Health Information

Floating Shoulder

(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 the Shoulder
shoulder anatomy
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Causes

Floating shoulder injuries are typically caused by severe trauma like what might occur in 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.
Floating shoulder injuries are rare. They are caused by a high-impact trauma. Specific injuries may be the result of:
  • Motor vehicle accident
  • Fall from a height
  • Gunshot wound
  • Crush injury
  • Bicycle accident
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

Symptoms may include:
  • Severe shoulder pain
  • Muscle spasm
  • Injured arm hangs lower than unaffected arm
  • Bruising
  • Swelling
  • Numbness or weakness

Diagnosis

You will be asked how you were injured. A full physical exam will be done. Your shoulder will be examined more closely. The doctor may ask a specialist to evaluate your shoulder. For example, an orthopedic surgeon specializes in bones.
Images may be taken of your shoulder. This can be done with:

Treatment

The location and size of the broken bones, and how severe your other injuries are 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. Your bones will be manually repositioned into their normal location during surgery. After surgery, your shoulder will be placed in a sling or shoulder immobilizer. You will be given 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. Your bones will be manually repositioned into their normal location during surgery. After surgery, your shoulder will be placed in a sling or shoulder immobilizer. You will be given 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 Orthopaedic Surgeons http://orthoinfo.aaos.org

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

CANADIAN RESOURCES

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

Trauma Association of Canada http://www.traumacanada.org

References

AC joint injuries. Academy Orthopaedic Society for Sports Medicine website. Available at: https://www.sportsmed.org/uploadedFiles/Content/Patient/Sports%5FTips/ST%20AC%20Joint%20Injuries%2008.pdf. Published 2008. Accessed September 25, 2014.

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. Updated April 2014. Accessed September 25, 2014.

Shoulder trauma. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00394. Updated September 2007. Accessed September 25, 2014.

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