GOOD NEWS: We have fixed the DICOM uploading problem. New cases should work fine. More info

Scapular stress fracture

Case contributed by David Llopis
Diagnosis probable


Unexplained pain in right posterior rib cage, not responding to treatment.

Patient Data

Age: 40 years
Gender: Male

Chest X-ray shows no abnormal findings in the rib cage.

Nuclear medicine

Early polyarticular disease is seen in many joints, appearing symmetrical and of age-coherency scintigraphy pattern. It flagged a single hot spot in right scapular area.


MRI shows a disruption step along the axillary border of the right scapula, demonstrated in axial T1 and sagittal T2. No edema evidence in fluid sensitive series.

Case Discussion

Chest and oblique X-ray without abnormal findings. A bone scan was performed because the upper back pain persisted, and despite polyarticular uptake, we focussed on a single hot spot in the right scapular area, not present on the contra-lateral side. MRI shows the cortical disruption corresponding to the abnormal uptake on the bone scan suggesting a stress fracture.

This is an unusual location for a stress injury. The underlying mechanism is not known with the patient having a normal bone mineral density and no history of overuse.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.