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Delayed Union of a Scapular Fracture-An Unusual Cause of Persistent Shoulder Pain


Medicine & Science in Sports & Exercise: December 2007 - Volume 39 - Issue 12 - p 2095-2098
doi: 10.1249/mss.0b013e318156e8ec
CLINICAL SCIENCES: Clinical Case Studies

Introduction: Scapular fractures in athletes are rare, although they have been reported in football and baseball players. Most scapular fractures heal with nonoperative management; delayed union is rarely a problem.

Case Summary: A 15-yr-old male fell onto his posterior shoulder after he had been pushed into the boards and then fell to the ice during a hockey check. He was diagnosed with a rotator cuff injury at an outside facility. Initial radiographs were negative. The patient was not immobilized, and he continued to play hockey despite intermittent pain. Seven months later, he presented to our sports medicine clinic, complaining of an aching pain at the base of his left shoulder. Examination revealed point tenderness along the base of the scapula, restriction of shoulder abduction, rhomboid weakness, scapular winging, and anterior impingement-type shoulder pain. A new radiograph, obtained at our sports medicine clinic, was nondiagnostic. Magnetic resonance imaging revealed increased signal on T2, with bone edema at the lateral margin of the scapular neck. A computed tomography scan revealed an unhealed, left-transverse, subglenoid scapular fracture. The fracture was nondisplaced. The patient was treated with transcutaneous electrical stimulation for 6 months and a physical therapy regimen focusing on periscapular strengthening. A final computed tomography scan, 6 months after initial presentation to our clinic, revealed healing of the fracture. Examination was normal. The patient was asymptomatic and was able to fully return to sports without any complications.

Conclusions: Although scapular fractures in athletes are rare, they may occur, particularly in "contact sports" that share the energies of injury seen in high-speed motor vehicle collisions. Early identification and proper management are integral to decrease symptoms and to avoid protracted disability, particularly in athletes.

1Harvard Medical School, Boston, MA; 2Children's Hospital Boston, Department of Orthopaedics, Division of Sports Medicine, Boston, MA; and 3Cincinnati Children's Hospital Medical Center, Department of Orthopaedics, Cincinnati, OH

Address for correspondence: Lyle Micheli, M.D., F.A.C.S.M., 319 Longwood Avenue, 2nd Floor, Department of Orthopaedics, Division of Sports Medicine, Children's Hospital Boston, Boston, MA 02115; E-mail:

Submitted for publication June 2007

Accepted for publication July 2007.

©2007The American College of Sports Medicine