A dislocation is an injury characterized by displacement of the articular surfaces relative to each other. Dislocation of the scapula is not a completely correct diagnosis, as damage to the humerus in the scapular or acromioclavicular region is mistakenly called.
As a result of damage, the scapula and humerus are displaced relative to each other. As a result, the motor function of the affected joint is impaired, in some cases the limb is completely immobilized.
The injury occurs as a result of a strong pull on the arm or a fall on the upper limb. Immediately after the injury, it is important to provide first aid to the victim and hospitalize him. Timely treatment will help avoid dangerous complications.
Common causes of scapula dislocation
To better understand the nature of the injury, it is necessary to delve into the anatomy. The scapula is a flat triangular bone that connects to the clavicular region using the scapular or acromial process. This is how the shoulder girdle and scapuloclavicular joint are formed. With the help of another joint, the scapula is attached to the head of the humerus, thus forming the shoulder joint.
A dislocated shoulder blade occurs as a result of a sharp and strong pull on the arm or a blow to the shoulder blade. The scapula shifts sideways, and its lower corner is pinched by the ribs. In some cases, damage to the muscles that fix the scapula may occur.
Dislocation of the acromioclavicular joint is often diagnosed. This injury occurs due to a fall on the shoulder or a blow to the collarbone area. It is connected to the scapula by the coracoid and acromioclavicular ligaments. Doctors distinguish the following types of dislocation depending on the nature of the rupture:
- Incomplete - one ligament is torn,
- Complete - characterized by rupture of both ligaments,
- Supracromial - the clavicle is displaced above the acromial process,
- Subacromial - the outer end of the clavicle is located under the acromion. This type of injury is the rarest.
The shoulder is injured as a result of a fall on a forward or extended upper limb. Displacement of the joints of the shoulder and scapula relative to each other occurs as a result of falling backward onto an abducted limb. The displacement of the shoulder joint in relation to the scapular cavity can be lower, posterior or anterior.
You can read about shoulder dislocation here.
Characteristics of the pathology
A fracture of the scapula is a rare occurrence, since, according to the anatomical structure, it lies in the thickness of the muscle tissue that serves as its protection. Various reasons can provoke a violation of the integrity of the body of the scapula itself and many of its components:
- acromion - a ridge crossing the posterior scapular surface (spine);
- process of the upper edge of the scapula (coracoid);
- the socket, which is a depression in which the head of the humerus lies;
- intra-articular and extra-articular fracture of the neck of the scapula (anatomical and surgical neck);
- socket bases;
- ridge (spine) fracture;
- inferior and superior internal angle of the scapula.
Often the integrity of the bone is disrupted in the area of the scapular neck, the lower angle of the scapula and its coracoid process, the scapular crest, the rosette and the superior internal angle. The cause is a direct blow or an unfortunate fall. For example, separation of the process of the upper edge of the scapula from its body is a consequence of complete dislocation of the inactive joint located between the crest of the scapula and the collarbone, or is caused by shoulder dislocation.
Symptoms and types of scapula dislocation
Dislocation of the scapula is divided depending on the severity and time elapsed since the injury. If the injury occurred less than 3 days ago, then it is fresh, about 20 days - stale, and from 21 days - old.
Dislocation of the scapula depending on the severity:
- I degree - injury in which the collarbone does not displace,
- II degree - incomplete dislocation of the clavicle, which is characterized by rupture of the acromioclavicular ligaments, while the coracoid ligaments remain unharmed. If the dislocation occurred more than 14 days ago, then degenerative changes in the upper limb girdle appear (grade B). If the injury appeared before 14 days and there are no degenerative changes, then this is grade A,
- Grade III is a dislocation of the clavicular region, in which the acromioclavicular and coracoclavicular ligaments are torn. Grades A and B, as in the previous paragraph, depend on the timing of the injury and the presence or absence of degenerative changes,
- VI degree – the clavicle moves posteriorly,
- V degree – the collarbone moves upward.
If the scapula is injured, the victim cannot make active movements of the limb , and pain is felt with passive movements. If you touch the damaged area, the pain intensifies. Upon visual examination, asymmetry of the shoulder blades is observed, the axillary edge and the lower part of one of them protrude.
In addition, the doctor cannot feel the lower edge of the scapula because it is pinched by the ribs. The vertebral side may deviate backward even after the scapula has been reduced. Visually, one limb is slightly longer than the other, and the forearm is shortened. After a day or two, a bruise appears in the area of the dislocation, and this is how a complete dislocation with rupture of the clavicular-coracoid ligaments appears.
Symptoms
Pain, swelling, and bruising may occur in both the scapula area of the upper back and the upper arm above the coracoid and acromion.
- The patient will keep the hand on the side of the injured shoulder blade pressed against the body.
- Movement of the arm will increase the pain in the shoulder blade.
- The patient will not be able to raise his arm on the side of the scapula fracture.
- The patient may experience pain with each deep breath as the chest moves during breathing. This movement can cause the broken shoulder blade to move, causing pain.
- There may be flattening or deformation of the shoulder when the scapula is fractured.
Symptoms that should prompt you to seek medical attention if a shoulder or upper back injury occurs:
- Pain when moving in an injured shoulder
- Shoulder swelling
- Bruises around the shoulder
- If shoulder pain does not improve within 3-5 days
Symptoms such as shortness of breath, numbness in the injured arm, severe pain in the arm or shoulder, or shoulder deformity, especially when there are other injuries to the chest, neck or back, are grounds for emergency hospitalization.
First aid for a dislocated scapula
If symptoms of a dislocated scapula occur, it is necessary to provide assistance to the person:
- Call an ambulance, place the victim on a backboard on his stomach,
- Swelling and bruising occur in the damaged area due to rupture of blood vessels. To do this, apply a cold compress to the area of dislocation.
- If the pain is very severe, you can take an analgesic.
- It is important to immobilize the injured limb. Failure to do so may cause severe pain or worsen the misalignment of the joint parts. For this purpose, use a tire made from any available material.
- The victim is transported to the emergency room.
Signs of a sprain are often confused with symptoms of other more serious injuries . For this reason, before reducing the displacement, an X-ray examination is performed.
Self-resetting the bone after a dislocated scapula can only aggravate the situation.
Treatment and methods of reduction
Once the diagnosis of scapula dislocation has been established, therapy can begin. The injury is treated conservatively or surgically.
In case of subluxation of the acromioclavicular joint, the damaged limb is placed in a scarf. To relieve pain, a solution of novocaine is injected. After 2–3 days, when the pain subsides, physical therapy is performed with shoulder abduction to 90°. This procedure is performed within 7 days.
In case of complete dislocation, all ligaments must be firmly fixed for 6–8 weeks. They will recover only after long-term treatment, and therefore the victim is hospitalized.
In case of irreducible dislocation (soft tissue gets into the space between the surfaces of the articulation), arthrotomy is prescribed. During the operation, the shoulder joint is exposed, the surgeon removes the obstruction and reduces the dislocation.
Regardless of the method of reduction, a plaster splint is applied to the damaged limb . The duration of wearing it depends on the age of the patient, for example, young people wear it for about 30 days, and older people - 20 days. Although for older patients they usually use a soft scarf rather than a plaster cast.
In addition, ultra-high frequency therapy is used to treat dislocation. The patient can also take analgesics and calcium supplements prescribed by the doctor.
While wearing a splint, the patient must perform special exercises, move the fingers and hand of the injured arm, clench and unclench his fist. This way the swelling will disappear faster and it will be possible to prevent muscle atrophy.
After reduction, a cold compress should be applied to the damaged area.
Shoulder blade pain
Treatment at home
In some cases, the symptoms of scapular dyskinesia can be leveled out by performing simple activities at home.
Restoring normal posture . When going about your daily activities, try to sit and stand correctly. Try to squeeze your shoulder blades together and push your elbows back, as if you were trying to put your hands in the back pockets of your pants.
Balanced exercise program . The exercise program must be balanced in terms of upper body exercises. For every set of presses, you should perform one set of swings and two sets of rowing. Your program should include exercises to strengthen the anterior shoulder muscles and rotator cuff muscles.
Heat therapy . Warm baths or local heating can help relieve excess muscle tension.
If symptoms persist, you should contact your doctor. The doctor will help determine the exact cause of dyskinesia and prescribe appropriate treatment.
Conservative treatment after a visit to the doctor
In almost all cases of scapular dyskinesia, conservative treatment is effective.
Conservative measures include:
Nonsteroidal anti-inflammatory drugs (NSAIDs) . Drugs in this group, such as ibuprofen, help relieve pain and swelling.
Physiotherapy . Your doctor or physical therapist will recommend a set of special exercises aimed at correcting specific causes of dyskinesia. Usually this:
- Exercises that help strengthen the muscles that stabilize and move the scapula;
- Exercises that help stretch excessively tight muscles that limit the movement of the scapula.
Surgery
Most patients suffering from systemic dyskinetic syndromes associated with muscle weakness or excessive tension do not require surgical treatment.
However, if your dyskinesia is due to a shoulder injury, your doctor may recommend surgery to repair or reconstruct the damaged tissue. After the operation, rehabilitation treatment will be prescribed to help restore normal mobility of the scapula.
Long-term results of treatment
After the causes of your dyskinesia are eliminated and the normal position and mobility of the scapula are restored, the doctor will recommend you a set of exercises aimed at maintaining the achieved result. Such exercises are most important if your work or lifestyle involves constant and intense stress on the shoulder joint. Exercises should be performed 3 times a week or as often as recommended by your doctor.
Rehabilitation after injury
After the bandage is removed, the recovery process begins. Rehabilitation includes procedures such as magnetic therapy and physical therapy. It is important to consult a doctor regarding behavior during the recovery period. At first, you should avoid lifting weights (carrying heavy bags, lifting heavy objects, doing push-ups, etc.).
If you notice that after removing the plaster cast, the shoulder blade has not taken the correct position, then do not panic. It goes into place 4 to 5 weeks after the injury.
If after this time the bone is in the wrong position, then you need to consult a doctor. In this case, surgery may be necessary. The operation is necessary to fix the angle of the scapula near the ribs and spine.
Treatment
Because scapula fractures are often associated with severe, potentially life-threatening injuries, the patient must be urgently hospitalized.
- It is necessary to fix and limit any movement. Fixation can be done using a special bandage. The arm is bent at the elbow joint, brought to the body and suspended on a scarf.
- Apply an ice pack, avoiding direct contact of the ice with the skin, to the injured area to reduce swelling and discomfort.
- Due to the fact that in 80% of cases a fracture of the scapula is accompanied by other injuries, the patient must be hospitalized in the emergency department.
Most scapula fractures can be treated without surgery.
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics can reduce pain and inflammation. The drugs are prescribed in the presence of pain during the period of bone tissue regeneration. Given the side effects of these drugs, the drugs should be taken only under the supervision of the attending physician.
Immobilization is usually necessary for 3-4 weeks until the pain disappears
Exercise therapy. Physical exercises must be included as early as possible (you can start a week after the injury) so as to avoid the development of glenohumeral periarthritis (a decrease in range of motion can occur with prolonged immobilization of the shoulder).
Physiotherapy is used during the recovery period to improve regeneration and improve blood circulation in the shoulder.
Surgery
Surgical treatment for scapula fractures is necessary for some types of fractures, mainly in cases where there is damage to the articular cavity (rosette) or the neck of the scapula. Timely consultation with a traumatologist allows you to determine the necessary treatment tactics.
Complications and consequences
Untimely or incorrect treatment of a dislocated scapula can lead to dangerous complications. If a subluxation is not treated, it will eventually transform into a complete dislocation, which damages tendons, ligaments, blood vessels and nerves.
As a result, the sensitivity of the affected hand is reduced and the motor function of the joint is impaired. In addition, such an injury risks rupture of the capsule, fracture of the humeral head, damage to the periosteum, or constant spontaneous repetition of the dislocation.
To avoid re-injury, you need to systematically perform special exercises, even after rehabilitation . If the patient is involved in active sports, then he must provide reliable protection to the joints with the help of knee pads, elbow pads, etc.
Thus, a dislocated scapula is a serious injury that can lead to dangerous complications. If symptoms occur that indicate displacement of the articular surfaces, the victim must be given first aid and sent to the emergency room. The patient must follow all the doctor's instructions regarding the restoration of the damaged joint. Only in this case can serious consequences be avoided.
Causes
Scapula fractures are caused by direct trauma with a large vector of force. As a rule, in 80% of cases, scapula fractures are accompanied by injuries to the chest, lungs and shoulder. Therefore, in the presence of a scapula fracture, a thorough examination is necessary for the presence of concomitant injuries. The main causes of a scapula fracture are as follows:
- Road traffic accidents
- Falls with direct shoulder injury
- Falling on an outstretched arm
- Direct blow, such as with a baseball bat or hammer