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Floating Shoulder

(Ipsilateral Fractures of the Clavicle and Scapular Neck)

Definition

A floating shoulder injury is when 2 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
Copyright © Nucleus Medical Media, Inc.

Causes    TOP

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    TOP

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

Symptoms    TOP

Symptoms may include:

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

Diagnosis    TOP

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    TOP

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, a sling may need to be worn for 1-2 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. The scapular bone may also be fixed surgically. The bones will be manually repositioned into their normal location during surgery. After surgery, the shoulder will be placed in a sling or shoulder immobilizer.

Rehabilitation    TOP

After surgery, a therapy will focus on regaining strength and range of motion to the shoulder.

Prevention    TOP

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

RESOURCES:

American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org
Ortho Info—American Academy of Orthopaedic Surgeons
http://orthoinfo.aaos.org

CANADIAN RESOURCES:

Canadian Association of Emergency Physicians
http://www.caep.ca
Trauma Association of Canada
http://www.traumacanada.org

References:

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:
...(Click grey area to select URL)
Updated April 2014. Accessed August 24, 2017.
Shoulder trauma. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at:
...(Click grey area to select URL)
Updated September 2007. Accessed August 24, 2017.
Last reviewed August 2017 by EBSCO Medical Review Board Warren A. Bodine, DO, CAQSM
Last Updated: 9/25/2014

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