Surgery to repair the scapula, or shoulder blade, and its attached muscles, tendons, and ligaments is performed using either a “closed” or an “open” procedure. “Closed” procedures are performed with an arthroscope and a tiny camera inserted through one or more incisions of up to 4 inches (10 cm), then closed with sutures and a small bandage. “Open” procedures are more complicated and can require larger incisions that result in more blood loss and larger bandages to cover the wound.
The scapula is the large triangular bone connecting the humerus, or upper arm bone, to the clavicle, or collar bone. The different types of scapula surgery involve either operating on the blade of the scapula itself, or on the close attachments of four major muscles — the supraspinatus, infraspinatus, subscapularis and teres minor. Repair of the proximal attachments of these muscles to the glenohumeral joint in the shoulder is generally termed orthopedically as shoulder surgery.
Scapula surgery does not involve surgery in the spaces around the scapula. Nor does scapula surgery involve any of the three major joints with which the scapula and its muscles are associated. Two extensions of the scapula, called the coracoid and the acromion processes, go into the shoulder and around the glenohumeral joint. Orthopedic surgery in these areas also is usually called shoulder surgery instead of scapula surgery.
While the scapula does not have any joints between itself and the ribs, it is connected to the clavicle, or collarbone, and these together are called the shoulder girdle. The scapula has powerful muscles connecting it to the ribs that enable the entire shoulder girdle to move flexibly without joints. The scapula consists mainly of a single hard bone in the upper back area, so it is difficult — but not impossible — to fracture. It can be fractured and even broken into several pieces by severe trauma.
Surgery for a broken scapula is not usually done unless the fracture fragments are “displaced” or are not lined up with the original position of the scapula. It has been clinically noted that more than 90 percent of scapular fractures have remained aligned, or “nondisplaced,” because of the heavy cushion of muscles around the main part of the scapula. Fractures of the scapula are usually allowed to heal without surgery, with “open” scapula surgery performed only to realign fracture fragments.
Surgery may also be done for a winging scapula. The scapula usually stays in a relatively flat position when a person is pushing something or raising his arms; however, when this activity causes the shoulder blade to protrude in the upper back, resembling a wing, it can indicate that the long thoracic nerve has been injured. If tests show that the nerve has indeed been injured, then “long thoracic decompression” surgery can be done. This surgery is not done on the scapula itself, but on the nerve, and it has been shown to be quite successful.