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Floating Shoulder

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(Ipsilateral Fractures of the Clavicle and Scapular Neck)

Definition

A floating shoulder injury is when two of the shoulder bones are broken. The clavicle bone (collarbone) and the upper part of the scapula bone (shoulder blade) break. These breaks cause the shoulder to pull out of place and look like it is floating.
Bones of Shoulder
shoulder anatomy
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Floating shoulder injuries are typically caused by a trauma like a car accident. You will likely be taken to an emergency room. You will be evaluated from head to toe. If you are experiencing shoulder pain or your shoulder looks out of place, your doctor will look for a floating shoulder injury.

Causes

Floating shoulder injuries are rare. They are caused by a high-impact trauma. Specific causes include:
  • Motor vehicle accident
  • Fall from a height
  • Gunshot wound
  • Crush injury
Shoulder Injury During Car Crash
car accident shoulder injury
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Risk Factors

A floating shoulder injury is a result of an accident or trauma. There are no known risk factors.

Symptoms

If you have any of these symptoms do not assume it is due to a floating shoulder. These may be caused by other conditions. Tell your doctor if you have any of these:
  • Severe shoulder pain
  • Muscle spasm
  • Injured arm hangs lower than unaffected arm
  • Bruising
  • Swelling
  • Numbness or weakness

Diagnosis

A doctor will ask how you were injured. A full physical exam will be done. Your shoulder will be examined more closely. The doctor may ask for a specialist to evaluate your shoulder. For example, an orthopedic surgeon specializes in bones.
Tests may include the following:
  • X-rays —test that uses radiation to form an image; used to look at for broken bones in the shoulder
  • CT scan —type of x-ray that uses computer to form an image; more sensitive than x-ray and used to look for broken bones in the shoulder

Treatment

The location and size of the broken bones will determine the options. A floating shoulder may be treated medically or surgically. Talk with your doctor about the best plan for you. Treatment options include the following:

Immobilization

A doctor may choose to use a sling or shoulder immobilizer. If this is the case you can expect to be in a sling or immobilizer for one to two months. Your doctor may suggest physical therapy to maintain shoulder range of motion.

Surgery

Surgical repair will mean inserting a plate and screws into the broken clavicle. Your scapular bone may also be fixed surgically. The surgeon will manually reposition your bones into their normal location during surgery. After surgery, your shoulder will be placed in a sling or shoulder immobilizer. Your doctor will give you instructions as to how long you need to wear it.
Surgical repair will mean inserting a plate and screws into the broken clavicle. Your scapular bone may also be fixed surgically. The surgeon will manually reposition your bones into their normal location during surgery. After surgery, your shoulder will be placed in a sling or shoulder immobilizer. Your doctor will give you instructions as to how long you need to wear it.

Rehabilitation

After surgery, your doctor will have you work with a therapist. The therapy will focus on regaining strength and range of motion to your shoulder.

Prevention

Floating shoulder injuries are a result of a traumatic injury. There are no known guidelines to prevent this type of injury.

RESOURCES

American Academy of Family Physicians http://www.aafp.org

American Academy of Orthopaedic Surgeons http://www.aaos.org

American Orthopaedic Society for Sports Medicine http://www.sportsmed.org

CANADIAN RESOURCES

Canadian Association of Emergency Physicians http://www.caep.ca/

Trauma Management Group http://www.trauma.ca/

References

AC joint injuries. Academy Orthopaedic Society for Sports Medicine website. Available at: http://www.sportsmed.org/secure/reveal/admin/uploads/documents/ST%20AC%20Joint%20Injuries%2008.pdf . Accessed November 13, 2008.

Edwards SG, Whittle AP, and Wood GW. Nonoperative treatment of ipsilateral fractures of the scapula and clavicle. The Journal of Bone and Joint Surgery. 2000; 82:774-780.

Herscovici D, Fiennes AGTW, Allgower M, and Ruedi TP. The floating shoulder: ipsilateral clavicle and scapular neck fractures. The Journal of Bone and Joint Surgery . 1992;74-B:362-364.

Low CK, Lam AWM. Results of fixation of clavicle alone in managing floating shoulder. Singapore Med . 2000;4(19):452-453.

Questions and answers about shoulder problems. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Shoulder%5FProblems/shoulder%5Fproblems%5Fqa.pdf . Accessed November 13, 2008.

Shoulder trauma. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00394 . Accessed November 14, 2008.

Scapular fractures. Orthopaedia website. Available at: http://www.orthopaedia.com/display/Main/Scapular+fractures . Accessed November 14, 2008.

Tubaki VR, Uppin RB. Floating shoulder—a case report. Journal of Orthopaedics. Available at: http://www.jortho.org/2005/2/6/e7/index.htm . Accessed November 13, 2008.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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