This 15-year-old goalkeeper presented with acute pain in his left shoulder. He described diving backwards, landing on the posterior aspect of the shoulder. He experienced immediate pain and was unable to continue. He was reluctant to abduct his shoulder beyond 30 degrees and had localised tenderness over the body of the left scapula.
There is an oblique fracture through the body of the scapula, inferior to the glenoid margin, which remains in gross anatomic alignment. The MRI images show moderate bone marrow oedema and surrounding periosteal oedema. There is also oedema extending into the adjacent subscapularis, infraspinatus and teres minor musculature.
This young player was managed with an eight-week period of rest and physiotherapy. During this period, he progressively increased his activity level. He was able to return to goalkeeping training progressively after three months.
Scapular fractures usually occur as a result of a crushing force. Although fractures can occur at any area of the scapula, the neck and body are most commonly involved. Patients generally present with marked swelling and tenderness. The majority of extra-articular fractures (glenoid neck, scapular body or spine, acromion and coracoid) are managed non-operatively and usually heal well, even if displaced, in a broad arm sling. Intra-articular fractures involving the glenoid are usually associated with instability and require operative treatment.
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