A 24-year-old man who works as a landscaper/tree-cutter presents for evaluation of right shoulder pain after a tree fell on him. He states that he attempted to run away as the tree fell, but it struck him nonetheless. He did not lose consciousness. The tree struck the right side of his body.
The patient’s medical history is unremarkable. He is complaining of right-side back and shoulder pain. Initial vital signs and primary survey appear to be normal.
Secondary survey shows decreased range of motion in the right shoulder, with point tenderness in the scapula. There are no obvious deformities. Distal pulses are strong, and the patient is otherwise neurovascularly intact.
Radiograph of the right shoulder is shown. What is your impression?
ANSWER The radiograph shows an osseous fragment along the inferior aspect of the glenohumeral joint. Close examination reveals a defect within the scapula itself, most likely consistent with an acute fracture.