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Where’d that tree come from?
A 29-year-old male presents to the ED with shoulder and back pain. He was lying in a hammock when the tree it was attached to broke and fell on top of him.
Where’d that tree come from?
Author: Alex Tomesch, MD, CAQ-SM
Peer-Reviewer: Jeremy Swisher, MD
Final Editor: Will Denq, MD, CAQ-SM
A 29-year-old male presents to the ED with shoulder and back pain. He was lying in a hammock when the tree it was attached to broke and fell on top of him.
Image 1. Plain radiograph of the shoulder. Case courtesy of Ashesh Ishwarlal Ranchod, Radiopaedia.org, rID: 167844
What is the diagnosis?
The patient has a scapular fracture. See Image 2 for annotation of the findings.
Image 2. Plain radiograph of the shoulder, AP (left) and scapular Y view (right). Annotations by Author. Case courtesy of Ashesh Ishwarlal Ranchod, Radiopaedia.org, rID: 167844
Which imaging modalities can be used?
An X-ray (AP, lateral, scapular Y, axillary) can be done to diagnose the fracture, but the scapula is difficult to fully capture on x-ray and, therefore, can be missed. Non-displaced fractures can especially be difficult to diagnose on x-ray. CT scan has a much better sensitivity for identifying scapular fractures.
Image 3. CT scan of fractured scapula. Annotations by Author. Case courtesy of Ashesh Ishwarlal Ranchod, Radiopaedia.org, rID: 167844
References
[1] Baldwin KD, Ohman-Strickland P, Mehta S, Hume E. Scapula fractures: a marker for concomitant injury? A retrospective review of data in the National Trauma Database. J Trauma. 2008;65(2):430-435. doi:10.1097/TA.
[2] Cole PA, Gauger EM, Schroder LK. Management of scapular fractures. J Am Acad Orthop Surg. 2012;20(3):130-141. doi:10.5435/JAAOS-20-03-130
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