SHOULDER-BLADE (SCAPULA) FRACTURE, NECK |
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General Information
DEFINITION--A complete or incomplete break in the neck of the scapula (shoulder blade). This injury results in marked displacement of the broken bone.
BODY PARTS INVOLVED
Scapula.
Shoulder joint.
Soft tissue around the fracture site, including nerves, tendons, ligaments, joint membranes and blood vessels.
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SIGNS & SYMPTOMS
Severe pain at the fracture site.
Swelling of soft tissue around the fracture.
Visible deformity if the fracture is complete and 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.
CAUSESDirect blow or indirect stress on the bone. Indirect stress may be caused by twisting or violent muscle contraction.
RISK INCREASES WITH
Contact sports such as football.
History of bone or joint disease, especially osteoporosis.
Poor nutrition, especially calcium deficiency.
Obesity.
If surgery or anesthesia are 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.
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 (sometimes) for anesthesia and surgery to set the fracture.
Hospitalized for traction (sometimes).
Self-care during rehabilitation.
Ultrasound or massage after healing (to displace excess fluid from the injured joint space).
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of injured areas.
POSSIBLE COMPLICATIONS
AT THE TIME OF INJURY:
Shock.
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.
Problems caused by casts. See Appendix 2 (Care of Casts).
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 6 to 8 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.
FIRST AID
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.
Use instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CARE
The doctor will set the broken bones with surgery or, if possible, without. Manipulation 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.
Immobilization will be necessary. A rigid cast placed around the injured area is the most common technique. Skeletal traction is sometimes necessary.
After traction or surgery, use a triangular sling for 2 weeks and begin progressive shoulder exercises on a regular schedule (5 to 10 minutes every waking hour).
After immobilization, 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.
Apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments or ointments.
MEDICATIONYour doctor may prescribe:
General anesthesia, local anesthesia, or muscle relaxants to make bone manipulation and fixation of bone fragments 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.
ACTIVITY
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.
REHABILITATIONBegin daily rehabilitation exercises when movement is comfortable. 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 treatment:
Pain, swelling or drainage increases in the surgical area.
You develop signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
You experience nausea or vomiting.
You notice swelling above or below the cast.
Color of skin changes beyond the cast to blue or gray, particularly under the fingernails.
You have numbness or complete loss of feeling below the fracture site.
You become constipated.
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