Presentation
Shoulder pain post fall from standing height.
Patient Data
No dislocation. No fracture identified.
High signal adjacent to the scapular blade, mainly adjacent/within the subscapularis and infraspinatus muscle bellies. Disruption of the scapular blade in keeping with a minimally displaced fracture.
Full-thickness partial-width supraspinatus tear with sub-footplate marrow edema.
CT confirms a comminuted, mildly displaced scapular blade fracture without intra-articular extension.
Case Discussion
In retrospect, a thin lucency can be seen within the scapular blade on the frontal with cortical disruption on the lateral (although the humeral shaft projects over this region making visualization difficult) on the initial x-ray. CT has been shown to be more sensitive and specific than x-rays for the diagnosis of scapular fractures. Scapular fractures are usually associated with high-energy blunt trauma, and unusual mechanisms of action (as in this case low-energy fall) can result in delayed or missed diagnosis.
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