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Scapulothoracic Dissociation: Evaluation and Management.

Andrew M Choo1, Patrick C Schottel, Andrew R Burgess

  • 1From the Department of Orthopaedic Surgery, University of Texas Health Science Center, Houston, TX (Dr. Choo and Dr. Burgess), and the Department of Orthopaedics and Rehabilitation, University of Vermont Medical Center, Burlington, VT (Dr. Schottel).

The Journal of the American Academy of Orthopaedic Surgeons
|April 14, 2017
PubMed
Summary

Scapulothoracic dissociation is a rare shoulder injury causing scapular displacement. Prompt diagnosis and management of vascular and neurologic injuries are crucial for limb and life preservation.

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Area of Science:

  • Orthopedic Surgery
  • Traumatology
  • Radiology

Background:

  • Scapulothoracic dissociation is a rare, severe shoulder girdle injury.
  • It involves lateral scapular displacement due to disruption of the scapulothoracic articulation.
  • Clinical signs include swelling, weakness, numbness, and pulselessness in the affected upper extremity.

Purpose of the Study:

  • To outline the diagnostic and management strategies for scapulothoracic dissociation.
  • To correlate injury severity with patient outcomes.

Main Methods:

  • Radiographic evaluation using scapular index, clavicle fracture assessment, and AC/SC joint integrity.
  • Clinical assessment of vascular status (pulselessness) and neurological deficits.
  • Surgical intervention decisions based on limb-threatening ischemia, active hemorrhage, or severe neurological injury.

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Main Results:

  • Vascular injury is common, necessitating emergent surgery for active hemorrhage or ischemia.
  • Neurologic injury management (observation, grafting, transfer, amputation) depends on severity.
  • Skeletal stabilization involves fracture fixation and joint reduction.
  • Outcomes correlate with neurologic injury extent, with complete brachial plexus avulsion yielding poorer scores.

Conclusions:

  • Scapulothoracic dissociation requires prompt, multidisciplinary management.
  • Early identification of vascular compromise is critical.
  • Neurologic injury severity dictates long-term functional outcomes.