding disorder such as hemophilia.
Poor nutrition, including vitamin deficiency.
Use of anticoagulants or aspirin.
HOW TO PREVENTWear appropriate protective gear and equipment , such as shoulder pads, during competition or other athletic activity if there is risk of a scapula contusion.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's care unless the contusion is quite small.
Self-care for minor contusions, and for serious contusions during the rehabilitation phase.
Physical therapy following serious contusions.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and physical exam by a doctor for all except minor injuries.
X-rays of the clavicle, shoulder and scapula to assess total injury to soft tissue and to rule out the possibility of underlying fractures. The total extent of injury may not be apparent for 48 to 72 hours.
POSSIBLE COMPLICATIONS
Excessive bleeding leading to disability. Infiltrative-type bleeding can (rarely) lead to calcification and impaired function of injured muscle.
Prolonged healing time if usual activities are resumed too soon.
Infection if skin is broken over the contusion.
PROBABLE OUTCOMEHealing time varies with the extent of injury, but all but the most serious contusions should heal in 6 to 10 days.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CARE
Use an ice pack 3 or 4 times a day. Wrap ice chips or cubes in a plastic bag, and wrap the bag in a moist towel. Place it over the injured area for 20 minutes at a time.
After 72 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, heat liniments or ointments, or whirlpool treatments.
Massage gently and often to provide comfort and decrease swelling.
MEDICATION
For minor discomfort, you may use:
Acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe stronger medicine for pain.
ACTIVITYBegin activities slowly and stop exercise as soon as pain begins. Increase activity as healing progresses.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Your doctor may prescribe vitamin and mineral supplements to promote healing.
REHABILITATION
Begin daily rehabilitation exercises when pain subsides.
Use ice massage for 10 minutes before and after workouts. 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 softball.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have a contusion that doesn't improve in 1 or 2 days.
Skin is broken and signs of infection (drainage, increasing pain, fever, headache, muscle aches, dizziness or a general ill feeling) occur.
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