Scapula Fracture Management: Types, Treatment & 25 Physiotherapy MCQs

Fractures of the Scapula

Scapula fractures are relatively rare (less than 1% of all fractures) because the bone is well-protected by thick muscles and the thoracic cage. Because it requires high-energy trauma to break, 80-90% of patients have associated injuries (Rib fractures, Pneumothorax, or Head injury).

1. Classification (Anatomical)

• Body (Most Common): 45% of cases. Usually benign.
• Glenoid Neck: 25%. Can alter joint mechanics.
• Glenoid Cavity (Intra-articular): Classified by Ideberg Classification.
• Acromion & Coracoid: Rare.

2. Clinical Features

• Arm held adducted against the body.
• Swelling over the back of the shoulder.
• Pseudo-rupture of Rotator Cuff: Pain inhibits movement, mimicking a tear.

⚠ The "Floating Shoulder"
A Double disruption of the Superior Shoulder Suspensory Complex (SSSC).
Definition: Fracture of the Scapular Neck + Fracture of the Clavicle (ipsilateral).
Result: The shoulder is unstable and "floats" from the axial skeleton. Usually requires surgery.

3. Management

• Conservative: 90% of cases. Sling for 2-3 weeks until pain subsides, then early motion.
• Surgical (ORIF):
  • Glenoid articular step-off > 4-5mm.
  • Unstable Floating Shoulder.
  • Severe medialization of the glenoid.

4. Physiotherapy

• Week 0-3: Sling immobilization. Hand/Elbow ROM. Pendulum exercises.
• Week 3-6: Active Assisted ROM. Scapular setting.
• Week 6+: Strengthening (Trapezius, Serratus Anterior, Rotator Cuff).

25 Practice MCQs

Q1. Scapula fractures are rare primarily because:

Answer: A). The envelope of muscles (Rotator cuff, Trapezius, Rhomboids) protects it.

Q2. Which classification system is used for Glenoid Fossa fractures?

Answer: B). Ideberg classifies intra-articular glenoid fractures.

Q3. "Floating Shoulder" involves fracture of the Scapular neck and:

Answer: B). Ipsilateral clavicle fracture + Scapular neck fracture.

Q4. What is the most common associated injury with scapula fractures?

Answer: A). Due to the high energy required, rib fractures and lung injuries are very common.

Q5. The most common part of the scapula to fracture is:

Answer: B). The body accounts for roughly 45-50% of cases.

Q6. Which nerve is most at risk in a fracture of the scapular notch?

Answer: B). The suprascapular nerve runs through the notch.

Q7. Which X-ray view is best for visualizing the Scapular Y?

Answer: B). This view shows the body of the scapula in profile.

Q8. The majority of scapula fractures are treated:

Answer: B). Muscle splinting usually prevents significant displacement.

Q9. A fracture of the Coracoid process may impinge on which structure?

Answer: B). The coracoid is close to the subscapularis and neurovascular bundle.

Q10. What is "Scapulothoracic Dissociation"?

Answer: A). A life-threatening injury often called "internal amputation".

Q11. Which muscle attaches to the Coracoid process?

Answer: B). Along with Coracobrachialis and Pectoralis Minor.

Q12. Intra-articular fractures of the glenoid can lead to:

Answer: B). Irregular joint surfaces cause rapid degeneration.

Q13. Ideberg Type I fracture involves:

Answer: A). An anterior rim fracture is common with anterior dislocation.

Q14. Early passive motion is contraindicated if:

Answer: B). Stability dictates the start of rehab.

Q15. Which muscle originates from the subscapular fossa?

Answer: A). It covers the anterior aspect of the scapula.

Q16. An Acromion fracture that is depressed can cause:

Answer: A). It reduces the subacromial space.

Q17. The Stryker Notch view is used to visualize:

Answer: A). Useful for coracoid fractures.

Q18. Os Acromiale is:

Answer: B). Often mistaken for a fracture on X-ray.

Q19. Scapular winging after a fracture might indicate injury to:

Answer: A). Resulting in Serratus Anterior palsy.

Q20. Which strengthening exercise is crucial for scapular fractures in late rehab?

Answer: B). To restore scapulohumeral rhythm.

Q21. The SSSC (Superior Shoulder Suspensory Complex) is a ring formed by:

Answer: A). Disruption of this ring often requires surgery.

Q22. A "Bankart Fracture" is:

Answer: A). Associated with anterior dislocation.

Q23. Generally, scapular body fractures heal:

Answer: A). Due to the rich blood supply from surrounding muscles.

Q24. Which movement is most restricted initially in Scapula fractures?

Answer: A). Because scapular rotation is required for elevation.

Q25. The normal glenoid is retroverted or anteverted?

Answer: A). Though variable, slight retroversion is normal. Fracture malunion can alter this.