A 25-Year-Old Man with Shoulder Pain After a Fall

Differential Diagnosis

• Clavicle fracture
• Rib fracture
• Scapula fracture
• Shoulder dislocation

Figure 2.

Diagnosis
The x-ray shows the patient experienced a scapula fracture, which is most likely to occur with a high-level trauma resulting in direct impact to the shoulder.

Learnings

• This diagnosis is often associated with other serious injuries such as pneumothorax, brachial plexus injury, or spinal fracture
• Common findings of the physical exam include tenderness, edema, and ecchymosis over the affected area

Pearls for Urgent Care Management and Consideration for Transfer

• An anteroposterior shoulder view and a lateral scapular view are most likely to reveal scapular fractures
• Superimposition of the shoulder girdle on the ribs can obscure these fractures on standard shoulder x-ray exam. Consider dedicated scapula series if there is strong clinical suspicion
• Ice and analgesics should be used to help minimize pain and swelling
• If there is not a suspicion of serious injury and if the fracture is not significantly displaced, the patient should be placed in a sling and swath for immobilization, with a recommendation for follow-up with an orthopedist