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Brachial plexus injuries in scapulothoracic dissociation
E H Masmejean1, H Asfazadourian, J Y Alnot
1Department of Orthopaedic and Hand Surgery, Hôpital Bichat, Paris, France. Emmanuel.Masmejean@wanadoo.fr
Journal of Hand Surgery (Edinburgh, Scotland)
|November 1, 2000
Summary
Scapulothoracic dissociation (STD) involves scapula displacement after severe shoulder girdle trauma. Prognosis is poor due to nerve damage, with limited recovery of elbow flexion, highlighting the need for nerve surgery.
Area of Science:
- Orthopedic Surgery
- Neurology
- Trauma Care
Background:
- Scapulothoracic dissociation (STD) is a rare injury resulting from severe scapular girdle trauma.
- It involves the lateral displacement of the scapula relative to the thoracic cage.
- STD often leads to significant brachial plexus injuries.
Purpose of the Study:
- To analyze the clinical presentation and outcomes of five patients with scapulothoracic dissociation.
- To evaluate the impact of nerve damage on prognosis and functional recovery.
- To assess the potential role of nerve surgery in restoring function, particularly elbow flexion.
Main Methods:
- Retrospective case series analysis of five patients diagnosed with scapulothoracic dissociation.
- Classification of brachial plexus injuries based on anatomical location (supraclavicular vs. retro-/infraclavicular).
- Assessment of functional recovery, focusing on elbow flexion, and evaluation of surgical interventions.
Main Results:
- Five cases of scapulothoracic dissociation were analyzed.
- Three cases involved supraclavicular brachial plexus palsies, and two involved retro- and infraclavicular palsies.
- Successful recovery of elbow flexion was achieved in only two patients, indicating a poor prognosis.
Conclusions:
- Nerve damage is the primary determinant of prognosis in scapulothoracic dissociation.
- Spontaneous nerve recovery is infrequent, making functional outcomes challenging.
- Nerve surgical interventions should be considered to improve the chances of reestablishing elbow flexion and overall function.