Isolated Scapular Body Fracture in A High School Football Player Volume 5 - Issue 3

Robert Casmus*, Robert Casmus, Kevin Burroughs, Patrick King and Donato Colucci

• Supervisor GWS, Athletic Trainers, Novant Health Forsyth Medical Center, Whitaker Rehabilitation Center, USA

Received:May 13, 2021   Published:May 21, 2021

Corresponding author:Robert Casmus, M.S., LAT, ATC, Supervisor GWS-Athletic Trainers Novant Health Forsyth Medical Center, Whitaker Rehabilitation Center 3333 Silas Creek Parkway, Winston-Salem, NC 27103, USA

DOI: 10.32474/OSMOAJ.2021.05.000211

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Abstract

History: A 16-year-old high school football player reported that as he was tackled his posterior shoulder was driven directly into the ground with multiple players landing on top of him. On initial exam there was no obvious deformity or swelling but demonstrated full but painful shoulder ROM for flexion and abduction which diminished as his pain level became intensified. Severe point tenderness noted to the lateral scapular border. Special test for glenohumeral instability were negative as were tests for the AC and sternoclavicular joints. There was no clavicular pain and no paresthesia’s noted. The athlete did note some upper thoracic and rib cage discomfort associated with the trauma. Both vital signs and breath sounds were within normal limits. Initial Care: The athlete was treated with ice and placed in a shoulder sling with instructions to follow-up with the team physician the following day. Differential Diagnosis: Shoulder contusion, rib fracture, glenohumeral sprain, AC sprain, occult clavicular fracture and scapular fracture. Diagnostic Testing: Radiographic images revealed a fracture to the scapula extending from the lateral border through the scapular body to the medial border. A confirmatory CT scan corroborated the initial radiographs for scapular body fracture. Followup Treatment and Care: The athlete continued wearing the sling for the next 4 weeks and was prescribed tramadol and permitted to take ibuprofen. At two weeks post-trauma he was permitted to begin elbow, hand and wrist ROM as pain levels subsided. Followup treatments included hot packs to reduce pain and soreness. Four weeks post-trauma revealed significant fracture site healing and the athlete began progressive upper extremity rehabilitation exercises. At eight weeks he returned to all weight room and football related activities without incident. Uniqueness: The scapula has large muscular coverage and thus fractures are uncommon and account for no more than .5% of all shoulder girdle injuries and no more than 1% of all shoulder girdle fractures. Scapular fractures are commonly associated with high energy forces and blunt trauma impacts such as motor vehicle accidents and falls from various heights. Scapular fractures will often have accompanied injuries to the chest and head. Direct trauma to the scapula leads to fractures of the scapular body, spine or the acromion. Indirect trauma that pulls or levers the arm will result in fractures of the glenoid fossa or scapular neck. Conclusion: Fractures of the scapula body are normally treated nonoperatively with 86% having excellent to good outcomes. 90% of scapular fractures are nondisplaced or moderately displaced and thus treated conservatively. The treatment goal of scapular body fractures is to rest, allow healing to occur and then begin rehabilitation. It is imperative to achieve full active and passive motion as soon as tolerable to decrease adhesion development in the scapulothoracic joint. This case illustrates the appropriate evaluation, conservative treatment and care leading to complete resolution of an isolated scapular body fracture. Complications of scapular fractures if not treated appropriately include altered shoulder girdle dysfunction, rotator cuff dysfunction or impingement and scapulothoracic dyskinesia. The athlete is currently asymptomatic and has returned to all athletic and activities of daily living.

Keywords: Scapula; Fracture Glenohumeral; Trauma

Abstract| Introduction| Case Review| Discussion| Implications for Clinical Practice| Conclusion| All the authors| Conflict of interests| References|